A US expert said: I got the HPV vaccine after my divorce at age 40, and it worked.
“I got the (9-valent) HPV vaccine after I got divorced in my 40s. I think it makes sense for lifelong self-protection,” Abraham Aragones, a gynecologic oncologist at Memorial Sloan Kettering Cancer Center, told the media.
The key point is that this official is a man.
Male, 40 years old to receive? This seems different from the target population for the 9-valent vaccine in China.
In 2018, the 9-valent human papillomavirus vaccine (hereinafter referred to as the 9-valent HPV vaccine) was launched in China. The National Medical Products Administration approved its applicable population as women aged 16-26.
At the time, media reports indicated that after some grassroots vaccination sites in Beijing opened appointments for the 9-valent HPV vaccine, their phone lines were overwhelmed with calls. However, many of these inquiries were deemed invalid because the recipients were "over the age limit" or "male."
"The United States and Hong Kong allow people over the age limit to play," one commentator remarked.
Recently, Scientific American published an article pointing out that the U.S. Food and Drug Administration (FDA) and the U.S. Centers for Disease Control and Prevention (CDC) have successively revised their relevant recommendations, relaxing the "age threshold" for the 9-valent HPV vaccine.
The US FDA has expanded the eligible population from 9-26 years old to 27-45 years old, and it is now suitable for both men and women. This provides an important opportunity to prevent HPV-related diseases across a wider age range, making up for the lack of access to the vaccine for young and middle-aged men and women.
The US CDC also stated that both men and women aged 9-26 should receive the full dose of the 9-valent vaccine; those aged 27-45, regardless of gender, can consult their doctor about whether they need a booster shot, as it may be beneficial.
Get the HPV vaccine.
Sexual experience is more important than age
Currently, including in China, there are three different valence HVP vaccines available globally for the prevention of cervical cancer.
The "valence" indicates the number of virus types the vaccine can prevent. The three types of vaccines are:
The bivalent vaccine can prevent infection with HPV types 16 and 18. More than 70% of cervical cancers are caused by these two viruses.
The quadrivalent vaccine can prevent infection with HPV subtypes 6, 11, 16, and 18. While HPV types 6 and 11 have a lower risk of causing cancer, 90% of genital warts are caused by these two genotypes. In some countries, this vaccine is also approved for the prevention of genital warts in both men and women.
The 9-valent vaccine is based on the 4-valent vaccine and adds 5 more viral subtypes: 31, 33, 45, 52, and 58. It can prevent 90% of cervical cancers and also prevent vulvar cancer, vaginal cancer, anal cancer, etc.
At the time, my country's National Medical Products Administration issued a statement saying that, based on the clinical research data submitted, my country had approved all three vaccines for women. However, the applicable age ranges differed. The bivalent HPV vaccine was suitable for ages 9-45; the quadrivalent vaccine for ages 20-45; and the nonavalent vaccine for ages 16-26.
It is claimed that after the age of 26, the proportion of people infected with HPV through sexual transmission and other channels is very high. The effectiveness of the vaccine will be reduced for people who have been infected before. "Furthermore, there is no evidence that this vaccine has a protective effect on people exposed to this age group." This was stated by the National Medical Products Administration in April 2018 when the 9-valent vaccine was launched.
However, since the HPV vaccine was launched, numerous commentaries have pointed out that the most important factor determining the cost-effectiveness of HPV vaccination for each individual is their sexual history. This may be more important than specific age.
Both of the major U.S. health departments have changed their recommendations.
In October 2018, the U.S. FDA revised the eligible population for the 9-valent HPV vaccine, stating that both men and women aged 27-45 can be vaccinated.
In its announcement, the FDA stated that a 3.5-year follow-up study of 3,200 women aged 27-45 showed that the 9-valent HPV vaccine was 88% effective in preventing persistent infection, genital warts, vulvar and vaginal precancerous lesions, cervical precancerous lesions, and cervical cancer associated with the HPV types covered by the vaccine.
A safety assessment of 13,000 men and women showed that the most common adverse reactions after vaccination were injection site pain, swelling, redness, and headache.
Based on these results and new data from long-term follow-up, the FDA approved the 9-valent vaccine to expand its age range of indications.
In June 2019, the Advisory Committee on Immunization Practice (ACIP) stated that some unvaccinated individuals may be at risk of contracting the new virus and may benefit from vaccination in that age group.
Based on this, the committee members voted 10 to 4 in favor of allowing individuals aged 27-45 to jointly decide with their trusted doctor whether they need a booster shot of the 9-valent HPV vaccine.
In August of the same year, after reviewing the evidence, the U.S. CDC updated its recommendations on HPV vaccination for adults in the United States, raising the age limit to 45.
According to the CDC, in nine clinical studies of HPV vaccines in adults aged 27-45, the serological response rate of any HPV vaccine was 93.6%-100% within 7 months after full vaccination (all 3 doses). The overall evidence for benefit was GRADE 2 (moderate quality evidence).
In the relevant studies, almost no serious adverse events occurred, and no vaccine-related deaths were reported. The overall evidence regarding harm also falls into GRADE Level 2.
Five recommendations for getting the 9-valent vaccine
Currently, the US CDC's recommendations regarding HPV vaccination and cervical cancer prevention include:
For individuals aged 9-26: It is generally recommended to receive the HPV vaccine at age 11 or 12; vaccination can also begin at age 9. It is recommended that all individuals under 26 years of age who have not received an adequate dose of the vaccine get vaccinated as soon as possible.
> 26 years old: HPV vaccination is not recommended for all individuals aged 26 and older. It is recommended that adults aged 27-45 who have not received an adequate dose participate in collaborative clinical decision-making regarding HPV vaccination spurs, as this may be beneficial. Vaccination is not recommended for individuals over 45 years of age.
Vaccination management: The schedule and intervals for the 9-valent vaccine vaccination remain unchanged. Pre-vaccination testing (including Pap smears or HPV testing) is not required.
Cervical cancer screening: Cervical cancer screening guidelines and recommendations should be followed.
Special populations: The recommendations for those aged 9-26 and >26 years apply to all populations. Pregnant women should postpone HPV vaccination until after delivery. However, a pregnancy test is not required before vaccination. Breastfeeding women can receive the HPV vaccine.
"Even those who are over the age limit for vaccination can benefit."
Abraham Aragones, who received the vaccine in his 40s, pointed out that even if you are already infected with HPV, the vaccine can still protect against other viral subtypes, including potentially high-risk types.
Meanwhile, life expectancy is increasing, and the incidence of sexually transmitted diseases among the elderly is on the rise. HPV infection may also increase among unvaccinated elderly individuals. "Based on these factors, I believe it is necessary for people over 26 years of age to get vaccinated, including men," he said.
But Gypsyamber D'Souza, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, believes that the data needs to be reviewed by the medical institutions that conduct prevention and disease screening: "We need solid evidence to show whether we should widely recommend vaccination to older age groups."
"The most important thing is to solve the problem of health insurance payment." Scientific American reported that, according to statistics from the U.S. CDC, 14 million people are infected with HPV every year in the United States, 12,000 women are diagnosed with cervical cancer caused by a certain type of HPV infection, and 4,000 women die from cervical cancer caused by a certain type of HPV infection.
In addition, HPV infection is closely related to many other malignant tumors, and patients can be either male or female.
Scientific American suggests that if health insurance could cover the cost of HPV vaccines for the entire population, it could greatly increase vaccination rates and thus reduce the incidence of related malignant tumors.
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