Megan Smith, Epidemiologist – Lowy Cancer Research Centre UNSW
Published 9 April 2013
As of 2013, boys are now included in the National HPV Vaccination Program (NHVP) in Australia. The HPV vaccine is delivered to boys through schools as it is for girls, generally in the first year of high school. There is also a catch-up program running until the end of 2014, during which time the quadrivalent vaccine, Gardasil®, is being offered to older boys in schools. The exact rollout schedule within schools varies by state. Boys aged 12 to 13 years who choose not to get vaccinated at school are eligible to receive it for free from healthcare providers outside school. Until the end of 2014, boys aged 14 to 15 can also access the vaccine for free outside school as part of a national catch-up initiative.
Sometimes the HPV vaccine is referred to as the “cervical cancer vaccine” because of the very strong link between HPV and cervical cancer. However HPV has also been linked to several other cancers, including cancers of the anus, penis, vulva, vagina and oropharynx. Many of these cancers affect males as well as females. Based on the most recent available data, it is likely that HPV caused approximately 550 cancers in males in Australia in 2009, taking into account the most recent Australian data on the proportion of oropharyngeal cancers which are HPV positive. The quadrivalent vaccine also protects against two HPV types which are associated with genital warts, HPV 6 and 11. In 2006, prior to the introduction of the NHVP in females, there were approximately 20,000 cases of genital warts in males, the vast majority of which are preventable by the quadrivalent vaccine.
In Australia we are already starting to see some of the early benefits of HPV vaccination, with reductions reported in genital warts, and high grade cervical abnormalities in young women in Victoria and nationally.
As well as the direct benefits to males of vaccination, another benefit of including males in the program is that this will help provide some protection for unvaccinated females, through herd immunity effects. Reductions in genital warts reported in young males since 2007 are probably due to herd immunity effects from the female-only program. Even at the level of coverage achieved in females in Australia, vaccination of males against HPV should provide additional benefits to both males and females.
The vaccine has been shown to be effective in males at preventing external genital lesions and precursors of anal cancer (AIN). Young males have also exhibited a strong immune response to the vaccine. This immune response is actually stronger in younger males (and females) than in the older females who were included in the main vaccine trials. This is one reason why the vaccine is offered at age 12 to 13 years. The vaccine is also most effective when delivered prior to the onset of sexual activity. In Australia the median age that this occurs at is 16 years.
The NHVP includes safety monitoring, as do other programs around the world, so there is now a lot of data about the safety of the HPV vaccine. The safety profile of the HPV vaccine is good, and comparable to other vaccines. In Australia there have been around 7 million doses delivered, with adverse events reported in less than 0.03 per cent of cases. The most commonly reported side effects include redness or swelling at the injection site, soreness, or mild fever, however these are just signs that the body’s immune system is responding effectively to the vaccine. Other reported side effects include headache, nausea and dizziness. Details on suspected adverse reactions which have been reported in Australia are available from the Therapeutic Goods Administration (TGA).
The HPV vaccine should not be given to anyone with a history of anaphylaxis to yeast, or a history of anaphylaxis following a previous dose of HPV vaccine or any vaccine component. Anaphylaxis is a rare reaction to the HPV vaccine (as of 17 June 2010, the rate was estimated as 2.6 per million doses in Australia).
What this means for GPs
- Most eligible boys will be offered the vaccine at school, but some age-eligible boys will not depending upon their school year level and the state rollout variations. Boys aged 12 to 13 years are eligible to receive the quadrivalent vaccine for free from healthcare providers, and boys aged 14 to 15 are also eligible until the end of 2014. Boys may also attend your practice to receive doses which were missed at school. Remember to report all doses administered to the National HPV Vaccination Program Register.
- The quadrivalent vaccine is the only HPV vaccine registered for use in males in Australia.
- As with females, the HPV vaccine is most effective when the full course of three doses is delivered. The recommended delivery schedule for the quadrivalent vaccine is at 0, 2 and 6 months.
- As the program was originally offered to females only, and described in terms of its cervical cancer benefits, some parents may be unsure of the benefits of vaccinating their sons. Discussions with healthcare providers are often important factors in parents’ decision-making about vaccines. Discuss the facts about the HPV vaccine with parents and patients as required.
- As with all vaccines, adverse events should be reported to the Therapeutic Goods Administration, online or by telephone (1800 044 114), and to the relevant state or territory authority if there are mandatory reporting requirements in place.
More information on HPV vaccination, including specific advice for health professionals, is available at hpvvaccine.org.au, and from the websites of the National HPV Vaccination Program, Immunise Australia, Cancer Council Australia (HPV Vaccine), the Australian Immunisation Handbook, the National Centre for Immunisation Research and Surveillance and the TGA.