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Column originally published Feb 25, 2014

HPV Vaccines Are Indicated For Both Boys And Girls

Question: My younger son is in grade 6. He brought home a permission form about HPV vaccine for boys. I am reluctant to sign it. Several years ago, his older sister did receive this vaccine, which I understood is important to protect her from cervical cancer. I don't understand why they have to give it to boys also. When I checked online about this vaccine recently, I read that there are many side effects. Fortunately, my daughter had no complication. Is our government spending our tax dollars wisely on such a vaccine?


You have asked a question that many governments and health professionals are debating about: should we vaccinate boys with HPV vaccine? Let me begin by explaining a little about the Human Papilloma Virus (HPV) so that you can have a better understanding about it.

As the name suggests, HPV infects humans. There are more than 100 strains of HPV, about 40 of them can infect the genitalia and surrounding areas, as well as mucous membranes of the mouth and throat. Some of them produce growths that are called warts, which are found in the genital areas, around the anus, as well as in our voice box. These warts are much more than a nuisance; they cause great embarrassment and a lot of anxiety. If they occur in the voice box, this can seriously affect a person’s voice.

The most dreaded impact of HPV is cancer. This is the virus that is most firmly linked to cancer of the cervix, vagina, vulva, penis, and anus. Most of us know about cervical cancer, and how it can devastate families. Many women with young families are struck by this cancer at an early age. Pap smears of the cervix can detect early cancerous cells, allowing women to be treated before their cancer becomes obvious and has already spread. Women are advised to get screening Pap smears regularly after they become sexually active.

More recently, some cancer in the mouth and throat, as well as other cancers in the head and neck regions, have been linked to HPV. Michael Douglas, a well-known actor, has recently revealed that he has throat cancer caused by HPV. He speculated that he caught the virus from having oral sex with women.

There is no question that the strains of HPV that I mentioned here are mostly transmitted through sex. This include sexual intercourse, sexual touching, oral and anal sex. It is passed from one sexual partner to another, regardless of the gender of the person, as long as there is the right kind of cells for it to attack. HPV attacks cells in the mucus membranes in and around the genitalia and anus, as well as the mouth and throat. We still don’t know exactly how infected cells are transformed into cancer cells, but once they become cancerous, they can spread to other parts of the body.

When the link between HPV and cancer was established, scientists worked feverishly to identify the strains that cause cancer and warts, and designed ways to prevent them. It turns out that two strains, 16 and 18, were responsible for around 80% of cervical cancer in North America. They used a recombinant technology to produce vaccines that can induce good immunity, but cannot cause any infection because there is no virus in the vaccine.

There are two HPV vaccines licensed in Canada, Gardisil and Cervarix. Both are effective against HPV 16 and 18. Gardisil also protects against types 6 and 11, which are responsible for most of the genital warts. Since 2007, all provinces and territories have implemented immunization programs for girls, mostly around grades 6 and 7. The aim is to give them protection before they engage in any form of sexual activity.

Ever since these two vaccines were licensed in Canada and around the world, there have been debates whether to immunize boys as well. These vaccines are effective for both girls and boys. Since HPV is passed from one sexual partner to another, through all forms of sexual activity, it is necessary to vaccinate the males, who can pass the virus from one female to another female through heterosexual sex, as well as from male to male in homosexual activity.

After much debate, the vaccines are approved in many countries for both boys and girls, women and men. Prince Edward Island is one of the first provinces in Canada to implement the universal immunization strategy, to vaccinate all girls and boys at grade 6, beginning in the fall of 2013. Research from Australia has already shown that this is the correct strategy: they have seen a significant reduction of HPV infection in their teens and young adults, which will extend to fewer genital warts and cancers caused by HPV.

It is important to know that these vaccines are very effective even for adults in their 40s and 50s. Gardisil is approved for women up to 45 years of age. For men, approval is up to 26. However, this does not mean those older than the approved age will not benefit from the vaccine, and this age likely will change over time when more research results become available.

Moreover, it is important to emphasize the importance of using condom for protection, as well as regular PAP screening for women.

Finally, I should warn about searching for side effects of vaccines through the internet. There are many bogus websites trying to scare the public about vaccination. When I tried Google search, it listed almost 4 million links. These vaccines have very minor local side effects, and with huge health benefits.

[Note to Readers: Please read the column in December 2020 about the updated Gardasil 9 vaccine.]