Vaccines against human papillomavirus in low and middle income countries: a review of safety, immunogenicity and efficacy

Abstract

Currently, there is limited data on the immunogenicity and efficacy of human papillomavirus vaccines in Low and Middle income countries (LMIC). The review aims to summarize the current status from published HPV vaccine safety, immunogenicity and efficacy studies in low and middle income countries (LMIC). Electronic databases (PubMed/MEDLINE and HINARI) were searched for peer reviewed English language articles on HPV vaccination in LMIC that have so far been published from 1st January 2006 up to 30th January 2015. Eligible studies were included if they had used the bivalent (bHPV) or quadrivalent HPV (qHPV) vaccines in a LMIC and investigated safety, immunogenicity and/or efficacy. The main findings were extracted and summarized. A total of fourteen HPV vaccine studies assessing safety, Immunogenicity and efficacy of the bivalent or quadrivalent vaccines in LMIC were included. There are only ten published clinical trials where a LMIC has participated. There was no published study so far that assessed efficacy of the HPV vaccines in Sub-Saharan Africa. From these studies, vaccine induced immune response was comparable to that from results of HICs for all age groups. Studies assessing HPV vaccine efficacy of the bivalent or quadrivalent vaccine within LMIC were largely missing. Only three studies were found where a LMIC was part of a multi center clinical trial. In all the studies, there were no vaccine related serious adverse events. The findings from the only study that investigated less than three doses of the bivalent HPV-16/18 vaccine suggest that even with less than three doses, antibody levels were still comparable with older women where efficacy has been proven. The few studies from LMIC in this review had comparable safety, Immunogenicity and efficacy profiles like in HIC. Overall, the LMIC of Africa where immune compromising/modulating situations are prevalent, there is need for long term immunogenicity as well as surveillance studies for long term clinical effectiveness after two and three dose regimens.

Role of HPV Vaccination in Fighting Cervical Cancer

“…Where only as low as 10.2% of the participants have heard about HPV vaccines, 21.2 % reported having heard of cervical cancer, and the majority of these knew someone who had the disease. This result shows that the knowledge of HPV is somehow still low in many places, as this result is consistent with other low income and middle-income countries (25) . Masika et al reported that in Kenya the insufficient information about HPV vaccines is one of the main barriers to recommending the vaccine (26) .…”

“…One strategy to reduce cost as discussed before is by reducing the dose from three-dose to twodose, with no change in immunogenicity (10) . As the two-dose strategy is said to be critically important to save resources on any extra dose administrated for lower and middle-income countries (25) . The support of government funding to make HPV vaccines as national health program is crucial, although, in reality, it is a difficult decision (31) .…”

The presence and distribution of high risk HPV types in simultaneous cervical cytology samples

“…High risk HPV DNA was determined 110 out of 328 patients (33.5%) and multiple types were detected 22.7% of the cases. The most determined types were HPV-16/51/18 and 56 respectively.…”

Awareness about human papilloma virus vaccine among medical students

“…6 Vaccine Safety have all confirmed and declared that the vaccine is safe and effective. [7][8][9] The FUTURE trials have demonstrated an efficacy of 91-100%.…”