Challenges of implementing human papillomavirus (HPV) vaccination policy

Raffle, Angela E.

doi:10.1136/bmj.39273.458322.be

Cited by 54 publications

(31 citation statements)

References 17 publications

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“…Currently, both HPV vaccines have been approved by the US Food and Drug Administration as well as by the European Union. To date, several European countries have already introduced vaccination programs to girls aged 11 to 12 years [45]. Clinical trials have shown that the quadrivalent vaccine is highly immunogenic, safe, well tolerated in females 9 through 26 years of age, and its efficacy remains high for at least 5 years following vaccination [6].…”

Section: Hpv Vaccination In Childhoodmentioning

confidence: 99%

Human papilloma virus (HPV) infection in children and adolescents

2008

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Human papilloma viruses (HPV) are common pathogens associated with a wide range of cutaneous and mucosal infections in childhood. Different HPV types can cause common warts, genital warts, low-grade as well as high-grade squamous intraepithelial lesions. Anogenital warts represent an issue with legal and clinical implications and evaluation of children for the possibility of sexual abuse should be considered in all cases. Recurrent respiratory papillomatosis has also been associated with HPV infection in a variety of studies. The recently introduced HPV vaccination is expected to prevent HPV-related cervical cancer in adulthood; however, HPV infection will continue to affect children.

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Section: Hpv Vaccination In Childhoodmentioning

confidence: 99%

Human papilloma virus (HPV) infection in children and adolescents

2008

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“…More recently, mathematical models are exploring alternative strategies that combine the power of vaccination to simplified screening schemes towards strategies that are sustainable in their context (Garnett et al, 2006;Raffle, 2007).…”

Section: Sustainable Screening and The Political Acceptabilitymentioning

confidence: 99%

HPV and cervical cancer: screening or vaccination?

2008

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Following the demonstration of the superior validity of human papillomavirus (HPV) tests in screening for cervical cancer and the arrival of highly efficacious HPV 16 and 18 vaccines, cervical cancer prevention enters a time of sustainable introduction in developing countries. Multidisciplinary efforts and novel protocols are being developed, and challenging situations are being faced to make cervical cancer, still the number two cancer in women worldwide, an eradicable condition. The provocative title proposed by the editors of the British Journal of Cancer could have at first sight, a quick and intuitive answer: we will need both. We need human papillomavirus (HPV) vaccines to significantly reduce the health care burden currently required for cervical cancer prevention, and we need screening because of the limitations of current HPV vaccines both in their lack of therapeutic effect (thus not protecting women with an ongoing neoplastic processes) and in their limited number of HPV types (thus leaving to evolve some 25 -30% of cervical cancer cases related to HPV types other than 16 or 18). However, the answer only applies in scenarios in which screening is already developed and reasonably efficient. In populations without adequate screening, one could equally argue that HPV vaccines at affordable prices are the only realistic option. While these arrive, more efficient screening schemes, for example with low-cost HPV tests, requiring fewer visits or strategies involving rapid intervention like 'screen and treat' protocols, remain the only option for currently living adult women. Moreover, should polyvalent vaccines (including some five -eight HPV types) result in extending protection against more than 90% þ of the oncogenic HPV types, vaccination alone would be the answer for both scenarios. Thus, a complex answer to an apparent straightforward question. PHASE III HPV VACCINATION TRIALSWith the publication of the key short-term results of the two major Phase III trials of HPV vaccines, the perspective of tackling cervical cancer prevention with vaccination has been unambiguously open. While recognising the limitations of the still moderate (5 -6 years) follow-up in a few tens of thousand young women, two vaccines to date have shown high efficacy, safety, immunogenicity, long-term duration of protection and a strong suggestions of induction of immune memory (Harper et al, 2006;Garland et al, 2007;Paavonen et al, 2007; The Future II Study Group, 2007).A number of clinically relevant issues remain to be fully described, including the magnitude and the HPV spectrum included in the cross protection effect, and the long-term effects of each of the HPV vaccines on cancer protection and safety. However, to solve these questions, it is unavoidable to continue the studies for additional follow-up time and the organisation of large Phase IV studies, some of which are already in place.The currently available vaccines offer full protection to HPV 16-and 18-naïve women for these two HPV types that cause an estimated 70% of ce...

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“…5,6 Delivering HPV vaccine to young adolescent girls may therefore require a different kind of health programming. 4,7 The Uganda Ministry of Health, in collaboration with PATH, an international non-profit organization, carried out an HPV vaccination demonstration project using existing human resources, structures, and systems of the Expanded Programme on Immunization (EPI) from 2008 to 2009 to explore the feasibil-ity of two HPV vaccine delivery strategies: 1) a standalone school-based strategy that selected girls based on their enrolment in primary grade 5 (P.5) (known as the "grade-based" strategy); and 2) a strategy that combined delivery of HPV vaccine for girls selected based on their age (10-year-olds) with the distribution of deworming medication and vitamin A through the existing Child Days Plus (CDP) program (called the "agebased" strategy). 8 The entire HPV vaccine demonstration project evaluated the coverage achieved by the strategies, acceptability of HPV vaccine by parents and eligible girls, feasibility of delivery within the existing EPI program, and the incremental economic and financial costs of implementation.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of delivering HPV vaccine to girls aged 10 to 15 years in Uganda

Mugisha¹,

LaMontagne²,

Ar³

et al. 2015

Afr H. Sci.

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Background: Cervical cancer is a leading cause of mortality among women in Uganda. The availability of the human papillomavirus (HPV) vaccine presents an opportunity to prevent cervical cancer. The Government of Uganda conducted a demonstration project exploring the feasibility of two delivery strategies. Objective: To explore the feasibility of two HPV vaccine delivery strategies: 1) a stand-alone school-based strategy that selected girls based on their enrolment in grade 5 (known as the "grade-based" strategy; and 2) an age-based strategy that delivered the HPV vaccine based on the girls' age (10-year-olds). This strategy combined the delivery of the vaccine with the distribution of deworming medication and vitamin A through an existing Child Days Plus program. Methods: A qualitative study that explored the feasibility of the two delivery strategies from the perspective of health workers, district leaders, and staff of the Uganda National Expanded Programme on Immunization, utilizing in-depth interviews and focus group discussions. Results: Coverage data showed that more girls (88%) were vaccinated using the grade-based strategy and completed all three doses compared to those (73%) vaccinated using the age-based strategy. Health workers and teachers indicated that determining vaccination eligibility was easier by grade than by age and there were minor disruptions to health services and school programs during vaccinations, as reported by health workers and teachers using the grade-based strategy. Conclusion: HPV vaccine delivery at schools using grade eligibility was more feasible than selecting girls by age. Lessons learned in Uganda could be relevant for countries considering implementing HPV vaccinations.

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Challenges of implementing human papillomavirus (HPV) vaccination policy

Cited by 54 publications

References 17 publications

Human papilloma virus (HPV) infection in children and adolescents

Human papilloma virus (HPV) infection in children and adolescents

HPV and cervical cancer: screening or vaccination?

Feasibility of delivering HPV vaccine to girls aged 10 to 15 years in Uganda

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