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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "264" "paginaFinal" => "265" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Carmen Hidalgo Tenorio" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Carmen" "apellidos" => "Hidalgo Tenorio" "email" => array:1 [ 0 => "chidalgo72@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vacuna del papilomavirus para mujeres y ¿para hombres?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Human papillomavirus (HPV) is the most common sexually transmitted infection in men and women worldwide. Around 90% of adults will be infected by any HPV genotype throughout their lives, for example, in the USA 6.2 million new cases are reported every year.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> To date, more than 100 HPV genotypes have been reported, being responsible for a wide range of diseases with different clinical manifestations and widely demonstrated oncogenic potential, such as cervical, head-neck and anus neoplasms. The most frequently involved genotypes are 16 and 18.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a> Some of the factors favoring chronic infection by these viruses are age (being young), smoking,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> a greater number of sexual partners,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a> HIV infection, low number of CD4 lymphocytes, men who have sex with men (MSM)<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a> and being a woman.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">With the introduction of the vaccine against HPV, first the bivalent (16/18), in 2006, and then the tetravalent vaccine (6/11/16/18), in 2007, a decrease in the incidence of some HPV infection-related cancers has been detected, such as cervical cancer. In the USA, from 1999 to 2015 the incidence of cervical neoplasm has dropped more than 3% per year, particularly in women between 20 and 24 years of age. However, oropharyngeal and anal cancers have increased. This increase is due to the significant burden of disease in men, for whom the recommendation to be vaccinated has been included later and very differently.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> This fact is one of the main factors that highlights the need to prevent HPV-related cancers regardless of sex.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Both vaccines have also been shown to prevent premalignant lesions of cervix, vulva, vagina and anus. Similarly, the tetravalent vaccine has been proved to prevent the occurrence of genital warts related to genotypes 6/11. This led to changing the vaccine paradigm: from being first understood as an approach to cervical cancer prevention strategy to currently occupy a determining role in preventing the infection and the HPV-related diseases (warts/condylomas, cancer) in either sex.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A universal HPV vaccination campaign, regardless of sex, would provide greater population coverage, which might be a key point in the fight against HPV, since it would reduce the burden of HPV-related diseases in both men and women. However, for the time being, there is still disagreement on the recommendations in both sexes between countries, organizations and scientific societies. Thus, for example, WHO only recommends vaccination in girls aged 9–13 based on a cost-effectiveness analysis.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a> However, in the USA, the American Cancer Society, the Center for Disease Control and Prevention and the Advisory Committee on Immunization Practices recommend vaccination in males aged 11–12, and in those aged 13–21 that have not been previously vaccinated or that have not completed the scheme, and up to 26 years of age in immunosuppressed men or MSM.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Regarding Spain, the Advisory Committee on Vaccines of the Spanish Association of Paediatrics recommends the routine vaccination of boys and girls aged 11–12.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a> However, the Ministry of Health, Consumption and Social Welfare recommends vaccination in risk groups of all ages. And, in certain situations up to 26 years of age, such as in primary immunodeficiency syndrome, women with solid organ transplantation or hematopoietic progenitor cells, MSMs and individuals who practice prostitution. Also in HIV-infected patients (boys and girls, men and women aged up to 26) and women who have received excision of the cervix.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a> However, the Spanish Vaccinology Association states that, although eligible individuals according to technical specifications could be vaccinated, they only recommend vaccination in women, since it has been shown to be more effective from the point of view of Public Health, and men would be indirectly favored.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a> Nonetheless, in some European countries such as Germany, where this has been analyzed, this advantage has not been detected in men, in part due to the low vaccination rate in girls (40%). This is why the German vaccination program does not distinguish between sexes when recommending the HPV vaccine in boys and girls aged 9–14.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> However, in Australia, where a very thorough vaccination program has been carried out in women aged ≤25 with a high compliance rate, it has been verified that heterosexual men aged 16–35 had a 78% lower prevalence of the 4 genotypes of the vaccine.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a> The difference between the two studies is related to the degree of coverage and compliance by women. Thus, in countries such as Australia, where female vaccination is high, only vaccination in girls seems to be cost-effective, but this type of analysis rarely includes MSMs, who benefit little or not at all from female vaccination.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Recently, a vaccine against 9 HPV genotypes has been authorized, the nonavalent vaccine (6/11/16/18/31/33/45/52/58), which provides a high and ongoing protection against infection and diseases related to these genotypes. In Spain it is estimated that there are approximately 68,900 cases of HPV-associated disease related to genotypes 6, 11, 16 and 18, and 82,000 related to all of the 9 types. Translated into costs, the 9 genotypes cost about 151 million euros per year, 34 of them being due to the treatment of diseases caused by the 5 additional genotypes (31, 33, 45, 52, 58) included in the new vaccine.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Regarding the action to be taken on the recommendation of the nonavalent vaccine in girls who have previously received a tetravalent vaccine, some studies do not consider this is a cost-effective approach.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> It has also been analyzed if the administration of this vaccine in men and women aged 22 to 26 turns out to be cost-effective and the result is negative in the case of men, this might be due to the fact that in said model the vaccine protection against reinfection was not included into the analysis and there was not a specific model for MSMs.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">There is no doubt that great advances have been obtained in the knowledge about HPV and its infective and oncogenic potential on the mucous membranes of men and women, as well as in the prevention of said infection and, therefore, in reducing the associated disease through vaccination. This vaccine has been improved over a decade, including new genotypes and new indications based on sex and signs and symptoms, proving to be cost-effective in girls and women up to 26 years of age. The new cost-effectiveness and cost-utility analysis should include in their models other types of patients, such as MSMs, where this benefit has not been proved yet. Finally, we should not forget that access to the healthcare system should comply with the key principles of equity and equality. The papilloma vaccine is one more example, it should be provided to men and women who have the same right to be protected against the papilloma virus, focusing on children, normalizing vaccination in preadolescents, reducing social and sexual inequalities, and protecting both women and men from unvaccinated women and men, and the most vulnerable population.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Hidalgo Tenorio C. Vacuna del papilomavirus para mujeres y ¿para hombres? Med Clin (Barc). 2019;152:264–265.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0100" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estimates of the incidence and prevalence of sexually transmitted diseases in the United States" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "American Social Health Association Panel" "etal" => false "autores" => array:1 [ 0 => "W.T. 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