Oct 252011
Authors: Shari Roan McClatchy-Tribune

LOS ANGELES — A vaccine that protects against the sexually transmitted human papillomavirus should be routinely given to boys ages 11 and 12 to prevent anal cancer, a government advisory committee has decided.

Though many parents may not wish to contemplate the future sex lives of their pre-adolescent children, vaccinating them young is the best way to avoid the risk of the cancer-causing virus, experts said Tuesday.

The recommendation is sure to ignite further debate among the Republican presidential candidates who have focused intently on whether the controversial vaccine, called Gardasil, is appropriate for girls — who receive it for prevention of cervical cancer — let alone for boys.

Texas Gov. Rick Perry was criticized by his fellow Republican presidential candidates for ordering mandatory HPV vaccination in girls in his state in 2007. The mandate was overturned by the state Legislature and Perry eventually withdrew his support for the idea.

Another presidential hopeful, Minnesota Rep. Michelle Bachmann, has placed Gardasil in the spotlight by suggesting that the vaccine can cause “mental retardation.”

Public health groups quickly criticized Bachmann for these remarks and the Advisory Committee on Immunization Practices, prior to its Tuesday vote, took time to state for the record that the vaccine does not cause mental retardation.

The vote of 13-0 (with one abstention) in favor of routine HPV vaccination of boys supercedes a 2009 vote by the panel recommending Gardasil be available to males ages 9 to 26 to prevent genital warts but not recommending routine vaccinations.

Since then, several studies have shown that the human papillomavirus is responsible for many cases of anal cancer in addition to cervical cancer and genital warts, and that the vaccine can curb this risk, warranting a shift to stronger recommendations, the panel members said. The vaccination of boys also will help protect unvaccinated females, the panel added.

Gardasil, administered as a three-shot regimen, has been advised since 2006 for girls ages 11 to 12 as well as for older unvaccinated females to prevent cervical cancer.

In addition to routinely administering Gardasil to boys age 11 to 12, the panel, which advises the Centers for Disease Control and Prevention, also advised vaccination for boys as young as age 9 and for males ages 13 to 21 who have missed the ideal vaccination age window of 11 to 12.

Although CDC officials do not have to follow the committee’s guidance, they often do — and a CDC vaccination recommendation is significant because health insurers typically shape their coverage to be in line with such recommendations.

“I think this a major step forward in prevention of HPV-related cancers,” said Dr. Joel Palefsky, a professor of medicine at the University of California, San Francisco, and director of the UCSF Anal Neoplasia Clinic. Palefsky’s lab reported last year that Gardasil curbs the development of precancerous anal lesions that can evolve into cancers; he has received grants from Merck, the maker of Gardasil, and has served as an adviser to the company.

“It also serves to equalize the burden of vaccination to not just one gender — and recognizes the responsibility of both males and females,” Palefsky said.

Anal precancers are difficult to treat and there is no routine screening test for the early diagnosis of the disease as there is for cervical cancer. The four strains of HPV that Gardasil protects against account for about 90 percent of all cases of anal cancers, he added.

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