In a  position paper published on December 16, 2022, the World Health Organization (WHO) updated its recommendations for the human papillomavirus (HPV) vaccine.[1]

Human papillomavirus (HPV) vaccination protects against HPV, a necessary risk factor for cervical cancer.[2]

The first HPV vaccine to target HPV-16 and HPV-18, types which cause the majority of HPV-attributable cancers, was licensed in 2006. Since the first regulatory approval, HPV vaccines had been introduced into national immunization programs in more than 100 countries. Over time, these vaccination polices have evolved, with most programs targeting vaccination of young adolescent girls and an increasing number also including boys.[2]

Importance of vaccination
The paper stresses the importance of vaccines and vaccination against diseases caused by human papillomaviruses (HPVs). The WHO’s primary focus is the prevention of cervical cancer, given the role of prophylactic HPV vaccination as a foundational pillar of the organization’s Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem.

It is estimated that implementation of this strategy could prevent 60 million cervical cancer cases and 45 million deaths over the next 100 years. It also considers the broader spectrum of cancers and other diseases preventable by HPV vaccination. It incorporates recent information regarding HPV vaccines, including the licensure of new HPV vaccines and evidence on vaccine immunogenicity and effectiveness with reduced dose schedules.

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Single-dose schedule
The paper states that a single-dose schedule, referred to as an alternative, off-label single–dose schedule can provide a comparable efficacy and durability of protection to a two-dose regimen. The recommendation for alternative single-dose scheduling was initially made by WHO’s independent expert advisory group, SAGE in April 2022.

Decline in vaccination
The position paper is timely in the context of a deeply concerning decline in HPV vaccination coverage globally. Between 2019 and 2021, coverage of the first dose of HPV vaccination fell by 25% to 15%. This means 3.5 million more girls missed out on HPV vaccination in 2021 compared to 2019.

The optimization of the HPV schedule is expected to improve access to the vaccine, offering countries the opportunity to expand the number of girls who can be vaccinated and alleviating the burden of the often complicated and costly follow-up required to complete the vaccination series. In a statement, The WHO says that it’s vital that countries strengthen their HPV vaccination programs, expedite implementation and reverse the declines in coverage.

WHO now recommends:

  • A one or two-dose schedule for girls aged 9-14 years
  • A one or two-dose schedule for girls and women aged 15-20 years
  • Two doses with a 6-month interval for women older than 21 years

Importance of vaccination
In the position paper, the WHO underscores the importance of vaccinating as a priority immunocompromised people, or those living with HIV.  Immunocompromised individuals should receive at a minimum two doses and where possible three doses.

The primary target of vaccination is girls aged 9-14, prior to the start of sexual activity.  The vaccination of secondary targets such as boys and older females is recommended where feasible and affordable.

Cervical cancer is the fourth most common type of cancer in women, and more than 95% of cervical cancer is caused by sexually transmitted HPV. Averting the development of cervical cancer by increasing access to effective vaccines is a highly significant step in alleviating unnecessary illness and death.

[1] Human papillomavirus vaccines: WHO position paper, December 2022. World Health Organisation Weekly Epidemiological Record No 50, 2022, 97, 645–672. Online. Last accesses on December 21, 2022.
[2] Markowitz LE, Schiller JT. Human Papillomavirus Vaccines. J Infect Dis. 2021 Sep 30;224(12 Suppl 2):S367-S378. doi: 10.1093/infdis/jiaa621. PMID: 34590141; PMCID: PMC8577198.

Featured image: Vaccination of young women. Photo courtesy: © 2016 – 2022. Fotolia/Adobe. used with permission.

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