Unmet needs in HPV vaccination strategies

There is an unmet need in the implementation of human papillomavirus (HPV) vaccination strategies, according to a recent study published in . Cancer medicine.

Globally, cervical cancer is the fourth most common cancer in women aged 15 to 44 years, with more than 75% of cases diagnosed at an advanced clinical stage. In 2020, the World Health Organization reported more than 600,000 new cases and more than 340,000 deaths from cervical cancer.

HPV16 and 18 infections are associated with more than half of high-grade cervical cancers. HPV is transmitted through sexual contact and often resolves on its own, but there is a significant risk that the infection can develop into chronic and precancerous lesions, which can lead to cervical cancer.

Vaccination is the most effective way to prevent HPV. To reduce the risk of cervical cancer, girls aged 9 to 14 years should receive a careful combination of widely available and affordable HPV vaccines.

Researchers conducted a review characterizing challenges, attitudes, and practices toward HPV vaccination, as well as related research gaps. Databases evaluated for literature on HPV vaccination since 2015 include Medlineplus, PubMed, and Embase.

Search terms used included “HPV” and “vaccination,” “HPV vaccination” and “vaccination strategy,” and “HPV vaccination” and “coverage.” Literature covered includes research articles, case reports, guidelines and recommendations from national health authorities, surveillance reports, and press releases from international health organizations.

Eligibility criteria included a description of HPV vaccination and cervical cancer prevention strategies, gray literature published in English and published between 2015 and 2023. Exclusion criteria included providing irrelevant information, not being peer-reviewed, and not having the full text available. Three researchers independently reviewed the articles and documents.

Thirty articles were included in the final analysis, which was conducted across 11 countries. The main outcomes of most of the included studies were knowledge, vaccination strategies, determinants, and challenges of HPV vaccination.

The global strategy to prevent cervical cancer aims to ensure that 90% of women are fully vaccinated with the HPV vaccine by the age of 15. The World Health Organization recommends national immunization programs that include the HPV vaccine, and several countries, including the United States, have adapted their programs to this recommendation.

Vaccines are often distributed in health care facilities, outreach efforts, or a combination of the two methods. High-income countries have implemented either school-based or facility-based approaches, while low-income countries often have a combination of these approaches.

Facility-based approaches include two-dose regimens delivered in health care facilities such as health centers or clinics. In the United States, this approach led to a 73% first-dose vaccination rate and 50% second-dose vaccination rate in 2022. Additional strategies to increase vaccination rates in the United States include regional campaigns and eliminating cost barriers.

School-based distribution involves administering vaccines to children in school settings, and vaccination rates in Brazil have been around 99%. A combination of this method and a facility-based approach was observed in Switzerland, with first vaccination coverage of 74% and final vaccination coverage of 71%. This success is believed to be due to easy and free access to vaccines, regulated supply and increased knowledge.

Facility-based strategies had coverage ratings above 70% for 36% of adopters, school-based strategies for 30%, and mixed strategies for 53%. Challenges to vaccination strategies include health system challenges, vaccine challenges, and individual challenges.

Distribution strategies need to be developed to effectively provide vaccination, and the internet and social media platforms should be considered to disseminate messages encouraging vaccination against HPV. To prevent dropouts, coverage needs to be broad and fair.

Additionally, supporting vaccines that provide better protection could further reduce HPV incidence. Do not unduly disseminate information about adverse events such as fever, nausea, headache, myalgia, pain, swelling, dizziness, erythema, pruritus, and bruising, as these events may increase vaccine hesitancy. That is important.

Available data indicate the effectiveness of single-dose vaccines in HPV prevention, but further research is needed. Additionally, new vaccinations should be developed to manage HPV subtypes, and if possible a child should be vaccinated at the age of 9 or 10.

This review demonstrated challenges in HPV vaccination that require interventions to improve vaccine uptake. The researchers concluded that, if implemented effectively, the intervention could lead to the introduction of effective approaches to achieve high vaccination rates.

reference

Aggarwal S, Agarwal P, Gupta N. A comprehensive narrative review of the challenges and drivers in the implementation of various HPV vaccination programs around the world. cancer treatment. 2023;00:1-14. doi:10.1002/cam4.6862