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Global human papilloma virus vaccine implementation: An update: HPV vaccine implementation
Abstract
Human papillomavirus (HPV) infections continue to be one of the most common sexually transmitted infections worldwide. The oncogenic potential of this virus was well established in anogenital malignancies and oropharyngeal cancers. Even though a fall in cervical cancer rates has been reported worldwide, the subsequent rise in HPV-associated head and neck cancers among men and women have been reported from developed countries, necessitating the vaccination of adolescent boys as well. The objective of this narrative review is to provide an update on the current status of HPV vaccination worldwide. This will be helpful for clinicians in counseling parents and guardians as this vaccine mainly targets sexually naïve preadolescents. An electronic search of the databases was carried out to retrieve information concerning HPV vaccine implementation between July 2006 and 2017, with special emphasis on the current viewpoints, controversies and ethical issues. Globally, 74 countries have implemented the HPV vaccine in the national immunization schedule, and this vaccine is listed as an essential medicine by WHO. About 60% of the low- and lower-middle-income countries have implemented the vaccine with financial assistance from Gavi and WHO. The HPV vaccine is a safe vaccine with no serious adverse effects as per the data available from developed nations as well as low/lower middle/upper middle-income countries. However, long-term follow-up is essential to substantiate the impact of the vaccination programs in cancer prevention.
... [5,[10][11][12] Few developing and Asian countries have also succeded in reducing the burden. [13,14] Hence, HPV vaccination policy, (4) HPV vaccination and men, and (5) HPV vaccination coverage. ...
... [26,41] States such as Punjab, Sikkim and Delhi have introduced the HPV vaccine to adolescent girls between the age of 9-13. [14,26,42,43] The Sikkim Government had self-financed the vaccine and used it as a preventive tool for cervical cancers. [42] Delhi Government has initiated an opportunistic HPV vaccination for adolescent girls at public health facilities. ...
... [48] High-income countries have significantly higher HPV vaccine coverage, with 32% of females aged 10-20 years receiving the full-dose vaccination by the year 2014. [14,49,51,52] On the other hand, only 1% of adolescent girls in low-income countries received a full course of HPV vaccinations; the majority of low-and middle-income countries are still unprotected. [49] Non-affordable prices of vaccination may hinder the uptake of HPV vaccination amongst poor socioeconomic status. ...
India contributes close to 20% of the global cervical cancer burden. This article reviews the preventive strategies against cervical cancer and suggest a few way forward for the prevention of cervical cancer in India. A literature review of online databases (Embase, Google Scholar, PubMed, Scopus) and reports from government websites regarding cervical cancer and HPV vaccination in India was conducted. Currently, four different HPV vaccines are available in India: a bivalent vaccine, a nonavalent vaccine and two quadrivalent vaccines. To reduce India’s cervical cancer burden, the National Technical Advisory Group on Immunization (NTAGI) has advocated the widespread implementation of HPV vaccination. An indigenous HPV vaccine was given market authorisation by the Drugs Controller General of India (DCGI) in July 2022. There is a need to raise awareness regarding the benefits of HPV vaccines in India. The introduction of indigenous HPV vaccine might enhance the supply logistics and may increase the uptake of the vaccine.
... strategies to expand genotype coverage, aiming to develop vaccines that protect against a broader range of HPV strains. Furthermore, efforts are being made to address barriers to vaccine access, particularly in resource-limited settings, to ensure equitable distribution and utilization of these life-saving vaccines(37). ...
Routine use of human papillomavirus (HPV) vaccines is recommended in adolescents under 15 years of age worldwide. Still, effective programs remain suboptimal for several factors, making the WHO strategy to eradicate cervical cancer public health with an uncertain future.
Objective
To review the literature on the effectiveness, long-term protection, and safety of HPV vaccination programs and vaccination as adjuvant management. This review aims to describe the current state of vaccination programs and demonstrate the long-term protection and safety of vaccines implemented worldwide targeting adolescent girls, with the most recent published evidence of the three prophylactic HPV vaccines – bivalent (bHPV), quadrivalent (qHPV), and nonavalent (nHPV)-. We mainly focus on publications evaluating efficacy, dosing schemes, and HPV vaccination, as well as studies contributing to the mounting evidence for the real-life effectiveness of prophylactic HPV vaccines from several countries.
Findings
Human Papillomavirus vaccination programs have made remarkable strides in preventing HPV-related diseases; countries with robust vaccination efforts have witnessed substantial reductions in HPV-related diseases with a decline in high-grade cervical abnormalities and genital warts (54%-83%). However, global coverage remains uneven, with disparities between high-income (HICs) and low-income countries (LMICs). The long-term efficacy of the available human papillomavirus (HPV) goes up to 9.4 years and continues to be immunogenic and well tolerated with an excellent safety profile.
Conclusions and relevance
As these are crucial topics in HPV vaccination, it is essential to establish systems for continued monitoring of vaccine immunogenicity, efficacy, and safety over time.
... Overall, in many regions, national HPV programs cover a low percentage of the global target population, and the dose coverage is low (26). In high-income countries, HPV coverage is more than 60%, such as Australia, Denmark, and Sweden, and about 32% of females aged 10 -20 years received the full-dose vaccination (27,28). Most low-income countries remain unprotected, and in low-income countries, less than 2% of adolescent girls receive a full course of the HPV vaccine (26). ...
Context: Human papillomavirus (HPV) infections contribute to the cause of 15% - 20% of all human cancers. This review aims to examine and provide updated information on various aspects, with a particular focus on topics that are of interest to dermatologists. Evidence Acquisition: Using published studies, the pathogenicity of HPV was investigated. Subsequently, the existing vaccines were explored, followed by a review of the loop-mediated isothermal amplification-lateral flow dipstick (LAMP-LFD) method. Results: For HPV detection, the polymerase chain reaction (PCR), self-sustained sequence replication (3SR), strand displacement amplification (SDA), and nucleic acid sequence-based amplification (NASBA) were used. These methods can have good detection but still have problems. In comparison with nested PCR, the detection of HPV16 and HPV18 using LAMP-LFD has higher sensitivity. Conclusions: Loop-mediated isothermal amplification-lateral flow dipstick is a simple and rapid method for the specific and sensitive detection of HPV. Thus, along with the previous HPV16 and HPV18 diagnostic tools, LAMP-LFD might be useful in field studies or local hospitals.
... Otro de los factores que intervienen en la prevención son las creencias sobre el CCU y las medidas de prevención. Estas desempeñan un papel determinante en que lleven a cabo detección oportuna y la aceptación de las vacuna contra el VPH (Smith y col., 2017), por ejemplo la creencia de que la vacuna contra el VPH es eficaz para prevenir el cáncer cervicouterino ha demostrado tener una influencia positiva en la aplicación de la vacuna contra el VPH (Sabeena, 2018). También, se tiene la creencia que las jóvenes no son susceptibles a desarrollar CCU (Rimandel-Joel, 2019), que la detección no es necesaria por la ausencia de síntomas y la creencia de que la prueba es innecesaria (Kirubarajan y col., 2021; Olaza-Maguiña y col., 2019). ...
Introducción: El cáncer cervicouterino es un problema de salud pública debido a su incidencia y mortalidad a nivel mundial. Su prevención debe realizarse en etapas tempranas debido a que es probable que las jóvenes se infecten con el virus del papiloma humano, factor principal para el desarrollo de este cáncer. Aunado a lo anterior los profesionales de enfermería tienen un papel fundamental en su prevención para disminuir factores que interfieren en esta. El objetivo de este artículo es reunir la literatura sobre la prevención, factores que intervienen en la prevención del cáncer cervicouterino en jóvenes y el rol que el profesional de enfermería tiene para su prevención. Desarrollo: Existen programas destinados para la prevención del cáncer cervicouterino los cuales son para mujeres adultas, la prevención para las jóvenes se enfoca principalmente en la detección oportuna, uso de condón, así como la vacunación contra el virus del papiloma humano la cual puede aplicarse a mujeres jóvenes, principalmente en el sector privado. En su prevención la falta de conocimiento que las jóvenes tienen, las creencias, las actitudes, aspectos económicos y del sistema de salud son factores que intervienen en que las jóvenes lleven a cabo su prevención. Los profesionales de enfermería tienen un papel importante en la educación para la salud sexual de los jóvenes, prevención del virus del papiloma humano, la detección oportuna del cáncer cervicouterino, aplicación de vacuna en la población blanco y en consulta. Conclusión: Es importante que las jóvenes lleven a cabo las medidas de prevención para el cáncer cervicouterino, para lograr esto los profesionales de enfermería deberán llevar acabo intervenciones independientes e interdependientes y desarrollar estrategias que le permita innovar su rol como educador en la prevención.
... Otro de los factores que intervienen en la prevención son las creencias sobre el CCU y las medidas de prevención. Estas desempeñan un papel determinante en que lleven a cabo detección oportuna y la aceptación de las vacuna contra el VPH (Smith y col., 2017), por ejemplo la creencia de que la vacuna contra el VPH es eficaz para prevenir el cáncer cervicouterino ha demostrado tener una influencia positiva en la aplicación de la vacuna contra el VPH (Sabeena, 2018). También, se tiene la creencia que las jóvenes no son susceptibles a desarrollar CCU (Rimandel-Joel, 2019), que la detección no es necesaria por la ausencia de síntomas y la creencia de que la prueba es innecesaria (Kirubarajan y col., 2021; Olaza-Maguiña y col., 2019). ...
Introducción: El cáncer cervicouterino es un problema de salud pública debido a su incidencia y mortalidad a nivel mundial. Su prevención debe realizarse en etapas tempranas debido a que es probable que las jóvenes se infecten con el virus del papiloma humano, factor principal para el desarrollo de este cáncer. Aunado a lo anterior los profesionales de enfermería tienen un papel fundamental en su prevención para disminuir factores que interfieren en esta. El objetivo de este artículo es reunir la literatura sobre la prevención, factores que intervienen en la prevención del cáncer cervicouterino en jóvenes y el rol que el profesional de enfermería tiene para su prevención. Desarrollo: Existen programas destinados para la prevención del cáncer cervicouterino los cuales son para mujeres adultas, la prevención para las jóvenes se enfoca principalmente en la detección oportuna, uso de condón, así como la vacunación contra el virus del papiloma humano la cual puede aplicarse a mujeres jóvenes, principalmente en el sector privado. En su prevención la falta de conocimiento que las jóvenes tienen, las creencias, las actitudes, aspectos económicos y del sistema de salud son factores que intervienen en que las jóvenes lleven a cabo su prevención. Los profesionales de enfermería tienen un papel importante en la educación para la salud sexual de los jóvenes, prevención del virus del papiloma humano, la detección oportuna del cáncer cervicouterino, aplicación de vacuna en la población blanco y en consulta. Conclusión: Es importante que las jóvenes lleven a cabo las medidas de prevención para el cáncer cervicouterino, para lograr esto los profesionales de enfermería deberán llevar acabo intervenciones independientes e interdependientes y desarrollar estrategias que le permita innovar su rol como educador en la prevención.
... Foreign-born college students with more than ten years length of living in the U.S. had a higher HPV vaccination rate compared with those with ten years or less length of living, and it is consistent with another study [35]. This finding might be explained by the fact that as the U.S. was one of the first countries that provided the HPV vaccine in 2006, foreign-born college students with more than ten years length of living in the U.S. have been exposed to the knowledge related to HPV and the HPV vaccine through public health campaigns on television, the internet, and in printed materials at a younger age that increased their HPV vaccination rate [36]. ...
Objective:
to measure the HPV vaccination rate and knowledge about HPV and its vaccine among foreign-born college students; additionally, to measure the effect of acculturation and HBM constructs on the HPV vaccination behavior among foreign-born college students.
Methods:
a cross-sectional design with a non-probability sample of foreign-born college students was collected via a web-based self-administered survey that measured the HPV vaccination rate, assessed knowledge about HPV and its vaccine, and evaluated the effect of acculturation and HBM constructs on HPV vaccination behavior among foreign-born college students.
Results:
Foreign-born college students had moderate knowledge about HPV and the HPV vaccine, and about 63% were HPV-vaccinated. Perceived susceptibility, perceived barriers, and cues to action were significantly associated with the HPV vaccination behavior, while knowledge levels about HPV and the HPV vaccine and acculturation levels were not significantly associated with the HPV vaccination behavior of foreign-born college students.
Conclusions:
The current study shows a moderate vaccination rate and moderate knowledge about HPV and its vaccine among foreign-born college students. Additionally, vaccination campaigns need to increase awareness about the susceptibility to acquiring HPV and minimize the barriers to receiving the vaccine to increase the HPV vaccination rate among foreign-born college students.
Over the years, the pace of developing vaccines for HBV and HPV has never stopped. After more than 30 years of application, the HBV vaccine has reduced 80% of hepatocellular carcinoma (HCC). However, vaccine escape variants occur under selective pressure induced by widespread vaccination and antiviral therapy, which results in fulminant infection and horizontal transmission. Several mechanisms have been studied to explain HBV vaccine escape, including vaccine escape mutations (VEMs) in the major hydrophilic region, which leads to a decrease in the binding ability to neutralize antibodies and is the primary escape mechanism, protein conformational and N‐linked glycosylation sites changes caused by VEMs, differences in genotype distribution, gene recombination, and some temporarily unknown reasons. However, effective solutions are still being explored. The HPV vaccine has also been proven to prevent 70%–90% of cervical cancer worldwide. Cases of HPV infection after being vaccinated have been observed in clinical practice. However, few researchers have paid attention to the mechanism of HPV vaccine escape. Thus, we reviewed the literature on vaccine escape of both HBV and HPV to discuss the mechanism of the virus escaping from vaccine protection and possible solutions to this problem. We analyzed the gap between studies of HPV and HBV and made prospects for further research in HPV vaccine escape.
Human papillomavirus (HPV) contributes to sexually transmitted infection, which is primarily associated with pre-cancerous and cancerous lesions in both men and women and is among the neglected cancerous infections in the world. At global level, two-, four-, and nine-valent pure L1 protein encompassed vaccines in targeting high-risk HPV strains using recombinant DNA technology are available. Therapeutic vaccines are produced by early and late oncoproteins that impart superior cell immunity to preventive vaccines that are under investigation. In the current review, we have not only discussed the clinical significance and importance of both preventive and therapeutic vaccines but also highlighted their dosage and mode of administration. This review is novel in its way and will pave the way for researchers to address the challenges posed by HPV-based vaccines at the present time.
Objective:
To estimate the health impact, financial costs, and cost-effectiveness of scaling-up coverage of human papillomavirus (HPV) vaccination (young girls) and cervical cancer screening (women of screening age) for women in countries that will likely need donor assistance.
Methods:
We used a model-based approach to synthesize population, demographic, and epidemiological data from 50 low- and lower-middle-income countries. Models were used to project the costs (US $), lifetime health impact (cervical cancer cases, deaths averted), and cost-effectiveness (US $ per disability adjusted life year [DALY] averted) of: (1) two-dose HPV-16/18 vaccination of girls aged 10 years; (2) once-in-a-lifetime screening, with treatment when needed, of women aged 35 years with either HPV DNA testing or visual inspection with acetic acid (VIA); and (3) cervical cancer treatment over a 10-year roll-out.
Results:
We estimated that both HPV vaccination and screening would be very cost-effective, and a comprehensive program could avert 5.2 million cases, 3.7 million deaths, and 22.0 million DALYs over the lifetimes of the intervention cohorts for a total 10-year program cost of US $3.2 billion.
Conclusion:
Investment in HPV vaccination of young girls and cervical cancer screen-and-treat programs in low- and lower-middle-income countries could avert a substantial burden of disease while providing good value for public health dollars.
The past 10 years have seen remarkable progress in the global scale-up of human papillomavirus (HPV) vaccinations. Forty-three low- and lower-middle-income countries (LLMICs) have gained experience in delivering this vaccine to young adolescent girls through pilot programs, demonstration programs, and national introductions and most of these have occurred in the last 4 years. The experience of Senegal is summarized as an illustrative country case study. Publication of numerous delivery experiences and lessons learned has demonstrated the acceptability and feasibility of HPV vaccinations in LLMICs. Four areas require dedicated action to overcome remaining challenges to national scaling-up: maintaining momentum politically, planning successfully, securing financing, and fostering sustainability. Advances in policy, programming, and science may help accelerate reaching 30 million girls in LLMICs with HPV vaccine by 2020.
In an essay, Paul Bloem and Ikechukwu Ogbuanu discuss the public health implications of HPV vaccination.
Purpose:
We sought to establish which human papillomavirus (HPV) vaccine communication approaches by pediatricians were associated with same-day HPV vaccination of 11- to 12-year-olds by evaluating audio recordings of visits.
Methods:
Verilogue, a market research company maintaining a panel of primary care pediatricians, provided audio recordings and transcriptions of well-child visits for 11- to 12-year-old patients from January through June 2013. Seventy-five transcripts from 19 pediatricians were coded for use of presumptive language (i.e., words conveying assumption of vaccine delivery), offer of delay, recommendation strength, and information provision. Using logistic regression, we evaluated the association between pediatrician communication approaches and agreement to same-day HPV vaccination. Generalized estimating equations accounted for clustering of patients within pediatricians.
Results:
Same-day agreement to HPV vaccination occurred in 29% of encounters. Pediatricians in the sample often provided parents with inconsistent, mixed messages and sometimes offered information about HPV or HPV vaccination that was inaccurate. Pediatricians used presumptive language in only 11 of 75 encounters; when used, presumptive language was associated with higher odds of accepting HPV vaccine (73% vs. 22%; odds ratio = 8.96; 95% confidence interval = 2.32-34.70). Pediatricians offered or recommended delay in most encounters (65%). HPV vaccine acceptance occurred far more often when pediatricians did not mention delaying vaccination (82% vs. 6%; odds ratio = 80.84; 95% confidence interval = 15.72-415.67). Same-day vaccination was not associated with strength of recommendation or pediatrician reference to vaccinating their own children.
Conclusions:
Our findings highlight the need to develop and evaluate physician-focused trainings on using presumptive language for same-day HPV vaccination.
Human papillomavirus (HPV) can cause a number of anogenital cancers (i.e., cervical, penile, anal, vaginal, vulvar) and genital warts. A decade ago, the HPV vaccine was approved, and has been shown to be a public health achievement that can reduce the morbidity and mortality for HPV-associated diseases. Yet, the mistaken over-identification of HPV as a female-specific disease has resulted in the feminization of HPV and HPV vaccines. In this critical review, we trace the evolution of the intersection of science, politics, economics and gender norms during the original HPV vaccine approval, marketing era, and implementation. Given the focus on cervical cancer screening, women were identified as bearing the burden of HPV infection and its related illnesses, and the group responsible for prevention. We also describe the consequences of the feminization of HPV, which has resulted primarily in reduced protection from HPV-related illnesses for males. We propose a multilevel approach to normalizing HPV vaccines as an important aspect of overall health for both genders. This process must engage multiple stakeholders, including providers, parents, patients, professional organizations, public health agencies, policymakers, researchers, and community-based organizations.
Objectives:
In England, uptake of human papillomavirus (HPV) vaccination to prevent HPV-related cancer is lower among girls from ethnic minority backgrounds. We aimed to explore the factors that prevented ethnic minority parents from vaccinating, compared to White British non-vaccinating parents and vaccinating ethnic minority parents.
Methods:
Interviews with 33 parents (n = 14 ethnic minority non-vaccinating, n = 10 White British non-vaccinating, n = 9 ethnic minority vaccinating) explored parents' reasons for giving or withholding consent for HPV vaccination. Data were analysed using Framework Analysis.
Results:
Concerns about the vaccine were raised by all non-vaccinating ethnic minority parents, and they wanted information to address these concerns. External and internal influences affected parents' decisions, as well as parents' perceptions that HPV could be prevented using means other than vaccination. Reasons were not always exclusive to non-vaccinating ethnic minority parents, although some were, including a preference for abstinence from sex before marriage. Only ethnic minority parents wanted information provided via workshops.
Conclusions:
Ethnic differences in HPV vaccination uptake may be partly explained by concerns that were only reported by parents from some ethnic groups. Interventions to improve uptake may need to tackle difficult topics like abstinence from sex before marriage, and use a targeted format.
Aim:
There is strong evidence to suggest vertical and horizontal modes of transmission of human papilloma virus (HPV), an established etiologic agent of cervical cancer. Infants, children, and adults can acquire both high-risk and low-risk infections by birth or by close contact even though HPV is mainly transmitted sexually. A thorough review of the literature was performed to assess the possible non-sexual modes of transmission of HPV.
Methods:
An electronic search of databases for review articles, cross-sectional studies, cohort studies, and case reports on non-sexual modes of transmission among sexually unexposed women and children was carried out using search terms such as "human papilloma virus, HPV, transmission, horizontal transmission, vertical transmission, and fomites". Articles published between 1983 and 2015 were retrieved.
Results:
Epidemiological and clinical data support various non-sexual modes of transmission especially at the time of birth and by close contact. Even though the role of fomites in the transmission of HPV is not well established, HPV-DNA positivity has been reported in transvaginal ultrasound probes and colposcopes after routine disinfection.
Conclusion:
Awareness needs to be spread among the public about alternate modes of transmission. For a proper understanding of the exact natural history of HPV infection acquired via the non-sexual route, long-term prospective studies need to be undertaken.
Human papillomavirus (HPV), a sexually transmitted DNA virus that can lead to cervical cancer, is the most common cancer among women in developing regions. More than 270,000 women die per year from cervical cancer globally, and 85% of those deaths occur in developing countries. In the past, many low- and middle-income countries (LMICs) have been unable to afford the implementation of HPV vaccination programmes, resulting in high cervical cancer mortality rates. Gavi, an organisation created to improve worldwide access to vaccines, undertook an initiative that had the goal of decreasing the price of an HPV vaccine to under $5 and increasing access for adolescent girl populations in LMICs. This was done through market shaping, co-financing and implementation support. This case study will present and evaluate Gavi's intervention by assessing targets, investigating cost-effectiveness and identifying strategic challenges.
Background:
Introduction of human papillomavirus (HPV) vaccination for adolescent girls is being considered in the Punjab state of India. However, evidence regarding cost-effectiveness is sought by policy makers when making this decision. The current study was undertaken to evaluate the incremental cost per quality-adjusted life-years (QALYs) gained with introduction of the HPV vaccine compared with a no-vaccination scenario.
Methods:
A static progression model, using a combination of decision tree and Markov models, was populated using epidemiological, cost, coverage, and effectiveness data to determine the cost-effectiveness of HPV vaccination. Using a societal perspective, lifetime costs and consequences (in terms of QALYs) among a cohort of 11-year-old adolescent girls in Punjab state were modeled in 2 alternate scenarios with and without vaccination. All costs and consequences were discounted at a rate of 3%.
Results:
Although immunizing 1 year's cohort of 11-year-old girls in Punjab state costs Indian National Rupees (INR) 135 million (US dollars [USD] 2.08 million and International dollars [Int$] 6.25 million) on an absolute basis, its net cost after accounting for treatment savings is INR 38 million (USD 0.58 million and Int$ 1.76 million). Incremental cost per QALY gained for HPV vaccination was found to be INR 73 (USD 1.12 and Int$ 3.38). Given all the data uncertainties, there is a 90% probability for the vaccination strategy to be cost-effective in Punjab state at a willingness-to-pay threshold of INR 10,000, which is less than one-tenth of the per capita gross domestic product.
Conclusions:
HPV vaccination appears to be a very cost-effective strategy for Punjab state, and is likely to be cost-effective for other Indian states. Cancer 2017. © 2017 American Cancer Society.
A 9-valent human papillomavirus (HPV 6/11/16/18/31/33/45/52/58) virus-like particle (VLP) vaccine (9vHPV) has been proven highly efficacious in preventing anogenital disease related with vaccine HPV types in a pivotal Phase III study in women aged 16 to 26 years. We report here the results of an open-label phase III study conducted to bridge the findings in women age 16 to 26 years to Japanese girls aged 9 to 15 years. All subjects (n = 100) received a 3-dose regimen of 9vHPV vaccine at day 1, month 2 and month 6. Anti-HPV serologic assays were performed at day 1, month 7, month 12, month 24 and month 30. At month 7 (4 weeks after dose 3), 100% of subjects seroconverted for each vaccine HPV type. Increases in geometric mean titers of anti-HPV 6/11/16/18/31/33/45/52/58 in girls were similar to those in Japanese women aged 16 to 26 years in the pivotal phase III study. Persistence of anti-HPV responses was observed through 2 years after dose 3. In addition, administration of 9vHPV vaccine was generally well tolerated in Japanese girls.