Abstract
  1. In 2008 following a detailed review of the cost-effectiveness and impact of human papillomavirus (HPV) vaccination in adolescents, JCVI recommended a universal programme of HPV vaccination in girls aged 12-13 years of age in schools, along with a catch up programme for girls 13 to under 18 years of age.1
  2. JCVI has kept the HPV vaccination programme under review, and since introduction of the adolescent girls programme evidence has emerged that HPV immunisation is likely to provide protection against a wider range of HPV-related diseases, including anal, penile and oropharyngeal cancers. In response to this new data JCVI identified concerns that men who have sex with men (MSM) are a group at high risk of HPV infection and associated disease who receive very little indirect health benefit from the current HPV vaccination programme.2
  3. The majority of evidence on the sexual behaviours, incidence and risk of infection in MSM is limited to those MSM who attend genitourinary medicine (GUM) and HIV services. GUM and HIV clinics are however the most accessed sexual healthcare service by self-declaring MSM. MSM accessing GUM services are known to be a high-risk group within the MSM population in terms of risk behaviour and STI transmission and JCVI considered it reasonable to undertake analysis on the costeffectiveness of vaccinating this sub-population of MSM.
  4. After considering modelling work from Public Health England (PHE) on the impact and cost-effectiveness of a programme to vaccinate MSM who attend GUM and HIV clinics JCVI issued interim advice for consultation. Following review of the consultation responses, and peer review comments, the Committee agreed to a number of updates to the modelling and cost-effectiveness analysis, and changes to the age ranges being considered.
  5. JCVI has now considered the revised analysis, which indicates that it is highly likely a programme to vaccinate MSM up to 40 years of age attending GUM and HIV clinics would be cost-effective, as long as the vaccine is procured, and the programme is delivered at a cost-effective price. JCVI considers it reasonable to extrapolate the findings to those MSM aged 45 years, although there is too much uncertainty in the data to extrapolate further. JCVI also agrees that there should no longer be a lower age limit, previously set at 16 years of age.
  6. JCVI recognises the complexities associated with commissioning and delivery of a programme involving GUM and HIV services, and that other providers such as GPs, may wish to offer the vaccine opportunistically. As access to GUM services may vary geographically, restricting a service solely to GUM and HIV clinics also introduces potential for concern around equity of access.
  7. Any analysis undertaken can only be based on the available evidence, which in this instance is on the impact and cost-effectiveness of vaccinating the GUM/HIV clinicattending MSM population. JCVI is offering advice on the basis of that evidence, however the advice provided does not preclude delivery through other providers and JCVI believes there is potentially scope for this.
  8. On the basis of the evidence considered, JCVI advises that a targeted HPV vaccination programme with a course of three doses for MSM aged up to 45 who attend GUM and HIV clinics should be undertaken, subject to procurement of the vaccine and delivery of the programme at a cost-effective price.
  9. JCVI considers that there may be considerable benefit in offering the HPV vaccine to other individuals who have a similar risk profile to that seen in the 16 to 40 year old GUM attending MSM population, including some MSM over 45, sex workers, HIV+ve women, and HIV+ve men. Clinicians are able to offer vaccinations outside of the national programme using individual clinical judgement, and HPV vaccination could therefore be considered for such individuals on a case-by-case basis. Following the meeting, the Department of Health has agreed to consider this from a national perspective alongside the advice of the Committee on the vaccination of MSM up to 45 years of age who attend GUM and HIV services, and will report back to the Committee at a future date
  • Recommendation
  • Europe
  • United Kingdom
  • Human papillomavirus (HPV)