Elsevier

Vaccine

Volume 26, Issue 51, 2 December 2008, Pages 6529-6541
Vaccine

Review
Country recommendations on the inclusion of HPV vaccines in national immunization programmes among high-income countries, June 2006–January 2008

https://doi.org/10.1016/j.vaccine.2008.08.067Get rights and content

Abstract

We analysed country recommendations and funding plans finalized through January 2008 for the inclusion of quadrivalent and bivalent human papillomavirus (HPV) vaccines in national immunization programmes. Fifteen industrialized countries have recommended HPV vaccine use based on careful review of scientific evidence and cost-effectiveness. There was a strong consensus among the guidelines regarding assessment of vaccine safety and efficacy, selection of primary target populations for vaccination, vaccine delivery strategies, and the need for vaccinated females to seek cervical cancer screening. The analysis informs ongoing discussions in several countries considering HPV vaccines for national immunization programmes and discussions at the World Health Organization about global recommendations for HPV vaccine use for national immunization programmes.

Section snippets

Background

Two vaccines to prevent human papillomavirus (HPV) infection have recently been licensed in many countries to provide protection against cervical cancer and cervical cancer precursors. The bivalent vaccine, Cervarix® (GSK), has been demonstrated, in a published interim analysis of a phase III clinical trial, to have efficacy of >90% against persistent infection with the most common high-risk, oncogenic HPV types 16 and 18 that cause about 70% of cervical cancer worldwide [1]. This vaccine has

Methods

We collected data from health ministry websites, government and corporate press releases, WHO documents and regional offices, national regulatory bodies (NRAs) and international vaccine experts from June 2006 (after HPV vaccines were first licensed) through January 2008. We restricted our analysis to formal country recommendations that had been finalized by national health authorities by January 2008.

All of the documents collected were reviewed by at least two of the authors. After this initial

Results

A total of 15 countries: 2 in North America, 12 in Western Europe, and Australia, had issued formal recommendations or delivery and finance plans about HPV vaccines by January 2008 (Table 1). All of these countries are wealthy and have well-developed health systems and national immunization policies or programmes. All of them have organized or opportunistic cervical cancer screening programs with moderate or high population coverage (above 50% of eligible women) and consequently, they have a

Summary

This analysis reveals a fairly strong consensus among recommendations in these 15 high-income countries regarding assessment of vaccine safety and efficacy, selection of primary target populations for vaccination, policies for vaccinating males, vaccine delivery/administration strategies, and guidelines for long-term monitoring. Most recommendations propose to rely on existing delivery and financing mechanisms, including school-based programs. Many countries emphasize the need for continued

Acknowledgements

We thank James Cheyne of PATH, and Nathalie Broutet, Caitlin Wetzel, Maria Mackroth, Neddy Mafunga, and Maggie Ndowa, World Health Organization, for assistance in identifying source documents.

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