title: Estimating the clinical benefits of vaccinating boys and girls against HPV-related diseases in Europe.
abstract: BACKGROUND
  HPV is related to a number of cancer types, causing a considerable burden in both genders in Europe. Female vaccination programs can substantially reduce the incidence of HPV-related diseases in women and, to some extent, men through herd immunity. The objective was to estimate the incremental benefit of vaccinating boys and girls using the quadrivalent HPV vaccine in Europe versus girls-only vaccination. Incremental benefits in terms of reduction in the incidence of HPV 6, 11, 16 and 18-related diseases (including cervical, vaginal, vulvar, anal, penile, and head and neck carcinomas and genital warts) were assessed.
  
  
  METHODS
  The analysis was performed using a model constructed in Microsoft(®)Excel, based on a previously-published dynamic transmission model of HPV vaccination and published European epidemiological data on incidence of HPV-related diseases. The incremental benefits of vaccinating 12-year old girls and boys versus girls-only vaccination was assessed (70% vaccine coverage were assumed for both). Sensitivity analyses around vaccine coverage and duration of protection were performed.
  
  
  RESULTS
  Compared with screening alone, girls-only vaccination led to 84% reduction in HPV 16/18-related carcinomas in females and a 61% reduction in males. Vaccination of girls and boys led to a 90% reduction in HPV 16/18-related carcinomas in females and 86% reduction in males versus screening alone. Relative to a girls-only program, vaccination of girls and boys led to a reduction in female and male HPV-related carcinomas of 40% and 65%, respectively and a reduction in the incidence of HPV 6/11-related genital warts of 58% for females and 71% for males versus girls-only vaccination.
  
  
  CONCLUSIONS
  In Europe, the vaccination of 12-year old boys and girls against HPV 6, 11, 16 and 18 would be associated with substantial additional clinical benefits in terms of reduced incidence of HPV-related genital warts and carcinomas versus girls-only vaccination. The incremental benefits of adding boys vaccination are highly dependent on coverage in girls. Therefore, further analyses should be performed taking into account the country-specific situation. In addition to clinical benefits, substantial economic benefits are also anticipated and warrant further investigation as do the social and ethical implications of including boys in vaccination programs.
authors.affiliation: HEVA, 186 Avenue Thiers, Lyon, 69006, France. rmarty@hevaweb.com
authors.forename: Rémi
authors.initials: R
authors.lastname: Marty
authors.forename: Stéphane
authors.initials: S
authors.lastname: Roze
authors.forename: Xavier
authors.initials: X
authors.lastname: Bresse
authors.forename: Nathalie
authors.initials: N
authors.lastname: Largeron
authors.forename: Jayne
authors.initials: J
authors.lastname: Smith-Palmer
mesh_terms: D001005:Anus Neoplasms / Q000276:immunology / Q000517:prevention & control / Q000821:virology; D002648:Child; D003218:Condylomata Acuminata / Q000276:immunology / Q000517:prevention & control / Q000821:virology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005833:Genital Neoplasms, Female / Q000276:immunology / Q000517:prevention & control / Q000821:virology; D006258:Head and Neck Neoplasms / Q000276:immunology / Q000517:prevention & control / Q000821:virology; D052140:Human papillomavirus 11 / Q000276:immunology; D052162:Human papillomavirus 16 / Q000276:immunology; D052161:Human papillomavirus 18 / Q000276:immunology; D052163:Human papillomavirus 6 / Q000276:immunology; D006801:Humans; D015994:Incidence; D008297:Male; D027383:Papillomaviridae / Q000276:immunology*; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission / Q000821:virology; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010412:Penile Neoplasms / Q000276:immunology / Q000517:prevention & control / Q000821:virology; D015397:Program Evaluation; D014611:Vaccination
chemical_list: D053918:Papillomavirus Vaccines