Dr. Keith Roach: Risks, benefits of HPV vaccine for boys
Dear Dr. Roach: What are your thoughts on the pros and cons of HPV vaccine for boys?
Dear L.P.B.: There are risks and benefits to the individual, but also benefits to society.
The HPV vaccine should really be considered an anticancer vaccine, since its goal is to reduce infection from the kinds of human papilloma virus strains that can lead to cancer. Cervical cancer is the most common HPV-related cancer, but some throat cancers, anal cancers and genital cancers also are HPV-related. The Centers for Disease Control and Prevention estimates that there are about 30,000 HPV-related cancers in the U.S. annually. It is possible, but unproven, that the HPV vaccine will provide protection against some or all of these.
When given to girls or women who have not been infected with HPV, the HPV vaccine is nearly 100 percent effective at preventing persistent infection with the strains of HPV most likely to lead to cancer. In males age 16-26 years, the efficacy of the vaccine at preventing high-risk HPV-related warts was about 90 percent. However, the HPV vaccine is relatively new, and it is not clear how long immunity will last. It has been proven to last only eight to nine years, but studies looking at protection up to 15 years are ongoing. It is possible that additional boosters may be necessary.
All vaccines have some degree of risk. The most serious risk of HPV vaccine is anaphylaxis, a possibly fatal allergic reaction to the vaccine. There have been 36 cases of anaphylaxis reported in the world literature and through the Vaccine Adverse Event Reporting system, according to the Institute of Medicine’s 2012 report on adverse effects of vaccines. There have been 67 million doses given, with a 0.003 percent rate of all adverse events, 90 percent of which were not considered serious. The most common nonserious adverse events in men were redness and soreness at the injection site, dizziness, headache and fainting. Among the adverse events considered serious, the most common were headache, nausea, vomiting and fever.
The societal benefit to vaccinating boys is that they are less likely to spread infection to others. Since essentially all cases of cervical cancer are HPV-related, males are the most common source of infection (although it can be transmitted female to female).
By vaccinating your boy, you are cutting his risk of developing HPV infection and might be decreasing his risk of several types of HPV-related cancer, at a small risk of an adverse event, which is usually minor. However, probably the most compelling reason is to protect your son’s future sexual partners. Put in the starkest terms, you are reducing the risk your future daughter-in-law will develop cervical cancer.
Dear Dr. Roach: Have you ever heard of someone with sleep apnea outgrowing the need of a breathing aid, such as CPAP?
Dear G.S.: Almost any condition can go away by itself, but in nearly every case of obstructive sleep apnea getting better without a specific treatment that I have seen, it has been associated with significant weight loss.
Email questions to ToYourGoodHealth@med.cornell.edu.