Tuesday 17 July 2018

HPV jab: why are boys missing out?

To prevent related cancers in males and the spread of the deadly virus generally, boys must be vaccinated too

HPV - 'boys must be vaccinated too'
HPV - 'boys must be vaccinated too'
Bobby Kerr

Ailin Quinlan

In the summer of 2015, coffee-chain entrepreneur Bobby Kerr went to see his GP about a sore throat and a small lump which had appeared on his neck.

Tests later showed that the self-made millionaire and founder of the hugely successful Insomnia coffee chain had head and neck cancer.

"It took them a while to find out whether it was related to HPV [Human papillomavirus]," Kerry recalls now.

It was.

HPV is a family of common viruses that are passed on through sexual contact. In most cases, HPV goes away on its own and does not cause any health problems. However, there are numerous strains of HPV, some of which can cause cancer or precancerous lesions.

HPV is now so common that around 80pc of Irish men and women will get the virus at some point in their lives.

Although HPV can cause cancer in males - around 85 men in Ireland are diagnosed with HPV-related cancers every year - the HSE currently offers HPV vaccination only to girls in their first year of secondary school.

However, the benefits of a vaccination programme for boys as well as girls is two-fold; not only does it help to prevent the spread of the virus to others, it also prevents HPV-related cancers in both males and females, by assisting the immune system to fight and clear HPV infection.

For Bobby Kerr, the months following diagnosis were difficult ones. The gruelling treatment required to clear his cancer - some surgery and several weeks of chemotherapy and radiotherapy - left him debilitated. However, he recovered, and was back at work the following January.

Now the former Dragon's Den star, who last Christmas left his career with Insomnia to concentrate on his career as a successful radio presenter, strongly believes that boys should be included in the HSE's vaccination programme.

"The HSE should vaccinate boys as well as girls," says Kerr.

"I contracted my head and neck cancer through the HPV virus, and I'd be in favour of anything that could prevent others contracting the virus like me."

"I definitely feel boys should be given the vaccine.

"If anything can prevent people going through what I had to go through it's worth it."

Kerr's life has changed radically in recent years.

"I now work as a radio presenter three days a week and do a lot of public speaking. I have de-stressed my life and I work when I want to work.

"I love what I am doing on the radio; it's all good," says Bobby who also jogs three times a week, swims in the Forty Foot and sails competitively.

There are HPV vaccination programmes for boys and girls in countries like Australia, the US, Canada and New Zealand - in Britain, only girls aged 12 and 13 are offered the vaccine by the NHS.

However, doctors attending the British Medical Association's (BMA) recent annual conference called for the jab to be given to children as young as 10 - in case that some children could become sexually active before puberty.

Delegates at the BMA's annual meeting in Brighton voted overwhelmingly in favour of a motion which called for the vaccination to be offered to all school-age children of both sexes - and to be administered at primary school.

Here in Ireland, the National Immunisation Advisory Committee has recommended that all boys at 12-13 years of age should receive the HPV vaccine as part of the national HPV vaccination programme on the recommendation of the World Health Organisation.

A Health Technology Assessment is now being carried out by the Health Information and Quality Authority (HIQA) for the Department of Health. This is due to be published next autumn, and the Department of Health will then make a decision as to whether the HPV vaccination programme should be extended to include boys.

"We are awaiting the outcome of that report. The HSE will then implement whatever policy the Department decides on," says Dr Brenda Corcoran, Head of the HSE National Immunisation Office, who points out that the vaccine protects against a range of cancers including cancers of the cervix, head, neck, anus and penis.

Even if the Department of Health decides against extending the vaccination programme to boys, says Dr Phil Kieran, a GP in Cork city, he will have both of his young sons vaccinated when the time comes.

Dr Kieran, well-known to TV viewers for his appearances in the RTÉ One medical series You Should Really See A Doctor, recently helped launch health insurance company Irish Life Health's 'Not Just for Girls' HPV awareness campaign, which aims to highlight the importance of HPV vaccination for boys as well as girls. The company is the first health insurer to offer up to €200 back on the cost of private HPV vaccinations for boys and girls.

Research commissioned by the company shows that while nearly half of the more than 1,000 Irish parents surveyed were receptive to the idea of vaccinating their sons against HPV, 95pc of them underestimate just how prevalent the virus is.

The study also highlighted a poor understanding among Irish parents about HPV-related cancers in men. Only 8pc of Irish parents surveyed believed the leading cause of throat cancer in men was from a HPV-infection. However, up to half of all oropharyngeal cancers in Ireland may be caused by HPV infection.

People who are diagnosed with HPV are 16 times more at risk of developing throat cancer and on average nearly one third, or 27pc of all HPV-related cancer diagnoses in Ireland are in men.

In addition to this, more than 99pc of cases of cervical cancers in women are thought to be caused by the virus.

HPV, points out Dr Kieran, has long been familiar to both the medical community and the general public - the warts that people get on their hands or feet are caused by a strain of we have known about for a long time in medicine.

The link between HPV and cervical cancer was proven in research carried out as far back as the 1990s when studies found that the majority of cervical cancer samples contained HPV. A few years later, it was determined that around 99.7pc of cervical cancers were caused by HPV, Dr Kieran explains.

"The vaccine was released in 2008. It's there to provide immunity to people against the most dangerous strains of HPV.

"The aim is to try to reduce the rates of cervical cancer and we have seen significant reductions in the rates of pre-cancerous changes in populations which have been vaccinated," says Dr Kieran.

Research has shown, he emphasises, that HPV is responsible for between 25pc and 40pc of head and throat cancer (though, he acknowledges, smoking is the biggest cause of head and neck cancers.)

"About 80pc of the population is exposed to, has had or has HPV, which turns into cancer in a minority of people.

"Most people who get HPV get no symptoms. Some will have warts. In others it will cause cervical cancer," he says, adding that like many other doctors, and parents, he is awaiting a decision on whether the vaccine will be made available to boys through the public health service.

It's an expensive procedure for those who decide to have their sons vaccinated privately through their GP.

The vaccine, says Dr Kieran, costs about €200 per shot - and a boy might need about two shots, depending on his age and the type of vaccine.

"I will give the vaccine to my sons when they reach the age of 12 or 13, as that is the age boys need it. If it's not available through the HSE by then, I will be buying it for them," he says, adding that he believes the Government should seriously consider extending the immunisation programme to include young boys.

"It can prevent cancers and it can prevent genital warts. It can reduce the risk of a woman contracting HPV from an unvaccinated man - currently, when you think about it, we're only vaccinating half of the population."

 

5 things you should know about HPV

• Human papillomavirus (HPV) infection is spread by direct (usually sexual) contact with an infected person. About 80pc of all women will have a HPV infection in their lifetime, usually in their late teens and early 20s.

Most HPV infections clear naturally but some caused by high-risk HPV types can progress to cervical cancer.

Two high-risk HPV types (16 and 18) cause over 70pc of cervical cancers.

• The human papillomavirus (HPV) vaccine protects seven out of 10 cervical cancers and works best when given at the age of 12 to 13 years. It also protects against head and neck, anal and penile cancers.

The HPV vaccine is currently available free of charge from the HSE for all girls in 1st year of second level school.

• The World Health Organisation says the HPV vaccine is safe. About 300 Irish women get cervical cancer every year and 90 of them will die from it. This year, two out of every three girls have received the vaccine as part of the school vaccination programme.

• The National Immunisation Advisory Committee has recommended that all boys at 12-13 years of age should receive HPV vaccine as part of the national HPV vaccination programme on the recommendation of the World Health Organisation. A decision on this by the Department of Health is expected towards the end of the year.

• HPV vaccines have also been shown to be effective in preventing infection in men. Some countries, for example Australia and the US, recommend routine vaccination for boys.

For more information about HPV, visit hpv.ie

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