Panel Recommends HPV Vaccine For Boys, Too

Oct 27, 2011
Originally published on October 27, 2011 1:05 pm
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And now, a warning. If children are listening, our next discussion involves some frank talk about the human body. A federal panel voted this week to recommend a vaccine to prevent the sexually transmitted human papillomavirus or HPV for all boys 11 or 12 years old. The vaccine was recommended for girls in 2006, but usage remains low and has sparked controversy. The panel, that advises the Centers for Disease Control, said the vaccine will help protect men against some anal and throat cancers that can occur because of sexual activity, and may protect women, too, indirectly by reducing transmission of HPV, which can cause cervical cancer.

If you have questions about the HPV vaccine and the recommendation, give us a call, 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our website. That's at npr.org and click on TALK OF THE NATION. NPR's science correspondent Richard Knox joins us from Dorchester, Massachusetts. And nice to have you back with us.

RICHARD KNOX, BYLINE: Thanks, Neal. Glad to be here.

CONAN: And, Richard, a lot of the controversy about the age. Why a vaccine to protect against a sexually transmitted virus at 11 and 12 years old?

KNOX: Well, it's because there's a lot of sexual activity that begins early, believe it or not, and also because it's more effective if you vaccinate early in the preteen years, and you get a better immune response. It's very difficult to know when a particular child is going to start experimenting sexually, and so the public health people think that it's better to get ahead of the curve.

CONAN: And the recommendation, as I understand it, was unanimous, with one abstention.

KNOX: That's right. It was 13 to - no votes, and one woman abstained. I think there's pretty good consensus in the public health community that this is a good idea. I mean, this is a vaccine that prevents cancer, several different kinds of cancer, probably. And that's pretty, you know, that's a pretty valuable thing to have.

CONAN: Do we know how effective it is?

KNOX: Yeah. It's very effective. I think, you know, a number of different strains of human papillomavirus, or HPV, there are two vaccines out there now. One of them is effective against - preventing two of them, and the other is effective against four. The one that's being recommended for boys is effective against four. These are the ones that are most responsible for the cause of cervical cancer, anal cancer, genital warts and other cancers that they're worried about. I think it's, you know, well over 90 percent effective.

CONAN: And as the - I certainly looked at the political fallout from the recommendation five years ago that this - the - given to girls ages 11 and 12 and we see very low usage rates.

KNOX: Yeah. It's - I think the public health people are disappointed. I think it's far fewer than half of girls between 13 and 17 have gotten the vaccine. It's about a third have gotten all three doses, and that's after five years. It hasn't been terrifically aggressively promoted, so maybe that's part of it. But I think a really fundamental reason is that a lot of parents have trouble thinking about vaccinating their young girls against a sexually transmitted disease. They're just thinking that's a - that that's a risk for them, and it isn't, thank goodness. But, you know, as I said before, the thinking is to get them protected before they enter those years.

CONAN: Here's an email from Tom(ph) in Raleigh, North Carolina. Please eliminate some confusion over this issue. We already know the HPV vaccine for girls now. You report about it for boys. Obviously, vaccines are for youths because they are preventative. Can they be used - are they effective for adult women and men, or are they just for youths?

KNOX: Well, the problem is that once you get infected with one of the strains of a virus that the vaccines protect against, then it's too late to be protected. So, you know, it's important to get them before the danger zone happens. The - I'm sorry. I think - what was the other question?

CONAN: Well, the question was: Is it OK to use it for adult men and women, or is it just effective if administered before sexual activity?

KNOX: Yeah. No, I think that's the rationale, is it's - it really needs to be, you know, kids need to be protected before they encounter the virus, and you're not quite sure when it's going to happen.

CONAN: This is an expensive vaccine, as far as these things go. Does this recommendation mean it might be covered under insurance policies?

KNOX: Probably so. It is expensive. I think the vaccine itself, it costs over $300. And then there's administrations fees that can bring that up considerably over 400. The importance - or one aspect of the vote this week by the Advisory Committee on Immunization to the CDC is that when the CDC recommends a vaccine for routine use, most insurers will follow suit. Also, a lot of childhood vaccines are paid for by a federal program - a federal state program. And so, once the CDC accepts these recommendations, as it's expected to do, then it will cover - that program will cover a lot of kids.

CONAN: We asked a question about, should you get it after - when you're an adult? Here's an email question from Kathy(ph) in Brigham City, Utah: I see the recommendation age is 11. Is it OK to give it earlier, or is 11 the youngest a girl should get the vaccine? I know we give a lot of vaccines earlier versus later in a child's life.

KNOX: Yes. The experts say that it can be given beginning at around age nine, and they recommend routine vaccination in 11 and 12-year-old boys, and I think it's the same for girls. It can be given and should be given up to the age of 21 in boys - I think 26 in girls, if I'm not mistaken - if they haven't gotten the vaccine before then.

CONAN: Let's see if we can go next to a caller. This is Stacy(ph), Stacy with us from Cleveland.

STACY: Yeah. So the age of nine is the recommendation now for this vaccination? And I wondered what - first of all, that's my first question. Second of all, you said that there's a routine vaccination that's now recommend. How often is this vaccination to given in the routine? And you said it's $400 for vaccine. So I'm wondering how much profit the company has made so far? Those are my questions.

CONAN: Go ahead.

KNOX: Sure. Well, first of all, just to be clear, it may be given as early as nine, but the recommendation is that it be routinely given to 11 and 12-year olds. You know, it's just at the discretion if you wanted to do it earlier than that, or the doctor recommends it earlier than that. It needs to - kids need to be given three shots over a period of months, I guess, in order to be fully protected. I don't have the vaccination schedule in front of me here, but it's, I think, you know, within six months after the first shot, and so on. And I didn't catch the list of - the last part of your third question.

CONAN: How much profit has the company that manufactures the vaccine made? I believe it's Merck.

KNOX: Ah-ha.

STACY: Correct. That was my question.

KNOX: Well, I don't think they've made very much, because it hasn't been terribly enthusiastically adopted. As to how much they would stand to make, you know, that's a good question. I don't have the answer to that.

STACY: No, no, no. That wasn't my question. Of course (unintelligible)...

KNOX: Obviously, if the recommendations get followed, there are, you know, tens of millions of young people every year who would be eligible. And so, presumably, it will be a profitable thing for these two companies that make these two vaccines.

STACY: Right.

CONAN: Stacy, thanks very much for the call.

STACY: Sure. (unintelligible).

CONAN: Let's go next to - this is Lee, and Lee's with us from Charlotte.

LEE: Yes. Good afternoon. Thank you for taking my call.

CONAN: Sure.

LEE: I'd like to know if there have been any follow-up studies. Although I'd like to get my young teenage daughter the vaccination, her father - with whom I am not with - has voiced his concern that this will, you know, give her some false confidence and create some kind of promiscuity. And I'd like to know if there had been any follow-up studies as to behavior in those girls that have gotten the vaccine. And have there been any follow-up studies on any kind of side effects?

KNOX: There have been studies on side effects. Let me talk a little bit about that first. They've been monitoring - something like 35 million doses of these - this vaccine has been shipped out, and something like that, presumably, have gotten vaccinated. And they've been monitoring - the CDC, that is - has been monitoring pretty closely any kind of side effect, serious or non-serious, in those kids. They have not seen anything out of the ordinary, which is to say that - well, a number of the kids have fainted, as happens with any vaccination, actually.

LEE: Yeah.

KNOX: Other - you know, side effects like tenderness of the vaccination site have happened, but that's not really out of the ordinary, either. There have been something like 35 verified deaths among kids who have had the vaccine, and that sounds really terrifying, of course. But really, you have to think about that carefully because, you know, this - it doesn't mean that the vaccine caused it. I mean, it's like a certain number of people, you know, 12-year-olds, for instance, die, unfortunately, after they've entered fifth grade. But that doesn't mean fifth grade caused the deaths. So they haven't found any unusual patterns of serious, adverse events or deaths among kids who've had the vaccine.

As to the behavioral studies, I haven't seen any, not to say that it - they're not happening, but I - it hasn't been considered in the debate that I've heard from the CDC so far. And I'm suspecting that they really haven't done that. I mean, I guess you would worry about whether somebody who feels - has been vaccinated feels less vulnerable to infection, at least by this virus. But there's a whole lot of reasons why you're still vulnerable to other sexually transmitted disease and other things that come from promiscuous sex. So this certainly doesn't change any of the messages that kids - that all kids should get, vaccinated or not, about, you know, being careful and about casual sex and, you know, and all that stuff. I don't - you know, I think that's unanswerable question, but, you know, it's not unique to this vaccine.

LEE: Right. And I think that's a lot of what was initially brought up, that, you know, oh, well, this is going to give the kids free license to go ahead and have sex. And I think that's kind of ridiculous, but, you know, it would be interesting if somebody did do a follow-up study on behavior.

KNOX: It would be good. Yeah, and I think that needs to be addressed, but I don't think it has been yet, as far as I know.

CONAN: Lee, thanks for the call.

LEE: Thank you.

CONAN: We're talking with science correspondent Richard Knox about the HPV vaccine, which is now recommended for boys, as well as for girls. You're listening to TALK OF THE NATION, from NPR News.

And here's a couple of emails, this one from Jordie(ph) in Oakland. I'm a pediatric nurse practitioner and a mother of a sexually active 19-year-old boy. I've been waiting to have this recommendation since they came out recommending it to girls. When I approached my son about getting the vaccine, he quickly responded: I'm down with that, and got his first one the next day. It's about time. The 16-year-old is next.

And this is from Judy in Bexley, Ohio: I wish the media would start consistently calling this a cancer vaccine. That's what it is. Perhaps, then, people will stop thinking about the method of transmission of the virus and start thinking rationally. And, well, is it - would it be accurate to call it a cancer vaccine?

KNOX: Absolutely. That's the - that's its purpose, and that's what it's been shown to be effective. Let's just go over those things a little bit, because, you know, when it was recommended and is recommended for girls, the main rationale is that it prevents cervical cancer, and that's proven that it does. And that affects 15,000 women a year and kills - I can't remember the number, but it's like maybe 4,000 a year, something like that. It's not a common cancer anymore because of pap smears, but it still does happen. But there are other - you know, there are other cancers of the reproductive tract in women that it probably prevents.

Anal cancer has been growing in recent years, and that is definitely a risk factor for men who have sex with men. But interestingly, there are slightly more women who get anal cancer every year - something around 3,700 - than men. So it's - women are at risk for that, and this was thought to be able to prevent that.

Mouth and throat cancers are - that's a really serious one. About 40,000 people in the United States get a diagnosis of mouth and throat cancer every year, and it's a very difficult one. It used to be a cancer of older people who had smoked and who had drunk a lot of alcohol. That's been shifting, according to the cancer experts I've talked to. And now, cases are younger. Men are more than twice as likely to get that. That is thought to be related to oral sex, and this is thought to prevent that, although the evidence is not as solid and nailed down as it is for these other cancers.

CONAN: The vaccine came up in the presidential campaign. Governor Rick Perry of Texas had passed a law mandating the use of the vaccine for all girls in public schools - or all girls in Texas. There was an opt-out, I think. But he was upbraided for that. He called it a pro-life issue, protecting the lives of women, and he later said he was sorry for that. He thinks he's made a mistake. Was Texas the only state to mandate the use of the vaccine?

KNOX: Yes, it is - or was. They've rolled it back.

Virginia and the District of Columbia require for kids entering middle school - girls entering middle school, at least - but there is a - if you get a note from your doctor, you can get permission not to have it.

CONAN: Here's an email from Lisa in Auburn, California: Please remind listeners the HPV vaccination can be available for a very reduced fee through your county health department, as was mine for both my daughter and son. It was quite easy and under-utilized here in Placer County, California, where we've walked in without a wait on many occasions. So there are alternatives.

KNOX: Yeah. That's that federal program that - that helps states and localities pay for childhood vaccines.

CONAN: And in align with this recommendation, is there going to be a public education campaign to get people to - persuade people to get over their squeamishness about using this vaccine which can save lives?

KNOX: The CDC says yes. They acknowledge that there's been a lot of confusion and a lot of emotion around the recommendation for vaccinating young girls. One of the reasons why the expert committee this week voted for, they said, was that it addresses the equity question. In other words, it should be an equal opportunity vaccine, and that boys should be bearing part of the burden of getting it and preventing these diseases, as well as girls. And they hope, I think, that that's going to diffuse a lot of the emotion. Although, I guess, it remains to be seen. But the CDC officials say that they realized they've got to do a better job at getting the message out, that - what this is for and why they're recommending at these young ages.

CONAN: Richard Knox, thanks very much for your time.

KNOX: Oh, you're welcome.

CONAN: NPR science correspondent, Richard Knox, who joined us from Dorchester in Massachusetts. On Monday, student loan debt and the choices many students are forced to make after they graduate. Join us for that. This is TALK OF THE NATION, from NPR News. I'm Neal Conan, in Washington. Transcript provided by NPR, Copyright NPR.