The Advisory Committee on Immunization Practices Expands Recommendations on HPV Vaccine, Leaves Some Decisions Up to Patients and Their Providers

The Advisory Committee on Immunization Practices has made two recommendations on the use of the vaccine against the Human Papilloma Virus (HPV). First, the upper bound of the age recommendation for women is now age 26. For men, it remains at 21. The committee also recommended that men and women aged 27 to 45 have a discussion with their healthcare providers and receive the vaccine if they’re deemed to be at risk for the infection. The recommendations did not extend beyond age 45 as the vaccine has not been proven effective in that population. (There are no data of the vaccine’s effectiveness for people over that age.)

HPV has a strong association with six types of cancer in both men and women. The infection initially may cause warts in the genital area, though many people experience no symptoms and clear the virus no problem. Those who do not clear the virus are at increased risk for cancer because the virus causes changes to cells at the genetic level. These changes trigger abnormal tissue changes that may eventually become cancer.

Even if the infected tissue doesn’t develop into full-fledged cancer, the infection has costs in terms of the medical care required for the warts, abnormal pap smears in women, and tissue abnormalities in both sexes. There are also psychological costs in waiting between an abnormal test and the confirmatory test results for cancer. And, of course, the interpersonal and social stigma of HPV as a sexually transmitted infection.

In Australia, which has similar HPV vaccine recommendations as the United States, cervical cancer is projected to be eliminated (less than four new cases per 100,000 women per year) by mid-century if the current vaccination rates hold. In the United States, where cervical cancer is projected to cause about 4,200 deaths in 2019, the rates of cervical cancer have been on the decline partially due to more access to regular pap smears and screenings. At a population level, cervical cancer rates declined significantly following the introduction of the HPV vaccine.

Like in Australia, the expansion of the age coverage for the vaccine and expansion of access and uptake of the vaccine may lead to elimination of cervical cancer in the United States. What once was the leading cause of death from cancer in women living in the United States may soon become a thing of the past.

(July 3, 2019: This post has been updated to mention that there is no data for people over the age of 45.)

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Author: René F. Najera, DrPH

I am the editor of the History of Vaccines site, an online project by the College of Physicians of Philadelphia. All opinions expressed on these blog posts are not necessarily those of the College or any of my employers. Check out my professional profile on LinkedIn: https://www.linkedin.com/in/renenajera Feel free to follow me on Twitter: @EpiRen

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