An active substance is believed to protect once morest HPV and related cancers. But young girls are too rarely vaccinated and young men are often unaware of the existence of this offer.
Why should boys get the HPV vaccine? Isn’t it a girl thing? Doctors often come up once morest these kinds of questions when informing parents and adolescents regarding the new screening offer. Since last summer, vaccination once morest human papillomavirus (HPV) has also been recommended for boys and is now covered by health insurance. “The fact that only women are at risk from HPV is one of the most important errors”, explains Professor Peter Schneede, chief physician of the urology department at the Memmingen clinic. Widespread viruses can cause not only cancer of the cervix (cervical carcinoma), but also other diseases, including cancer of the mouth and pharynx, anus and penis, as well as genital warts . HPV experts like Schneede hope that vaccination will take hold in the coming years and the pathogens will be pushed back globally.
According to Dr. Heike Kramer, president of the Medical Society for Health Promotion, however, there is a huge “knowledge gap” regarding HPV, both among parents and young people. This has been shown by surveys on the subject. “There is too much false information,” she criticizes. Another problem is that lay people usually associate the keyword with cervical cancer. “We have to be careful not to talk regarding cervical cancer vaccination, but regarding HPV vaccination,” Kramer points out. Otherwise, the boys and their parents would not feel concerned.
Vaccination once morest HPV viruses for girls was introduced in 2007
In 2007, vaccination once morest HPV viruses was introduced for girls. The results on the occasion of the tenth anniversary were disappointing: Less than 50 percent of 17-year-old girls in Germany are vaccinated. “It is precisely this country, which has contributed so much to the development of vaccination, which is far behind other countries,” says Schneede. In the 1980s, the virologist Harald zur Hausen from Heidelberg discovered that cervical cancer was caused by infection with certain HP viruses and thus made a major contribution to the development of vaccination. He was awarded the Nobel Prize for Medicine in 2008 for his scientific contribution.
Human papillomaviruses (HPV) under the microscope.
Photo: German Cancer Research Centre, dpa
German citizens’ fatigue with vaccination might one day take bitter revenge, warns Schneede: “Germany might then find itself at the top of the list for types of cancer that have been prevented in other countries” . In particular, he sees Australia as a model, where nearly 80 percent of young people are vaccinated. That is why there are practically no more genital warts in this country, and the precancerous stages of cervical cancer have also decreased markedly. It can therefore be inferred that there will be fewer cases of cervical cancer in these countries, and probably also other HPV-related carcinomas. But solid numbers will only be available in 20 or 30 years, as tumors grow slowly.
Associations of urologists want to launch an information campaign on HPV
In order to convince boys and their parents to get vaccinated, urological associations have launched a campaign. In general, they and other institutions, such as the Bundeszentrale für gesundheitliche Aufklärung (BZgA), want to provide more in-depth information regarding HPV. “As physicians, we have to be active and speak to the public,” says Schneede. One of the problems, he says, is that boys rarely go to the doctor, leaving little opportunity for informational talks. Paediatricians are most likely to inform parents regarding this measure as part of preventive examinations – but offers aimed at adolescents are not well accepted.
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“Parents also don’t want to imagine too much that their children will have sex in the near future,” says Schneede. This is why urologists now want to address themselves more to young people themselves. During “boy consultations”, during which adolescents can discuss all questions relating to sexuality with a urologist, vaccination should also be discussed.
One of the challenges faced by immunization educators is that the HPV context is complicated and difficult to convey. There are indeed regarding 200 different types of human papillomaviruses, of which around 40 are present in the genital area and are sexually transmitted. During intimate contact, they enter the body through tiny lesions in the skin or mucous membranes and can trigger infections. The pathogens are extremely widespread: “About 80 percent of people are infected at least once in their lifetime,” explains Schneede. Most of the time, the infection goes unnoticed. Depending on the type of pathogen, unpleasant, although harmless, genital warts may appear. Or, in the long term, precancerous stages develop.
Vaccine reduces risk of cellular changes due to HPV
High-risk HPV types 16 and 18 are primarily responsible for carcinomas, while low-risk types 6 and 11 are responsible for genital warts. The “Gardasil 9” vaccine protects once morest nine types of virus and thus reduces the risk of having cellular changes due to HPV by 90 percent. Heike Kramer explains: “So you can still get cancer despite vaccination, but the probability is much lower.” Due to the residual risk, however, it is important that all vaccinated women over the age of 20 go for cancer screening once a year.
Vaccination only protects if you have not yet been infected with HPV. Otherwise, it is powerless once morest the type of pathogen that one has contracted. To ensure that adolescents are vaccinated the first time they have sex, screening is recommended from the oldest children. In addition, the immune response is better in them: between the ages of nine and 14, only two vaccines are necessary, compared to three later. The substance is well tolerated: “So far, around 300 million doses of vaccine have been administered without any serious side effects,” says Schneede.
Most frequent reactions: Pain, redness, swelling at the injection site
BZgA also qualifies the vaccination as safe and thus rejects reports of serious consequences. The most common reactions are pain, redness or swelling at the injection site. Also, headache or muscle aches, fever, gastrointestinal upset, dizziness and fatigue may occur temporarily. However, serious side effects are rare.
Professor Peter Schneede, who has worked in HPV research for 30 years, was strongly committed to the new vaccination recommendation. Germany thus has a “second chance” and might contribute to reducing the pathogen as a whole. One day, HPV infections might be eradicated by a global vaccination program, like smallpox once was, Schneede believes. But until then, there is still a long way to go.
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