Should routine HPV vaccination programs include males 25-29 years? A systematic review and global meta-analysis

Area of Science:

• Public Health
• Vaccinology
• Epidemiology

Background:

• Males aged 25-29 years are key in human papillomavirus (HPV) transmission.
• Current vaccination programs often exclude this demographic due to cost and efficacy concerns.

Purpose of the Study:

• To synthesize evidence on the efficacy of the 4vHPV vaccine in males.
• To evaluate herd effects of HPV vaccination on unvaccinated males aged 25-29 years.
• To support the expansion of HPV vaccination to males aged 25-29 years.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials and observational studies (Jan 2007-Feb 2025).
• Searched PubMed, Embase, and Cochrane Library for studies on 4vHPV vaccine efficacy in males and herd effects on anogenital warts (AGW).
• Pooled relative risks (RRs) for HPV infection and AGW incidence using random-effects models.

Main Results:

• Direct 4vHPV vaccination reduced HPV infections in males aged 13-26 years (RR=0.35).
• Extrapolated benefits for males aged 25-29 years showed an absolute risk reduction of 22.75% (NNT=4).
• Female vaccination coverage (FVC) ≥50% led to a 37% reduction in AGW incidence in unvaccinated males aged 25-29 years (RR=0.63), with significant annual increases in protection.

Conclusions:

• Extending HPV vaccination to males aged 25-29 years provides individual and population benefits.
• Findings support revising age-restrictive policies to include this demographic in vaccination programs.
• This inclusion can aid global efforts to eliminate HPV-related diseases, especially with suboptimal female coverage.