In Europe, recommended HPV vaccination programmes vary by country. All EU /EEA have introduced HPV vaccination into national vaccination programs and many countries have moved or are about to move from a strategy to vaccinate girls to a one-size-fits-all strategy for girls and boys as well [1].
The most common programs are as follows:
Program with two doses: This program involves the administration of two doses of HPV vaccine every 6-12 months. The European Medicines Agency (EMA) has approved a two-dose programme for girls and boys aged 9 to 14 years.
Program with three doses: This program involves the administration of three doses of the HPV vaccine. The first dose is followed by a second dose 1-2 months later, and the third dose is administered 6-12 months after the first dose. This program is recommended for girls and boys aged between 15-26 years.
Catch-up Schedule: This program is dedicated to people who did not receive the HPV vaccine during the routine vaccination program. The alternative scheme may involve the administration of two or three doses of the HPV vaccine, depending on the age of the individual.
The HPV vaccine is recommended for both girls and boys in Europe. The age range for routine HPV vaccination varies by country but generally falls between 9-14 years for girls and 11-14 years for boys. Vaccination by recovery is usually recommended up to the age of 26 for both girls and boys.
Multiple HPV vaccines are available. The bivalent vaccine covers HPV types 16 and 18, the quadrivalent vaccine covers HPV types 6, 11, 16, and 18, and the nonavalent vaccine covers HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. The nonavalent vaccine is the most comprehensive and offers protection against a broader range of HPV types.
While the primary goal of the HPV vaccination programs was the prevention of cervical cancer, the vaccine also prevents other cancers and conditions caused by HPV.
Updated WHO recommendations on HPV vaccination
In a new position paper published in December 2022, WHO updated the recommendations for vaccination against human papillomavirus (HPV). Notably noteworthy, the paper states that a single-dose vaccination program, referred to as an alternative, off-label in the single dose program can provide comparable efficacy and protective durability at a two-dose regimen [2] The recommendation for single dose alternative programming was initially made by the WHO's independent expert advisory group, SAGE, in April 2022.
The position paper is important in the context of a significant decrease in vaccine coverage against HPV globally. Between 2019 and 2021, coverage of the first dose of HPV vaccination decreased by 25% to 15%. This means that an additional 3.5 million girls missed out on the HPV vaccination in 2021 compared to 2019.
Optimising the HPV programme is expected to improve access to the vaccine, giving countries the opportunity to expand the number of girls who can be vaccinated and alleviating the burden of the often complicated and costly monitoring required to complete the vaccination series. It is vital that countries strengthen their HPV vaccination programmes.
WHO recommends:
Given the extensive burden of HPV-related diseases globally, the vaccine has the potential to prevent a substantial number of cancers and improve global public health.
While screening can detect precancerous and cancerous changes, it requires regular intervals of testing and follow-up, and there's room for errors. On the other hand, vaccination offers more consistent protection against the most dangerous types of HPV.
Treating HPV-related conditions and diseases is costly, both in terms of direct medical costs and the broader socioeconomic impact (like loss of work). Preventing these diseases through vaccination can result in significant savings for healthcare systems worldwide.
With high vaccination coverage combined with effective cervical screening, there's potential to drastically reduce, and possibly eliminate, cervical cancer in the future.
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