Human papillomavirus vaccination in men who have sex with men – what will be required by 2020 for the same dramatic changes seen in heterosexuals

Abstract

Abstract. This paper addresses the issue of whether men who have sex with men (MSM) will share the spectacular reductions in human papillomavirus (HPV) infection and its associated neoplasia that we are currently witnessing in heterosexuals. The reproductive rate for HPV infection in heterosexuals is not well established, but 70% vaccination coverage in women has resulted in a fall of more than 90% in genital warts and HPV types 16/18 in young women and 80% fall in young men indicating that the critical vaccination threshold has been exceeded for this group. Published data on the three elements of the reproductive rate for HPV infection (i.e. transmission probability per sexual partnership, rate of partner change and duration of infectiousness) suggest they are higher in MSM than heterosexuals. This indicates that the reproductive rate for HPV will be higher in MSM and hence the critical vaccination threshold will also be higher. But while vaccinating 70% of girls protect 70% of sexual partnerships in heterosexuals, vaccinating 70% of boys protect more than 70% of partnerships in MSM. Only 9% (30% by 30%) of sexual partnerships in MSM are not protected with 70% coverage. Therefore vaccinating 70% of boys will protect 91% of sexual partnerships in MSM. However the efficacy of the HPV vaccine is much lower when sexually active MSM are vaccinated rather than boys. We argue that if MSM are to have the same benefit from the HPV vaccine that heterosexuals had, boys and not adult MSM will need to be vaccinated.Additional keywords: human papillomavirus vaccine, men who have sex with men.

Human papillomavirus vaccine uptake among young gay and bisexual men who have sex with men with a time-limited targeted vaccination programme through sexual health clinics in Melbourne in 2017

“…Similar reductions have also been observed among unvaccinated heterosexual men due to herd protection 4 5 26. In order to observe a similar reduction in MSM, it is hypothesised that the vaccine coverage in MSM would need to reach at least 70%, which effectively protects 91% of partnerships (100% (30% by 30%)) 27. Furthermore, an Australian-based mathematical model has predicted that implementing both school-based vaccination programme for boys and a targeted programme for MSM aged up to 26 years would be highly cost-effective 10.…”

Should human papillomavirus vaccination target women over age 26, heterosexual men and men who have sex with men? A targeted literature review of cost-effectiveness

“…Since the reproductive rate of HPV infection in MSM is much greater than heterosexual men, it is likely that a higher level of vaccination coverage will be required. 53 Despite only 16 of 26 studies in heterosexual men demonstrating cost effectiveness, our data suggest that a gender neutral vaccination strategy may become increasingly costeffective for a number of reasons. First, recent literatures reported that 1-or 2-doses vaccination is as effective as 3doses vaccination for people age 9-14 years, which means a potential 30% cost reduction per head if this is implemented in any school age vaccination programs.…”

2020, sexually transmissible infections and HIV in gay, bisexual and other men who have sex with men

“…15 Yet, among these predictions, there is some good news, with considerable decline in human papillomavirus (HPV) infection and associated cancers likely in countries where HPV vaccination coverage exceeds critical vaccination thresholds. 16 However, declines are likely only in countries where childhood vaccination of boys has been implemented, because HPV is so rapidly acquired after commencing sexual activity that vaccination of GBM after sexual debut will have much less impact. 16,17 …”

“…16 However, declines are likely only in countries where childhood vaccination of boys has been implemented, because HPV is so rapidly acquired after commencing sexual activity that vaccination of GBM after sexual debut will have much less impact. 16,17 …”

“…A meta-analysis in this issue assesses hepatitis C virus (HCV) infection 16 in GBM. Injection drug use remains the predominate route of transmission, but new cases were seen in men who did not inject drugs.…”