FROM this month, the National HPV Immunisation Programme will, for the first time, include boys.
They will be offered the free vaccine in their first year of secondary school. It makes sense as males and female transmit HPV, or Human Papilloma Virus, to each other through sexual intercourse and other types of sexual activity. Girls have been getting the vaccination in this country at school since 2010.
HPV immunisation prevents certain HPV infections which can lead to cancers in women, such as cervical cancer, and anal cancer and penile cancer in men. Immunisation is most effective before a person becomes sexually active. In Ireland, HPV infection caused up to 420 cancer cases in men and women each year between 2010 and 2014.
Cork GP, Dr Phil Kieran, welcomes the inclusion of boys in the immunisation programme.
“The original reason for only vaccinating girls was to prevent cervical cancer,” he said. “When you have finite resources, you look at where you can get the most bang for your buck.
“Now, we’re learning that more and more illnesses and cancers are related to HPV. The big ones for men would be penile cancer and anal cancer. Extending the vaccine out to the male population is possible now. Whether or not the money is there, money has been found to be there.
“The other side of it is trying to increase the overall number of vaccinated people in the community. It doesn’t really make sense to vaccinate only half the population from something that is actually transmitted.
“For anyone who can’t get the vaccine because of allergies, they are going to have to rely on what is called ‘herd immunity’, meaning low circulating numbers of people with HPV. If you can vaccinate enough of the population, any individual who, for medical reasons, can’t receive the vaccine is at a much lower risk of contracting HPV because there is not as much of it around.”
New research highlights a lack of awareness of HPV, which infects over 80% of the population when they are sexually active. Some 75% of people don’t fully understand what HPV is.
However, the research also highlights a 17% increase among the general public in awareness levels that HPV can infect both males and females when compared with research from the previous year. This is supported by 70% of respondents, who agree that both males and females should be vaccinated against HPV.
Dr Kieran says it’s really important to get rid of the idea that it only affects people who are promiscuous or people who aren’t careful.
“HPV is incredibly common. For most people, there are no symptoms. Their immune system will clear it.
“But it doesn’t matter whether you’ve had one partner or 50 partners. Your chance of meeting someone who has it is four in five.”
HPV has been known about for a long time.
“We knew it cause genital warts, which are very unpleasant and distressing. I see cases of them week in, week out. But they’re not life-threatening. It’s really only since the ’70s that it was discovered that HPV was in all cervical cancer patients. So, all of a sudden, this was something that could be targeted.
“Research shows that we can reduce the rates of cervical cancer by vaccinating against HPV. We see that HPV is implicated in a lot of cancers.”
As to the anti-vaccination movement, Dr Kieran says objections to vaccination stemmed from the notion that vaccinating young people sexualised them.
“It was conservatism or religious pressure groups which had non-medical reasons against vaccination. Then, as Ireland moved towards becoming a more secular society, the pressure groups said (vaccination) caused this and that, that it was dreadful and it’s all a conspiracy to do this to children. But it’s not. With pressure groups, there’s almost always an ideological or financial reason behind them.”
Is there a reluctance among parents to see their children as potentially sexually active?
“Exactly. But the reality is that most people will become sexually active at some stage. That’s why we’re still around. No one wants to think of their children as sexually active. But that’s just hiding your head in the sand and avoiding reality.”
The reason the HPV vaccination is targeted at 12-year-olds going into first year at secondary school is, according Dr Philip, that: “we know their immune system responds very well to it and gives them the best shot at lifelong immunity from conditions associated by HPV.
“Secondly, it’s the age when you can guarantee across the board that these children haven’t been sexually active.
“None of us likes to think about how young their first sexual contact might be. That’s where all the pressure against vaccination came from initially.”
People say they use condoms and are therefore safe from HPV. But Dr Kieran points out that the virus is also spread through oral sex or intimate skin to skin contact.
“It is spread incredibly easily. Most of us have had it.”
Dr Kieran says that while he hopes there will be no resistance to boys being vaccinated against HPV, he expects that there will be some objections.
“From the science points of view, there is no legitimate argument against it. But I think we’ll be fighting this battle again. There is no evidence to support the worries. It’s just scare-mongering. I’m not naive enough to think that people won’t use fear to try and further their own agenda.”
What would Dr Kieran say to parents in doubt about having their sons vaccinated?
“I think they should have their sons vaccinated. I will be getting my sons vaccinated. They’re aged five and three so it’s a while away yet. But I’ve said over the last number of years that if the vaccination wasn’t brought in (at schools) for boys, I’d be paying to get it for my sons.
“Unless your sons have an allergy or a medical condition that means they can’t get the vaccination, I strongly and unequivocally recommend that they get their sons vaccinated. Information leaflets will be available shortly.”
There are more than 200 different types of HPV and most HPV infections have no symptoms and clear naturally. One in 20 of all cancers worldwide is caused by HPV infection.
Dr Kieran says that side effects from the vaccination are not a big issue.
“You can have pain in your arm from having a needle stuck into it. It hurts a little bit.
“You can be allergic to the vaccination but that is incredibly rare.
“I suppose the two big conditions that people tried to link to HPV are chronic fatigue syndrome and chronic regional pain syndrome. But there’s no scientific link from them to the vaccine. Chronic fatigue syndrome is reported from as far back as ancient Egyptian times. It’s not a new condition.”
From the start of the roll-out of the HPV vaccination, Dr Kieran said: “There has been a pushback from religious elements not to talk about sexuality. That was the Irish religious ethos.
“It would surprise me if that isn’t still around to an extent,” he said.
Dr Kieran hopes that in 10 or 20 years, people won’t talk about HPV as much as they do now.
“We don’t talk about rubella. I’d love the HPV vaccination to go that way, just for it to be normalised, like the measles vaccine. I’ve only seen one case of measles in my career, which is amazing.”
Faith in the cervical cancer screening programme has undoubtedly been shaken by the scandal of undiagnosed cases of the disease and subsequent deaths.
“That is really unfortunate because on the whole, I think it is a very good screening programme. The way the scandal was handled was atrocious. The screening programme is quite good. The questions raised about screening programme in general highlight the need for vaccination. Screening programmes are trying to catch cervical cancer when it happens. Vaccination is trying to prevent it from happening.”
FACTS ABOUT HPV CANCERS:
HPV is a family of very common and highly contagious viruses.
Almost every sexually active man and woman in Ireland will get HPV in their lifetime.
There is no treatment for HPV infection.
For most people, HPV clears up on its own but for many men and women, it can cause cancers including cervical cancer and anal cancer.
Ireland has one of the highest rates of cervical cancer in Western Europe — 14 cases per 100,000. In the UK, it’s 10.2 per 100,000 and in Spain, 8.2 per 100,000.
An estimated 420 cancers were caused by HPV in Ireland each year during 2010-2014.
An average of 130 men and women die from HPV-related cancers in Ireland every year.
Currently, 31 countries globally provide gender neutral HPV vaccination programmes.
www.hpvaware.ie and www.hpv.ie.