HPV vaccination in EU countries: review of new evidence

ECDC comment

​Recent evidence on use of HPV vaccines in boys and men and on the efficacy of a two dose schedule may warrant to significant policy changes in the near future.

Human papiloma virus (HPV) vaccination is variably implemented in the EU. At present, 23 EU/EEA Member States recommend the vaccination (for the list of those countries see the ECDC vaccine scheduler). Recent evidence on use of HPV vaccines in boys and men and on the efficacy of a two dose schedule may warrant to significant policy changes in the near future.  

Vaccination in boys/men

HPV can infect both females and males. Although the major burden of HPV is cervical disease, the virus is also associated with other morbidities affecting men as well as women (e.g. anogenital warts, penile, anal and oropharyngeal cancers. There is evidence suggesting that vaccinating boys and men against HPV is beneficial  in preventing these HPV-related conditions in the male population, even though the follow-up time of these studies is short (1).
 
Decisions to recommend the vaccine for boys and/or men depend on the epidemiology of HPV-related diseases in a specific country, the cost-effectiveness, and the affordability of the vaccine. Economic models have shown that including adolescent males  and men  in the current HPV vaccination programmes is unlikely to be cost-effective as the value HPV vaccination provides in this population is low for the money it costs(1). However, these models rely on assumptions such as duration of protection, coverage rates in girls, incidence of HPV-related morbidities in the general population and price of the vaccine. As more data becomes available, both from follow up data of ongoing studies as well as from new ones, these models should be reassessed.
 
This has led the UK Joint Committee on Vaccination and Immunisation to request the government to review the HPV models done in the past taking into account new data on vaccines and new assumptions (like vaccination of men who have sex with men).  With the information from these reviewed models the UK government will reconsider whether HPV vaccination should be offered to men who have sex with men and/or adolescent males (5).
 
Boys are routinely vaccinated against HPV in some countries, such as Australia and the US (2, 3). In the EU, only Austria recommends both boys and girls to be vaccinated, although at their own expense (4).

Two dose-schedule

At the beginning of 2014 Cervarix© and Gardasil© (both vaccines against HPV and authorised centrally by the European Medicines Agency) received new marketing authorisation for two-dose schedule use instead of the previous three-dose. In particular, Cervarix is now registered to be used with the reduced schedule in girls aged 9-14 years and Gardasil received a positive opinion to be used in 9-13 year old adolescent girls and boys (6).
 
The new reduced schedules provide more room for updated health economic assessment of HPV vaccine programmes, as the cost of vaccination per individual will be reduced.

Conclusions

Follow-up data of ongoing studies of HPV in boys and men will help explore new vaccination strategies and might change future recommendations regarding HPV vaccination in many countries. Nonetheless, ECDC’s guidance published in September 2012 is still valid. ECDC is working on revising the guidance and aims to publish an updated version next year which would take into account new developments, studies and follow-up data of ongoing trials.
 
Any changes to the two doses schedules will be captured and communicated through the ECDC Vaccine Scheduler

References

  1. ECDC guidance  http://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/20120905_GUI_HPV_vaccine_update.pdf
  2. http://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
  3. http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-hpv
  4. http://bmg.gv.at/cms/home/attachments/3/7/1/CH1100/CMS1391182290312/hpv-parents_information__.pdf
  5. http://www.gov.uk/government/uploads/system/uploads/attachment_data/file/294845/Minutes_HPV_Subcommittee_meeting_Jan_2014_final.pdf
  6. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Summary_for_the_public/human/000721/WC500024634.pdf