The week of October 2 marks the start of a free vaccination campaign against human papillomaviruses for 5th grade students.e in educational establishments, as Emmanuel Macron announced in February. The objective set is to have at least 30% of these students vaccinated in college at the end of the school year. According to Public Health France, 47% of 15 year old girls had received a first dose in 2022 (compared to 45%, in 2021), and only 12.8% of boys of the same age (6%, in 2021).
Papillomaviruses, viruses that also affect men
Long associated with exclusively female problems, human papillomaviruses (or HPV, from English human papillomavirus) also concern men. A study published in August in the journal The Lancet Global Health showed that 31% of men over 15 years old would be affected by at least one of these viruses, and 21% would carry a high-risk HPV, that is to say potentially oncogenic.
HPV belongs to a family of viruses with more than a hundred variants, around fifteen of which are considered high risk.
Human papillomaviruses are the leading cause of sexually transmitted infections, with the use of condoms not preventing transmission. The latter occurs through contact with the skin and mucous membranes, most often during sexual intercourse, with or without penetration. Since HPV is particularly contagious, majority of men (91%, according to a study conducted in the United States in 2014) and sexually active women (85%) will be infected at some point in their lives.
There is no treatment. Most of the time, the body eliminates the virus within a year of infection, but it is possible that the latter can induce precancerous lesions that can develop into cancer. Each year, HPV causes more than 6,000 new cases of cancer, including 2,900 cervical cancers causing more than 1,000 deaths. HPV is also the cause of 1,500 ENT cancers, 1,500 of the anus, 200 of the vulva or vagina and around a hundred penile cancers each year. Around 1,750 of these new cases are detected in men, and 4,580 in women.
Who can be vaccinated and with what results?
The human papillomavirus vaccine is not mandatory, but it has been recommended since 2007 among young girls aged 11 to 14. Until 2021, only these adolescent girls, as well as, at the margin, people with a deficiency in their immune system and men who have sex with men were affected by vaccination. Since January 2021, the vaccination recommendation also concerns young boys, in the same age group.
To date, therefore, girls and boys can be vaccinated according to a two-dose schedule – three if vaccination occurs between 15 and 19 years of age. Catch-up coverage up to age 26 is only possible for men who have sex with men. From October 2023, a widespread and free campaign should enable students aged 5e to be vaccinated at their school, with the agreement of both parents. Furthermore, since a decree of August 2023pharmacists and nurses can prescribe and administer mandatory and recommended vaccines without prior authorization from the attending physician.
It has been proven that the HPV vaccine is effective in preventing both precancerous lesions and cancers, assures Judith Michels, medical oncologist at Gustave-Roussy and member of the HPV group created in early 2023. A Swedish study on cervical cancer showed in 2020 that the risk of cancer in participants vaccinated before the age of 17 was ten times lower than that of participants who had never been vaccinated. With later vaccination, between 17 and 30 years of age, the risk remains two and a half times lower.
In Australia, where vaccination coverage has almost reached 80% among men and women in 2022, the rate of people infected with HPV fell from 22.7% over the period 2005-2007 to 1.5% in 2015 among young women aged 18-24. In the four or five years following the launch of vaccination, the number of precancerous lesions also fell by 34% among women aged 20 to 34.
What are the reasons for the delay in vaccination of men?
If almost fifteen years separate vaccination recommendations for girls and boys, it is in particular because papillomaviruses have been considered as female health problems. In fact, cancers induced by HPV represent 5% of cancers worldwide, 90% of which affect women. When vaccination was launched at the end of the 2000s, emphasis was placed on cervical cancer, 99.7% of which was caused by HPV.
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From, “with changes in sexual practices, these cancers reach other areas », explains Judith Michels. While oropharyngeal cancers – oral passages, such as the tongue or throat – were mainly caused by alcohol and tobacco consumption, “HPV is now the cause in 50% of cases”. Furthermore, the incidence of these cancers has increased in Europe and the United States, especially among men – “there are three to five times more oropharyngeal cancers in men than in women”relates the oncologist.
Hence the importance of vaccinating the entire population. The medical oncologist at Gustave-Roussy even calls for alignment with the recommendations of the World Health Organization, which recommends vaccination from the age of 9 for everyone. Studies show it: the earlier the vaccination, the more effective it is. However, she should “be independent of sexual orientation” patients, argues Judith Michels, who questions the authorization of catch-up up to the age of 26 reserved for men who have sex with men.
The government is aiming for 80% vaccination of 11-14 year olds by 2030. At stake, “eradication of HPV-induced diseases”summarizes Judith Michels, citing an Australian study presented at international HPV congress, Euroginand predicting the disappearance of cancers induced by papillomaviruses in eighty years if all women were vaccinated, and within forty years if both men and women received the vaccine.