School-based HPV Vaccination: The Challenges in a Brazilian Initiative

Abstract

Objective The present study assesses the implementation and the impact after 2 years of a school-based human papillomavirus (HPV) vaccination program in a Brazilian city. Methods A prospective study assessing the implementation of the program, offering quadrivalent HPV vaccine in two annual doses to girls and boys aged from 9 to 10 years old. The program was started in the city of Indaiatuba, state of São Paulo, Brazil, in 2018, and had authorization from the National Immunization Program. The number of HPV vaccine first doses applied and the coverage in 2018 was calculated and compared to the year 2017. There were described events that have influenced the results. Results The program invited 4,878 children through schools (87.1% of the target population), and 7.5% refused vaccination. Several concurrent events required or competed for health professionals of the vaccination teams. The coverage of the first dose (between 9 and 10 years old) was 16.1% in 2017 and increased to 50.5% in 2018 (p < 0.0001). The first dose in all ages increased 78% in 2018 compared with 2017 (6,636/3,733). Competing demands over the program continued in 2019, and the first dose coverage dropped (26.9%). For 2020, a municipal law instituted school-based vaccination and the creation of dedicated teams for vaccination, and these strategies are waiting to be tested. Conclusion School-based annual HPV vaccination in children between 9 and 10 years old was feasible and increased vaccination coverage, regardless of gender, although the program was vulnerable to competing events.

HPV vaccination in Latin America: Coverage status, implementation challenges and strategies to overcome it

“…The vaccine was also made available at Barretos Cancer Hospital for the girls who could not be vaccinated on the day when the team visited the school ( 22 ). In the city of Indaiatuba, a school-based annual HPV vaccination in children between 9 and 10 years old proved itself feasible and increased vaccination coverage, regardless of gender, although the program was vulnerable to competing events ( 23 ). Another Brazilian study that interviewed 826 parents through an online questionnaire suggested that low coverage seemed to be due to challenges in vaccine delivery and HPV vaccination barriers at healthcare centers rather than to vaccine refusal.…”

Cobertura projetada para 2030: É hora de resgatar a vacina contra o HPV nas mulheres brasileiras?

“…Vacinação em escolas e campanhas educativas de incentivo, estratégias que foram bem-sucedidas na primeira dose da campanha de 2014, devem ser aplicadas novamente para manter alta adesão. (Bednarczyk et al, 2019;Teixeira et al, 2021).…”

Cervical cancer screening, treatment and prophylaxis in Brazil: Current and future perspectives for cervical cancer elimination

“…Coverage for the second dose followed the same socio-economic patterns, but with generalized lower percentages across the country compared to the first dose, as expected. In summary, a great impact of the social inequality across Brazil was seen on the spatial heterogeneity of the HPV vaccine coverage, urging for specific planning of strategies for each territory by state health authorities, including the expansion for a school-based program ( 23 , 24 ).…”