Why are so many boys not immunized against HPV?

By: Ruobing Han

April Williams is the mother of two teenagers, a boy and a girl.

“My daughter got the HPV vaccine,” said Williams, the special events and marketing manager at Athens Regional Medical Center in Athens. Working at one of the biggest hospitals in northeast Georgia makes Williams keenly aware of health issues, especially when it comes to keeping her own children safe.

This vaccine protects against most infections caused by human papilloma virus, or HPV, sharply lowering the risk for genital infections and cancers. Three shots are needed for maximum effectiveness. Although doctors and public health officials strongly recommend the vaccine for adolescent boys and girls, boys are far less likely to be immunized.

Maybe girls are singled out for HPV shots, as they are for services related to contraception and STI prevention, “because we are all sexist,” Williams joked. Then suddenly she realized something – “Oh, my son wasn’t offered the HPV vaccine.”

This is the only vaccine where coverage for boys and girls is different in Georgia. For 7th graders, 45.8 percent of girls received at least one dose of the HPV vaccine compared with 39.6 percent of boys. This gap is even larger in the Northeast Health District, the 10-county district headquartered in Athens.

The stakes are high because HPV is the most common sexually transmitted infection in the United States. “What we know is that between 50 and 80 percent of all sexually active individuals, which is most humans, will acquire [it] at sometime during their lifetime,” said Dr. Julie Martin, who coordinates pediatric training at the Georgia Regents University-University of Georgia Medical Partnership.

The Centers for Disease Control and Prevention urges all doctors to recommend HPV vaccines to both boys and girls, along with standard shots to protect against measles, mumps, and other infectious diseases. Still, when parents are surveyed about why their sons haven’t gotten HPV shots, the most common answer is that their doctor didn’t recommend it.

“The recommendation for [HPV] vaccination for boys is newer, compared to the recommendation for females, so some physicians are maybe not fully up to date, or have not incorporated that into their practice,” said Martin, who also practices pediatrics in Athens.

When the Food and Drug Administration approved Gardasil in 2006, they recommended this HPV vaccine specifically for young women. But because the infection is typically spread through sexual contact, in 2011 the FDA approved Gardasil for both males and females. Public health authorities have been recommending it for all early adolescents since then.

“Every provider here knows that every visit is a chance to immunize,” said Cshanyse Allen, chief operating officer for the Athens Neighborhood Health Center. “We give information to the parents and let them know that boys need HPV immunizations as well.”

This federally qualified health center in Athens may be ahead of the game. The Ohio State University researchers found that only 76 percent of Minnesota health care providers routinely recommend HPV vaccines for girls aged 11 to 12 years, and a scant 46 percent made the same offer for boys.

People wave off flu shots because they’re skeptical about how well they’ll work, which indeed varies from year to year. Parents refuse the HPV vaccine – or hesitate to accept it – for entirely different reasons.

“For many parents I think the concern is, if I vaccinate my child against HPV, am I promoting sexual promiscuity as they get older?” said Martin, the pediatrician.

“There is a misconception that just because they (boys) get the vaccination which gives them the idea that ‘hey, go out and have sex!’ But it’s not true,” said Allen, who manages the Athens Neighborhood Health Center.

“You want to give the vaccine to the boys anyway before they become sexually active,” said Sharon Washington, nursing supervisor for the Clarke County Health Department. “And many people don’t think about oral sex – the virus spreads that way, too.”

The CDC has been recommending HPV immunization for boys since October 2011. Although vaccine protection benefits boys directly, public health messages usually focus on reducing their role as carriers and spreaders of the virus. HPV is still seen mainly as a women’s health issue, because cervical cancer rates have been falling since the vaccine became available.

In Georgia, the proportion of 13-to 17-year-old girls who are immunized goes up a little every year; the coverage rates for boys did not change significantly from 2013 to 2014.

“Our goal is really reducing the incidence of the human papillomavirus at population level,” said Martin. This means protecting more boys as well as girls.

Starting HPV vaccination is just the first step – full protection requires a three-dose series.

“Many adolescents don’t go to the doctor, they don’t go unless they have perhaps a sports physical, or they are sick at some point,” said Martin. “The fact that parents and their adolescent child may need to take time off from work or school to complete the series can be a barrier.”

Clarke County has made HPV vaccination a priority, Washington said. “I wouldn’t say that they (boys) always come back, and that’s why we are starting to do the reminder call.”

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