[One decade of HPV vaccination in Germany].

As a worldwide very common sexually transmitted infection (STI), HPV causes millions of genital warts every year and is responsible for 5% of all cancers in men and women. With strong empirical evidence for both vaccine safety and efficacy, the HPV vaccines proved to protect against these HPV-related conditions over the last decade. But current HPV vaccination coverage is suboptimal in many countries. Even in Germany the absence of a school-based immunization program and the recommendation of a publicly funded girls-only HPV vaccination strategy are the main reasons for a female coverage rate under 40%, which does not achieve herd immunity for the boys. Therefore, the German immunization program urgently needs revision to fight an increasing number of young Germans missing out on the most important development in cancer prevention. Gender-neutral bundling of the HPV vaccine to other routinely recommended vaccines for preteens at one visit will have many advantages at the same time: Lowering the age of HPV vaccination to 9-12 years will improve the cost-effectiveness because a two-dose vaccination schedule is established on this score. Time-consuming and redundant explanations of the attending physician as well as parent's discussion on feeling stigmatized by the STI nature of HPV could be avoided in a combined vaccination setting. By expanding the HPV vaccination to boys, the resulting gender-neutral vaccination program can be cost-effective if all HPV-related diseases which can be prevented by vaccination are considered.