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HPV vaccination in men How to boost uptake
While the human papillomavirus (HPV) vaccine has been approved for use in men, how many are open to receiving it? New research indicates men might be more willing to receive vaccination when they learn the vaccine can prevent cancer.1
The Food and Drug Administration (FDA) in December 2010 approved Gardasil, the Merck & Co. quadrivalent vaccine, for prevention of anal cancer and associated precancerous lesions (anal intraepithelial neoplasia grades 1, 2, and 3, related to HPV types 6, 11, 16, and 18 in males and females ages 9-26. The vaccine also is approved for the prevention of genital warts caused by types 6 and 11 in males and females.
Researchers at the University of North Carolina at Chapel Hill (UNC-CH) Gillings School of Global Public Health and the Lineberger Comprehensive Cancer Center have found that men are more open to getting the HPV vaccine when it is described as also preventing HPV-related cancers, including anal cancer, as opposed to preventing genital warts alone.
What led the research team to look at this issue? The researchers were seeking how to get more boys and men to get their recommended doses of HPV vaccine, says Annie-Laurie McRee, a UNC-CH doctoral student and lead author of the study. "In a previous study, we found that how you 'frame' HPV vaccination messages can make the vaccine more acceptable to women,"2 says McRee. "So we wanted to explore how the added benefit of preventing cancer in men would affect men's interest in HPV vaccine."
Researchers surveyed a national sample of more than 600 men ages 18-59 and asked about their willingness to get vaccinated. Sixty percent wanted the cancer-preventing vaccine, compared to 42% when the vaccine was depicted as only protecting against warts. The effect of outcome framing was the same for heterosexual and gay/bisexual men and for the cancer types examined.
Why is it so important that men be reached with the correct message about HPV vaccination? The very low use of HPV vaccine by men and boys indicates clinicians are missing an important public health opportunity, says Noel Brewer, PhD, senior investigator on the study, UNC-CH Lineberger member and associate professor of health behavior and health education in the public health school. It is estimated that fewer than 1% of boys ages 11 to 17 have been immunized against HPV; on college campuses, the share of vaccinated men might be closer to 15%.3
"Some men mistakenly believe that the vaccine is just for women; now they can know that it is for men, too," Brewer says. "Our findings show that it is critical for men to get the message that HPV vaccine can prevent cancer in men in addition to genital warts, because that increases their willingness to get vaccinated."
Data upholds efficacy
In talking about the Gardasil HPV vaccine, be sure to include results from a just-published study which shows it prevents 90% of genital warts in men when it is offered before exposure to the four HPV strains covered by the vaccine.4 The study also found a nearly 66% effectiveness in the general population of young men regardless of prior exposure to these strains.
The four-year international clinical trial study, led by researchers at the H. Lee Moffitt Cancer Center in Tampa, FL, and the University of California San Francisco (UCSF) provides the first reported results of using the HPV vaccine as a prophylactic in men. Initial data from the study was reviewed by the FDA in its initial approval for use of the vaccine in men to prevent warts, while results from a substudy led the agency last year to expand approval to prevent anal cancer.
The double-blind study included 4,065 healthy men ages 16-26, enrolled at 71 sites in 18 countries. Of those patients, 85% reported having exclusively female sexual partners, with the remainder self-identified as having sex with men.
The men were tested at the onset of the trial for previous exposure to HPV strains 6, 11, 16, and 18, and were randomly selected to receive a placebo or a vaccine that targeted the four strains. Men with a history of anal or genital warts or lesions were excluded from the study. Participants received six follow-up examinations over the following three years to assess the vaccine's effectiveness. Researchers report that in addition to preventing warts, the vaccine also effectively prevented HPV-persistent infection in 86% of the participants without previous exposure.
The study results represent an "exciting development" in the world of sexually transmitted diseases, said Joel Palefsky, MD, a UCSF professor of medicine who co-led the research along with epidemiologist Anna Giuliano, PhD, from the H. Lee Moffitt Cancer Center and Research Institute. "It shows that if we vaccinate males early enough, we should be able to prevent most cases of external genital warts in this population," said Palefsky in a release accompanying the study's publication.