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POLICY FOCUS:
PROMOTING HUMANPAPILLOMA VIRUSVACCINE TO PREVENTGENITAL WARTS ANDCANCERS
 
PROMOTING HUMAN PAPILLOMA VIRUS VACCINE TO PREVENT GENITAL WARTS AND CANCERS 
01
POLICY FOCUS:
 
Promoting Human Papilloma Virus Vaccine toPrevent Genital Warts and Cancers
John Trinidad, MPH
WHAT IS KNOWN TODAY
Human papilloma virus (HPV) is one of themost common sexually transmitted infectionsin the U.S. Every year 6 million people contractHPV, mostly through sexual contact. Currently, 20million people in the US have detectable infectionwith HPV.
1
Most cases of genital warts, found inabout 1% of the US population (3 million people),are caused by specific HPV types. Men who havesex with men (MSM) represent the majority of prevalent cases of genital warts.
2
HPV also causesseveral forms of cancer, including cervical cancer(11,000 cases per year), and anal cancer (estimatedat 1600 cases per year in women and 900 casesper year in men).
3, 4
HPV has also been implicatedin some head and neck cancers.HIV research has revealed that anal canceris emerging as among the most important non-AIDS-defining malignancies. Despite the adventof antiretroviral therapy, the incidence of HPV-related malignancies, including anal cancer, isnot declining.
5
MSM with HIV are at even greaterrisk for HPV and its related complications.Though rare among the general population,HPV-related anal cancer is 40–80 times moreprevalent among HIV-infected MSM than amonguninfected heterosexual men.
6
 Prevention of HPV-related cancerincludes primary and secondarymethods. Primary preventioninvolves education regardingSTI risk/behavioral modificationand vaccination against HPV.Secondary prevention includessurveillance and treatment of HPV and HPV-related dysplasiaprior to progression to cancerthrough routine vaginal and anal pap smears.
7
 Vaccination against HPV has been shown toprevent infection with high-risk types of HPV (e.g.,HPV-16, HPV-18 which cause 72% anal cancers and70% of cervical cancers) and low-risk types (e.g.,HPV-6, HPV-11 which cause the majority of genitalwarts).
8, 9
Vaccination has been shown to preventdevelopment of high-grade lesions among MSM.
10
 A host of other cancers may also be preventedwith HPV vaccination, including vulvar, penile, andsome oropharygeal cancers.On October 25, 2011 the U.S. Advisory Committeeon Immunization Practices (ACIP) expanded itsrecommendation for HPV vaccination from allgirls and young women 11–26 to include boys
HPV vaccination couldprevent thousands of casesof cervical, anal and othercancers each year in the U.S.
 
PROMOTING HUMAN PAPILLOMA VIRUS VACCINE TO PREVENT GENITAL WARTS AND CANCERS 
02
and young men aged 11–26, expanding the role of primary prevention in HPV related cancers.
11
Whilethe recommendations are for vaccinations startingat age 11, they “can be started as young as age 9years.” On February 27, 2012, the American Academyof Pediatrics updated its vaccination guidelinesto reflect these recommendations.
12
Studies haveshown that vaccination remains cost effective forMSM up to age 26.
13, 14
Many doctors offer HPVimmunizations to men older than 26, especially if they believe that they have notbeen exposed to the virus.As of 2010 the Centers forDisease Control and Prevention
Morbidity and Mortality WeeklyReport
reported that only 32%of eligible adolescent girls aged13–17 in the U.S. completed thethree-dose regimen of eitherquadrivalent or bivalent HPV vaccine. Idahoand Arkansas had the lowest rates of coveragefor adolescent girls, below 20%. Six states hadvaccination rates of above 40% for girls: Colorado,Connecticut, Delaware, Massachusetts, Nebraska,and New Hampshire. New York City’s vaccinationrate was also above 40%, but in the rest of NewYork State only 37.9% had had all three dosesof the HPV vaccine. As of 2010 only 1.4% of adolescent boys had initiated the vaccinationprotocol, although at the time the data werecollected from the National Immunization Survey—Teen, HPV vaccine for adolescent boys was notyet part of ACIP’s recommendations.
15
We hopethat vaccination rates among boys and young menwill increase as word of the ACIP recommendationgets out and pediatricians and other providerspromote HPV vaccine for boys and young men.
CURRENT POLICY
ACIP recommendation is a significant step towardwidespread implementation of HPV vaccinationto eligible recipients. Under the Affordable CareAct, all new private insurance plans are requiredto cover ACIP-recommended vaccinations withoutcost-sharing in the next plan year that occurs oneyear after the date of the recommendation.
16
Thiswould mean that many insurers must fully coverHPV vaccine for boys and young men starting inDecember 2012, one year after the Centers forDisease Control and Prevention journal
Morbidityand Mortality Weekly Report
published the ACIPrecommendation.
17
(Benefit year start dates varyfrom employer to employer.) However, someinsurance plans will be grandfathered under ACAand not required to cover ACIP-recommendedvaccinations.
18
And the Vaccines for Children(VFC) program provides vaccines at no cost toMedicaid eligible recipients.In Massachusetts, all of the major private insuranceproviders and MassHealth, the Commonwealth’sMedicaid program, cover HPV for boys and youngmen.
19
In August, 2011, Blue Cross/Blue Shield of Massachusetts, the largest insurance provider inthe Commonwealth, announced it would coverHPV vaccination for all recommended patients inanticipation of the new guidelines expected later
Only 32% of adolescent girlsaged 13–17 in the U.S. havecompleted the three-doseHPV vaccine.
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