HPV vaccination programmes should be extended to gay and other men who have sex with men (MSM), an interim statement issued by the UK’s expert vaccine committee recommends.
Vaccinating all MSM aged 16-40 years attending sexual health or HIV clinics would be cost effective, preventing both anal cancer and ano-genital warts.
Vaccine campaigners have welcomed the decision, but believe that HPV immunisation should be extended to adolescent boys.
Persistent infection with certain strains of HPV (human papillomavirus) can cause ano-genital cancers. Vaccines have been developed that provide high-level protection against these strains of HPV and also other types of the virus that cause ano-genital warts. Since 2008, HPV vaccination has been recommended for adolescent girls in the UK.
Rates of HPV-related anal cancer are higher among MSM, especially MSM living with HIV, than any other group. MSM also have a high burden of ano-genital warts.
As a result, the UK Joint Committee on Vaccination and Immunisation (JCVI) asked Public Health England and the London School of Hygiene and Tropical Medicine to look at the impact and cost-effectiveness of a targeted programme of vaccinating MSM.
The study considered vaccination for four groups of MSM attending sexual health and HIV clinics:
HIV-positive MSM aged 16-25.
HIV-positive MSM aged 16-40.
All MSM aged 16-25.
All MSM aged 16-40.
The recommendations took into account a number of factors, including:
Vaccine efficacy.
Sexual behaviour of MSM.
Attendance at sexual health clinics by MSM.
HIV prevalence among MSM.
HPV disease progression to anal cancer.
Incidence of HPV infection according to age.
Costs.
Where data were lacking or incomplete it was assumed that:
There would be 100% acceptance, uptake and completion of a three-dose vaccination schedule.
The vaccine provides life-long protection.
The duration of protection was unaffected by HIV infection status.
Anal cancer incidence is higher among MSM attending sexual health services than non-attendees.
HIV-positive MSM attend sexual health clinics more frequently than HIV-negative men.
Results showed that the quadrivalent vaccine (Gardasil) would be effective at preventing both anal cancer and ano-genital warts. The benefits were especially clear for HIV-positive MSM. However, there was enough evidence to show that vaccinating all MSM aged 16-40 years should be considered.
“The Committee agreed that a programme to vaccinate MSM aged 16-40 years should be considered, provided that the programme would be undertaken at a price where administration and vaccine costs combined were cost-effective,” says the statement.
The JCVI calls for the Department of Health, Public Health England and local authorities to develop implementation plans.
“The Committee has acknowledged stakeholder concerns that MSM are a group at high risk of HPV infection and subsequent disease,” concludes the statement, which is now open for public consultation. The deadline for comments is 7 January 2015, and they should be submitted to JCVI-consultation@phe.gov.uk.
The charity HPVACTION.org welcomed the recommendation to extend vaccination programmes to MSM. However, they believe the statement doesn’t go far enough and are calling for all adolescent boys to be vaccinated against HPV.
The British HIV Association (BHIVA) welcomed the announcement, noting the disproportionate impact that anal cancer has on MSM living with HIV. Terrence Higgins Trust has invited supporters to ask their MPs to call on health ministers to provide the HPV vaccination to men who have sex with men.
JCVI interim position statement on HPV vaccination of men who have sex with men (MSM). The statement can be downloaded here.