Particular strains of Human Papillomavirus (HPV), such as high-risk types can cause changes in cell DNA, leading to various cancers. Consequently, protecting against HPV infections, through vaccination is critical and can reduce the risk of HPV related cancer development (1). The HPV vaccine is safe and effective, and is primarily used for young girls, but is also recommended for boys aged 12-13 (1,2).
HPV infections affect the skin and/or lining of cells inside the body. In most people, the infection causes no harm, and disappears naturally overtime. However, HPV strains such as HPV16 and 18 are known to be a major cause of cervical cancer in women. A high percentage of penile and anal cancers have also been linked to HPV16 (3). In certain high-risk groups, such as men who have sex with men (MSM) as well as HIV-positive individuals, an even higher prevalence of anal infections are related to HPV (4).
Vaccines are one of the most effective ways to prevent disease, and work by training the body’s immune system to fight an infection. The benefits of HPV vaccination for women in cervical cancer prevention is well-researched. National HPV vaccination programs are implemented in many high-income countries since 2010 (5). Developing countries, such as Bhutan (2010) and Rwanda (2011) were also among the first countries in Asia and Africa respectively to roll-out HPV vaccination programs for school girls (5).
However, in several developing countries, HPV vaccines are still not widely available, and many women are unaware of their benefits (6). Therefore, vaccine impact studies that highlight the benefits and potential of vaccination on a population could help create more awareness and reach a wider group.
In this regard, urine, as a sample type offers an easy and simple approach. A lot of evidence shows that HPV DNA can be found in urine, in particular in first-void urine (first 20ml of urine flow) (7). Using this knowledge further, researchers carried out studies in Bhutan and Rwanda to monitor the effectiveness of HPV vaccination (5,8).
HPV urine surveys were conducted in both countries with around 1,000 girls. Participants self-collected a urine sample using Novosanis’ urine-capturing device, Colli-Pee®, suited to capture first-void urine. The results concluded that HPV presence in urine was associated with sexual activity. In both Bhutan and Rwanda HPV6/11/16/18 prevalence was lower in vaccinated than in unvaccinated participants (5), highlighting the importance of vaccination.
Despite the potential benefits, HPV vaccination in boys is currently only available in a few countries, including Australia, Canada, USA, UK, Austria and Belgium (1,9,10). While research is ongoing to understand the overall impact of extending HPV vaccination programs across all genders, it has the potential to reduce the burden of HPV as well as prevent many HPV-linked conditions, especially in high-risk groups (3,9).
1) Cancer Research UK - Does HPV cause cancer? - https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/infection...
2) CDC Features - HPV Vaccine is Cancer Prevention for Boys, Too! . USA: Centers for Disease Control and Prevention; 2018 December. Available from: https://www.cdc.gov/features/hpvvaccineboys/index.htm 3) Harder T, Wichmann O, Klug SJ, van der Sande MAB, Wiese-Posselt M. Efficacy, effectiveness and safety of vaccination against human papillomavirus in males: a systematic review. BMC Med. 2018 Jul 18;16(1):110. doi: 10.1186/s12916-018-1098-3. Review. PubMed PMID: 30016957; PubMed Central PMCID: PMC6050686.
4) Human papillomavirus vaccines: WHO position paper, May 2017. Wkly Epidemiol Rec. 2017 May 12;92(19):241-68. PubMed PMID: 28530369.
5) Franceschi S, Chantal Umulisa M, Tshomo U, Gheit T, Baussano I, Tenet V, Tshokey T, Gatera M, Ngabo F, Van Damme P, et al. Urine testing to monitor the impact of HPV vaccination in Bhutan and Rwanda. Int J Cancer. 2016 Aug 1;139(3):518-26. doi: 10.1002/ijc.30092. Epub 2016 Apr 15. PubMed PMID: 26991686.
6) Graham JE, Mishra A. Global challenges of implementing human papillomavirus vaccines. Int J Equity Health. 2011 Jun 30;10:27. doi: 10.1186/1475-9276-10-27. PubMed PMID: 21718495; PubMed Central PMCID: PMC3143925.
7) Vorsters A, Van Keer S, Van Damme P. The use of urine in the follow-up of HPV vaccine trials. Hum Vaccin Immunother. 2015;11(2):350-2. doi: 10.4161/21645515.2014.995058. PubMed PMID: 25664398; PubMed Central PMCID: PMC4514373.
8) Franceschi S, Clifford GM, Baussano I. Options for design of real-world impact studies of single-dose vaccine schedules. Vaccine. 2018 Aug 6;36(32 Pt A):4816-4822. doi: 10.1016/j.vaccine.2018.02.002. Epub 2018 Mar 21. PubMed PMID: 29571973; PubMed Central PMCID: PMC6066174.
9) Green A. HPV vaccine to be offered to boys in England. Lancet. 2018 Aug 4;392(10145):374. doi: 10.1016/S0140-6736(18)31728-8. Epub 2018 Aug 2. PubMed PMID: 30152370.
10) Vaccinatie tegen HPV- https://www.zorg-en-gezondheid.be/vaccinatie-tegen-hpv