AAP Guidelines Now Recommend HPV Vaccine for Boys

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Ενα ενδιαφέρον άρθρο απο Medscape σχετικά με την ένδειξη του εμβολίου έναντι του HPV σε αγόρια!!

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AAP Guidelines Now Recommend HPV Vaccine for Boys CME
News Author: Steven Fox
CME Author: Laurie Barclay, MD Faculty and Disclosures
CME Released: 03/01/2012; Valid for credit through 03/01/2013

CME Information Earn CME Credit »
CLINICAL CONTEXT
In the United States, human papillomaviruses (HPVs) are the most common sexually transmitted viruses, with the highest prevalence of HPV infection in sexually active adolescents and young adults. The virus has been implicated in several cancers of the mouth and throat, cervix, and genital organs. The HPV vaccine is most effective if given before the onset of sexual activity, and antibody responses are highest at ages 9 to 15 years.

A revised policy statement by the American Academy of Pediatrics (AAP) updates recommendations for the use of HPV vaccine in boys and young men as well as in girls and young women and includes the underlying evidence, rationale, and background to support the HPV vaccine recommendations given in the 2012 Adolescent Immunization Schedule issued February 1.

STUDY SYNOPSIS AND PERSPECTIVE
The AAP has published new guidelines for the use of the HPV vaccine and, for the first time, has specifically recommended use of the vaccine in adolescent boys as well as girls.

The recommendations were published online February 27 and in the March print issue of Pediatrics.

The vaccine was recommended for girls in 2006, but even though at that time the AAP said the vaccine could be used in boys, it was not specifically recommended for that population.

The new recommendations were spurred in part by mounting evidence that the HPV vaccine is effective as prophylaxis against genital warts in both males and females. HPV infection has been associated with increased risk for cervical cancer, anal cancer, and oropharyngeal cancer.

The AAP recommends that the vaccine be administered at 11 to 12 years of age in both boys and girls. Their rationale is 2-fold: First, the vaccine is most effective if it is administered before the individual begins engaging in sexual activity, mainly because the vaccine is inactive against HPV strains acquired before vaccination. Second, children mount the most robust antibody responses to the vaccine when they are between the ages of 9 and 15 years, the AAP says.

Two HPV vaccines are currently available in the United States, but there are differences in their approved indications. Quadrivalent HPV vaccine (HPV4) is the only vaccine approved for use in boys. Bivalent HPV vaccine (HPV2) is only approved for use in girls; HPV4 is also approved for girls.

Among the AAP's updated recommendations are that:

Girls aged 11 to 12 years should be routinely immunized using 3 doses of the HPV4 or HPV2 vaccine, administered intramuscularly at 0, 1 to 2, and 6 months.
Girls and women aged from 13 to 26 years who have not been previously immunized or who have not completed their vaccinations should finish the series.
Boys aged 11 to 12 years should be routinely immunized with HPV4, using the same schedule as for girls.
Boys and men aged from 13 to 21 years who have not already been immunized or who have not completed their vaccines should finish the series.
Men aged from 22 to 26 years who have not already been immunized or who have not finished the full series may be administered the recommended vaccine. (The AAP guidelines note that "cost-efficacy models do not justify a stronger recommendation in this age group.")
Special efforts should be made to target use of the vaccine in gay or bisexual men up to 26 years of age who have not previously received the vaccine.
People infected with HIV should be vaccinated or complete their series of vaccinations.
The vaccine is not recommended during pregnancy, nor should it be administered to individuals with a known immediate hypersensitivity to yeast. However, it may be administered during lactation, as well as to those who are immunocompromised from either illness or medication
The AAP recommends that because the HPV vaccine will not prevent infection from all types of HPV types, cervical screening should continue after HPV vaccination.

The organization also says that administration of the vaccine should not alter physicians' recommendations regarding use of barrier methods for preventing HPV and other sexually transmitted diseases.

The AAP urges that use of the vaccine be covered by all public and private health insurance.

More information on implementing the guidelines, including guidance on supply, payment, coding, and liability issues, is available on the AAP's Web site.

The authors have disclosed no relevant financial relationships.

Pediatrics. 2012;129:602-605.

STUDY HIGHLIGHTS
Girls 11 to 12 years old should be immunized routinely with 3 intramuscular doses of HPV4 or HPV2 at 0, 1 to 2, and 6 months. At the clinician's discretion, immunization can be started in girls at 9 years old.
All girls and women 13 to 26 years old who were not previously immunized or who did not complete the full vaccine series should complete the series.
Boys 11 to 12 years old should be immunized routinely with 3 intramuscular doses of HPV4 at 0, 1 to 2, and 6 months. At the clinician's discretion, immunization can be started in boys at 9 years old.
All boys and men 13 to 21 years old who have not been immunized previously or who did not complete the full vaccine series should receive the HPV4 vaccine.
Men 22 to 26 years old who were not previously immunized or who did not complete the full vaccine series may receive the HPV4 vaccine, but cost-efficacy models do not warrant a stronger recommendation in men of this age.
A special effort should be made to immunize men who have sex with men up to age 26 years who were not previously immunized or who did not complete the full vaccine series.
Previous sexual activity is not a contraindication to HPV immunization or completion of the immunization series because patients infected with a single HPV type may still benefit from protection against the other HPV types in the vaccine.
Testing for previous HPV exposure is not recommended.
The HPV vaccine can be given to a female patient with an abnormal or equivocal Papanicolaou test result. However, the HPV vaccines have no known therapeutic (as opposed to prophylactic) value.
HIV-infected people 9 to 26 years old of either sex who have not been immunized previously or who have not completed the full vaccine series should receive or complete their series with HPV4.
HPV vaccines can be given at the same visit as all other recommended vaccines.
HPV vaccine can be given to immunocompromised or breast-feeding patients.
HPV vaccine is not recommended during pregnancy. Although the clinician should ask sexually active female patients about pregnancy, the vaccine series may be started without performing a pregnancy test.
If a woman who was vaccinated becomes pregnant, subsequent doses should be delayed until the pregnancy is completed, and the pregnancy should be reported to registries recording outcomes data.
Women who have received the HPV vaccine should continue to have Papanicolaou testing because the HPV vaccine will not prevent infection attributable to all high-risk HPV types.
Administration of the HPV vaccine does not affect current counseling recommendations for use of barrier methods to prevent HPV and other sexually transmitted infections or for discussion about healthy sexual activity choices, including condom use and abstinence.
All public and private health insurers should cover HPV immunization of children who are at least 9 years old.
CLINICAL IMPLICATIONS
A revised AAP policy statement recommends that girls 11 to 12 years old, or girls starting at age 9 years at the clinician's discretion, be immunized routinely with 3 intramuscular doses of HPV4 or HPV2. All girls and young women 13 to 26 years old who were not previously immunized or who did not complete the full vaccine series should complete the series.
Boys 11 to 12 years old, or those starting at age 9 years at the clinician's discretion, should be immunized routinely with 3 intramuscular doses of HPV4. All boys and young men 13 to 21 years old who have not been immunized previously or who have not completed the full vaccine series should receive the HPV4 vaccine.

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