February 27, 2012 — The American Academy of Pediatrics (AAP) has published new guidelines for the use of the human papillomavirus (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, Gardasil, Merck) is the only vaccine approved for use in boys. Bivalent HPV vaccine (HPV2, Cervarix, GlaxoSmithKline) 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.