Current global status & impact of human papillomavirus vaccination: Implications for India

Abstract

This review addresses the effectiveness and safety of human papillomavirus (HPV) vaccines, the current status of its introduction in the National Immunization Programmes (NIPs) and its relevance to India, which contributes a fifth of the global burden of cervical cancer. The vast literature on efficacy, acceptability and safety of HPV vaccination and its impact after population level introduction was reviewed and discussed. The efficacy of HPV vaccines in preventing high-grade precancerous lesions caused by vaccine-targeted HPV infections was 90 per cent or higher in HPV naïve women in randomized clinical trials. Two doses at 6 or 12 months apart are recommended for 9-14 yr old girls and three doses over six months to one year period for those aged above 15 yr. More than 80 countries or territories have introduced HPV vaccination in their NIPs, of which 33 are low- and middle-income countries (LMICs); in addition, 25 LMICs have introduced pilot programmes before a phased national expansion. Significant reductions in the frequency of HPV 16 and 18 infections, genital warts and cervical premalignant lesions in vaccinated cohorts and herd immunity in general populations have been reported from countries that introduced vaccination in NIPs as early as 2007. More than 280 million doses of HPV vaccines have been administered worldwide with the excellent safety profile with no serious adverse events linked to it. The high burden of cervical cancer and the high efficacy and safety of HPV vaccination justify its introduction in the Indian NIP at the earliest possibility to substantially reduce the cervical cancer burden in future.

Management algorithms for cervical cancer screening and precancer treatment for resource‐limited settings

“…An additional future consideration for screening and management is the advent of highly effective HPV vaccines, first against HPV 16 and 18, and now against additional high‐risk types. Over a relatively short period, more than 80 countries or territories have introduced HPV vaccination into their national immunization programs, and 33 of these are LMICs, with many more implementing pilot projects . The impact of large‐scale HPV vaccination will be an eventual drastic reduction in the prevalence of disease, accompanied by a decline in both sensitivity and positive predictive value of cytology and VIA .…”

“…Over a relatively short period, more than 80 countries or territories have introduced HPV vaccination into their national immunization programs, and 33 of these are LMICs, with many more implementing pilot projects. 51 The impact of large-scale HPV vaccination will be an eventual drastic reduction in the prevalence of disease, accompanied by a decline in both sensitivity and positive predictive value of cytology and VIA. 52 Furthermore, the early vaccines targeted just HPV 16 and 18, and the high-grade premalignant lesions caused by other oncogenic HPV types may have a more indolent natural history and may require a different management approach.…”

Global human papilloma virus vaccine implementation: An update

“…Panama became the first Latin American country to implement the HPV vaccine in October 2008, the same year Sir Harald Zur Hausen received the Nobel Prize for his research on the causal association of HPV in cervical cancers . Presently, in the Latin American regions, 80% of girls aged 9–13 years have access to HPV vaccination through NIP . HPV vaccination was introduced in Africa when Rwanda implemented the vaccine in 2010 .…”

“…The success of HPV vaccine implementation was credited to widespread community awareness prior to national introduction and a high level of political commitment . Currently, countries such as Brazil, Mexico, Malaysia and South Africa follow a two‐dose HPV vaccination schedule …”

HPV vaccine knowledge and coverage among female students in a medical college, Kerala

“…HPV vaccines claim about 99% seroconversion rates. 5 With more than 270 million doses administered globally, HPV vaccine appears to have excellent safety record. There have been no serious adverse events reported from any part of the world.…”