13 Based on mathematical models suggesting that male HPV4 vaccination programmes exceed cost-effectiveness thresholds, 14–16 many European countries do not include men in HPV vaccination programmes, as in the USA, Canada and Australia, 10, 17, 18 instead focusing on achieving expanded coverage among women to promote herd immunity. Nevertheless, substantial debate surrounds HPV4 vaccination programmes for men. 11 It has also demonstrated efficacy among MSM in preventing anal epithelial neoplasias that are precursors to anal cancer. HPV4 is over 90% effective in preventing a variety of types of HPV infection and genital warts in young men. 10 HPV4 is recommended for MSM through age 26 years. 10 In 2011 the US Advisory Committee on Immunisation Practices approved and recommended routine use of HPV4 for boys aged 11–21 years, with approval for administration up to age 26 years, in order to prevent genital warts and anal cancer. The quadrivalent HPV vaccine (HPV4 Gardasil) was licensed in the USA for men in 2009.
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