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Reuters Health Information (2010-01-04): New vaccine schedule says HPV vaccine can be given to prevent warts in men

Professional Development

New vaccine schedule says HPV vaccine can be given to prevent warts in men

Last Updated: 2010-01-04 17:00:10 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Doctors should discuss using the quadrivalent human papillomavirus vaccine (HPV4) to protect against warts with their male patients, according to new recommendations from the Advisory Committee on Immunization Practices (ACIP). However, the "permissive recommendation" does not go as far as recommending the routine use of the vaccine.

"A permissive recommendation means that providers are encouraged to discuss with their patients the pros and cons of using such a vaccine and to provide the vaccine if a patient asks for it," Dr. Carol Friedman, an ACIP member from the Centers for Disease Control and Prevention, Atlanta, told Reuters Health. "Thus, a permissive recommendation is not a universal recommendation; it is not a mandate on children, parents, providers, or programs; and it is not meant to be promoted by vaccine manufacturers."

The 2010 recommended adult immunization schedule also advises that unvaccinated healthcare workers born before 1957 who do not have laboratory evidence of immunity to measles, mumps or rubella should receive two doses of MMR during measles or mumps outbreaks and one dose during a rubella outbreak.

Before an outbreak, the ACIP says, healthcare facilities "should consider vaccinating" their unvaccinated personnel born before 1957.

Other additions to the recommendations, published in the January 5 issue of Annals of Internal Medicine, include:

-- Acknowledgment that a newly licensed bivalent HPV vaccine (HPV2) is available for use in young women.

-- An indication for hepatitis A vaccination for people who expect to adopt a child from a country where the virus is endemic, as well as anyone likely to be in close contact during the child's first 60 days in the U.S. Ideally, the first dose of the 2-dose series should be given at least 2 weeks before the child arrives.

-- Schedule information for the 3-dose hepatitis B vaccine. The second dose of this vaccine should be given one month after the first, and the third at least two months after the second. The combined hepatitis A and hepatitis B vaccine can be administered in a three- or four-dose schedule.

-- New examples of risk groups, such as adults with asplenia or persistent complement component deficiencies, military recruits, students living in dormitories, and travelers to areas in which meningococcal disease is hyperendemic or epidemic, for whom the meningococcal vaccine would be appropriate, as well as information on who needs to be revaccinated and who does not.

With regard to the permissive recommendation for an HPV4 vaccine in young males ages 9 through 26, Dr. Friedman said that HPV4 "protects against four strains of HPV (6, 11,16, 18). HPV 6 and 11 are considered low-risk or nononcogenic and can cause benign or low-grade cervical cell abnormalities and genital warts."

Dr. Friedman said the HPV4 and HPV2 vaccines cost about the same, and the ACIP does not recommend one HPV vaccine over the other. She added that clinicians can explain to their female patients that HPV2 protects against high-risk HPV types and HPV4 protects against two additional low-risk HPV types known to cause genital warts.

"Many adult vaccines are grossly underutilized," Dr. Friedman continued, ranging from 52% of the targeted adult population for the tetanus, diphtheria and whooping cough vaccine, to 7% of all adults for whom the herpes zoster vaccine is advised.

The authors of an editorial accompanying the recommendations say that part of the problem is that "for too many years, vaccines have been viewed as routine only for children and travelers."

According to Dr. Robert H. Hopkins Jr. and Dr. Keyur S. Vyas at the University of Arkansas for Medical Sciences, Little Rock, the solution is to make immunizations "an essential component of the comprehensive care of adults in ambulatory and inpatient settings."

Ann Intern Med 2010;152:36-39,59-60.

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