Background: HPV is related to a number of cancer types, causing a considerable burden in both genders in\r\nEurope. Female vaccination programs can substantially reduce the incidence of HPV-related diseases in women\r\nand, to some extent, men through herd immunity. The objective was to estimate the incremental benefit of\r\nvaccinating boys and girls using the quadrivalent HPV vaccine in Europe versus girls-only vaccination. Incremental\r\nbenefits in terms of reduction in the incidence of HPV 6, 11, 16 and 18-related diseases (including cervical, vaginal,\r\nvulvar, anal, penile, and head and neck carcinomas and genital warts) were assessed.\r\nMethods: The analysis was performed using a model constructed in MicrosoftWExcel, based on a\r\npreviously-published dynamic transmission model of HPV vaccination and published European epidemiological data\r\non incidence of HPV-related diseases. The incremental benefits of vaccinating 12-year old girls and boys versus\r\ngirls-only vaccination was assessed (70% vaccine coverage were assumed for both). Sensitivity analyses around\r\nvaccine coverage and duration of protection were performed.\r\nResults: Compared with screening alone, girls-only vaccination led to 84% reduction in HPV 16/18-related\r\ncarcinomas in females and a 61% reduction in males. Vaccination of girls and boys led to a 90% reduction in HPV\r\n16/18-related carcinomas in females and 86% reduction in males versus screening alone. Relative to a girls-only\r\nprogram, vaccination of girls and boys led to a reduction in female and male HPV-related carcinomas of 40% and\r\n65%, respectively and a reduction in the incidence of HPV 6/11-related genital warts of 58% for females and 71%\r\nfor males versus girls-only vaccination.\r\nConclusions: In Europe, the vaccination of 12-year old boys and girls against HPV 6, 11, 16 and 18 would be\r\nassociated with substantial additional clinical benefits in terms of reduced incidence of HPV-related genital warts\r\nand carcinomas versus girls-only vaccination. The incremental benefits of adding boys vaccination are highly\r\ndependent on coverage in girls. Therefore, further analyses should be performed taking into account the\r\ncountry-specific situation. In addition to clinical benefits, substantial economic benefits are also anticipated and\r\nwarrant further investigation as do the social and ethical implications of including boys in vaccination programs.
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