Include boys in HPV vaccination

 

Sir, – We, as Irish oncology physicians and surgeons, request Minister for Health Simon Harris to include boys in the HPV vaccination programme as a matter of national urgency. In modern Ireland it is simply unacceptable that every year young women and men are dying of preventable human papilloma virus (HPV) driven cancers. HPV is known to cause several different types of malignancies, including cervical, vulvar, vaginal, penile, oropharyngeal, anal, and rectal. The HPV vaccine is one of the outstanding scientific achievements in modern times. If evidence-based medicine is our mantra then anecdotal information has no substance and no value. The positive results for both boys and girls from this vaccine are staggering. Repeated multicentre clinical trials all around the globe have concluded that this vaccine is highly effective and has an excellent safety profile. In a recent head and neck cancer audit 2014-18, in the eight cancers hospitals around Ireland we report a 37 per cent increase in oropharyngeal (tonsil and base of tongue) cancer compared to similar audit conducted by the National Cancer Registry of Ireland 2009-13. Nearly 50 per cent of this increase in cancer is directly related to HPV. We report 728 oropharyngeal cancers of which 338 were HPV positive. Furthermore, of those HPV positive cancers, 262 (77.5 per cent) were in males. These results highlight the evolving reality of HPV cancer and the impact on Irish males.

There are no screening tools for oropharyngeal cancer and the disease requires chemotherapy and radiation therapy followed by lifelong clinical follow up. The overall burden of HPV-related benign and malignant diseases is now almost the same in men as in women.

In the United States the number of new HPV-associated cancer cases each year based on data from 2010 to 2014 has shown that oropharyngeal HPV cancer figures have now surpassed cervical cancer. There are multiple reasons we should have gender neutral vaccination. Including boys will offer greater protection to girls, boost herd immunity, eradicate genital warts, and improve the overall resilience of our vaccination programme.

The World Health Organization Global Advisory Committee for Vaccine Safety has never reported safety concerns with the HPV vaccine. They have reviewed the evidence on the safety of Gardasil vaccine on seven occasions – in 2007, 2008, 2009, 2013, 2014, 2015 and 2017. As part of the 2017 review, 79,697 serious adverse events were investigated and the conclusion reached was that HPV vaccines are considered to be extremely safe. HPV vaccination rates in 2014-15 were 89.6 per cent. This fell in dramatic fashion to an estimated 50 per cent in 2016-17. Thanks to excellent work in the National Immunisation office the percentage has risen to 61.7 per cent for 2017/18.

There has been a grave injustice to those children who have missed out on this vaccine and where at all possible catch-up schedules should be used to protect them. A decision on whether or not to vaccinate boys should not solely be made on the basis of cost. The psychosocial impacts of life-threatening and life-altering HPV-related diseases must be considered when calculating the benefits of male HPV vaccination.

Withholding a vaccine from any group of individuals at risk of developing that vaccine-preventable disease is unethical. Gender-neutral vaccination for girls and boys is now required so that that the full benefits of the Irish vaccination programme can be realised. – Yours, etc,

Prof JAMES

PAUL O’NEILL,

Beaumont Hospital

and the Royal College

of Surgeons in Ireland;

Mr KENNETH MEALY,

President,

The Royal College

of Surgeons in Ireland;

Prof MARY HORGAN,

President,

The Royal College

of Physicians of Ireland,

Prof FERGAL MALONE,

Master,

Rotunda Hospital, Dublin, and RCSI;

Prof JOHN J MORRISON, Master, Department of Obstetrics & Gynaecology, National University of Ireland Galway; Dr SHARON SHEEHAN, Master, Department of Obstetrics and Gynaecology, Coombe Women & Infants University Hospital; Prof JOHN R. HIGGINS, Clinical Director, Cork University Maternity Hospital; Prof NASH PATIL, President. Irish Institute of Otorhinolaryngology, Head and Neck Surgery; Prof PATRICK SHEEHAN, Department of Otolaryngology Head and Neck Surgery, South Infirmary-Victoria University Hospital; Prof HELENA ROWLEY, Department of Otolaryngology Head and Neck Surgery, Mater Misericordiae University Hospital & Children’s University Hospital, Temple Street; Prof MARY LEADER, Department of Pathology, Beaumont Hospital & The Royal College of Surgeons in Ireland; Prof RORY McCONN Walsh, Department of Otolaryngology Head and Neck Surgery, Beaumont Hospital & The Royal College of Surgeons in Ireland; Prof DENISE MacCARTHY, Dublin Dental University Hospital; Mr NEVILLE SHINE, Department of Otolaryngology Head and Neck Surgery, Beaumont Hospital & The Royal College of Surgeons in Ireland; Mr BARRY O’SULLIVAN, Department of Plastic and Reconstructive Surgery, Beaumont Hospital; Mr LIAM SKINNER, Department of Otolaryngology Head and Neck Surgery, University Hospital Waterford; Mr TOM MORAN, Department of Otolaryngology Head and Neck Surgery, Mater Misericordiae University Hospital; Mr STEPHEN RYAN, Department of Otolaryngology Head and Neck Surgery, University Hospital Limerick; Ms ORLA YOUNG, Department of Otolaryngology Head and Neck Surgery, Galway University Hospital; Mr PAUL LENNON, Department of Otolaryngology Head and Neck Surgery, St James’s Hospital; Mr ROBERT O’CONNOR, Head of Research, Irish Cancer Society; Dr MARY TONER, Department of Pathology, Dublin Dental University Hospital & St James’s Hospital; Dr LINDA FEELEY, Department of Pathology, Cork University Hospital; Dr ORLA McCARDLE, Department of Radiation Oncology, Beaumont Hospital; Dr SINEAD BRENNAN, Department of Radiation Oncology, St James’s Hospital; Dr KATHY ROCK, Department of Radiation Oncology, Cork University Hospital; Dr PATRICK MORRIS, Department of Medical Oncology, Beaumont Hospital; Mr CONOR BARRY, Department of Oral & Maxillofacial Surgery, Dublin Dental University Hospital & St James’s Hospital; Dr ESTHER O’REGAN, Department of Medical Oncology, St James’s Hospital; Dr SEAMUS LOOBY, Department of Radiology, Beaumont Hospital.