Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.
Gynecol Oncol. 2010 May;117(2 Suppl):S20-5. doi: 10.1016/j.ygyno.2010.01.027. Epub 2010 Feb 16.
Sexually transmitted human papillomavirus (HPV) infection is very common in men and women. Oncogenic HPV is strongly associated with cancers and high-grade dysplasias of the anogenital tract, including the anus, penis, and also a proportion of oropharyngeal cancers. In reducing male disease burden, some consider screening and treatment for high-grade anal dysplasia (AIN) to prevent anal cancer in high-risk populations. Such strategies have wide implications for the workforce, and require more evidence for the optimal management of AIN. Male sexual behavior, with consequent HPV infection and disease contribute to considerable disease burden in females. Hence, inclusion of males in prophylactic HPV vaccination programs should prevent HPV-related disease in males as well as substantially reducing disease burden in females. Clinical trial data in males 16-26 years for the quadrivalent vaccine show it is well tolerated, induces a strong type-specific immunological response comparable to that of females, and reduced vaccine HPV-type-related genital infection, as well as disease. Cost-benefit analyses and mathematical modeling show that the most cost-effective strategy involves routine administration of this vaccine to 12-year-old females, with catch-up vaccination of 12- to 24-year-olds, with the most effective strategy in disease reduction including men and/or boys in the program. Such a vaccination strategy including 12-year-old boys is projected by 2050 to reduce HPV 16 infection by 88-94% in females and 68-82% in males, plus the aforementioned male HPV- related cancers by 22-27%. Therefore, inclusion of males in an HPV vaccination program is likely to have significant health and economic benefits over and above those observed from current female-only programs. However, comprehensive cost-benefit analyses are needed to determine the efficacy of these programs in the overall population. Such analyses will be crucial for the design, acceptance, and implementation of these vaccination programs into clinical practice globally.
性传播人乳头瘤病毒（HPV）感染在男性和女性中非常普遍。致癌 HPV 与人肛门生殖器部位的癌症和高级别发育不良（包括肛门、阴茎，以及一部分口咽癌）密切相关。为了降低男性疾病负担，一些人认为对高危人群进行高级别肛门发育不良（AIN）筛查和治疗以预防肛门癌。这些策略对劳动力有广泛的影响，需要更多证据来优化 AIN 的管理。男性性行为会导致 HPV 感染和疾病，从而给女性带来相当大的疾病负担。因此，将男性纳入预防性 HPV 疫苗接种计划不仅可以预防男性 HPV 相关疾病，还可以大大降低女性的疾病负担。16-26 岁男性四价疫苗的临床试验数据表明，该疫苗耐受性良好，可诱导与女性相当的强烈的型特异性免疫反应，并可降低疫苗 HPV 型相关的生殖器感染和疾病。成本效益分析和数学模型表明，最具成本效益的策略是对 12 岁女性常规接种该疫苗，对 12-24 岁女性进行补种，最有效的减少疾病策略包括在该计划中纳入男性和/或男孩。包括 12 岁男孩的这种疫苗接种策略预计到 2050 年将使女性 HPV16 感染减少 88-94%，男性感染减少 68-82%，以及上述男性 HPV 相关癌症减少 22-27%。因此，将男性纳入 HPV 疫苗接种计划可能会带来比当前仅针对女性的计划更大的健康和经济效益。然而，需要进行全面的成本效益分析，以确定这些计划在整个人群中的效果。这些分析对于这些疫苗接种计划在全球范围内纳入临床实践的设计、接受和实施至关重要。
