Intended for healthcare professionals


Who should be vaccinated against HPV?

BMJ 2015; 350 doi: (Published 12 May 2015) Cite this as: BMJ 2015;350:h2244
  1. Karen Canfell, director1
  1. 1Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW 2011, Australia
  1. Correspondence to: Karen.Canfell{at}

As richer countries consider vaccinating males, the focus for lower income countries should remain on cervical cancer prevention

Vaccination of girls against the human papillomavirus (HPV) has been implemented in most developed countries, driven by prevention of cervical cancer as a public health priority. Bivalent (Cervarix, GSK) and quadrivalent (Gardasil, Merck) vaccines protect against subsequent infection with oncogenic HPV16/18, and quadrivalent vaccine protects against HPV6/11, which cause anogenital warts. Although HPV vaccination effectively protects against external genital lesions and anal intraepithelial neoplasia in males, only a few jurisdictions have so far recommended universal vaccination of boys. These include Australia, Austria, two Canadian provinces, and the United States. In other countries, a cautious approach has been due, in part, to uncertainties around the population level impact and cost effectiveness of vaccination of boys.

In a linked article, Bogaards and colleagues (doi:10.1136/bmj.h2016) estimated the benefits to men of offering HPV vaccination to boys.1 They used a dynamic simulation and a bayesian synthesis to integrate the evidence on HPV related cancers in men. The analysis takes account of indirect protection from female vaccination: heterosexual men will benefit from reduced HPV circulation in females, so if coverage in girls is high the incremental benefit of vaccinating boys is driven by prevention of the residual burden of anal cancer in men who …

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