The World Health Organization’s Strategic Advisory Group of Experts on Immunization (SAGE) convened from 4 to 7 April, 2022 and reviewed the evidence on Human Papillomavirus (HPV) vaccine (in addition to COVID-19 vaccines, poliovirus vaccines, typhoid conjugate vaccine, and Hepatitis A vaccination).
Background Information:
More than 95% of cervical cancer is caused by sexually transmitted HPV, which is the fourth most common type of cancer in women globally with 90% of these women living in low- and middle-income countries.
The HPV vaccine is highly effective for the prevention of HPV serotypes 16 & 18, which cause 70% of cervical cancer.
The current HPV vaccine policy is for a
- 2-dose schedule in 9–14-year-old girls,
- 3 doses for girls 15 and older, and
- 3-doses to immunocompromised populations of any age (9 and older), including persons with HIV.
Key Messages:
SAGE noted with alarm that HPV vaccination implementation is not on track to meet the 2030 global cervical cancer elimination strategy targets. However, the HPV vaccine supply situation and supplier base were noted as improving in the short- and medium term.
Noting this improving HPV supply situation, SAGE recommended that all countries urgently introduce the HPV vaccine for the primary target of 9-14-year-old girls and, when feasible and affordable, prioritize catching up older cohorts and missed girls through multi-age cohort vaccination. Vaccination of boys and older cohorts should be carefully managed until there is unconstrained supply of vaccine.
SAGE reviewed new evidence on the efficacy of a single dose HPV vaccine schedule. Based on all available evidence, SAGE advised that countries may now choose between a one- or two-dose schedule for 9–14-year-old girls. This off-label single-dose option for routine and multi-age cohort catch-up vaccination was considered because it provides comparable and high levels of individual protection while from a public health perspective being more efficient (fewer doses per cancer case prevented), less resource-intensive and is easier to implement than a two-dose schedule. This advice applies to those HPV vaccines for which corresponding 1-dose data have been collected.
Similarly, either a one- or a two-dose schedule may be applied for young women aged 15 to 20 years old, while two doses with a 6-month interval should be used for females older than 21 years.
Boys and older males can follow the same dose schedule as females, while additional evidence is generated on the efficacy and immunogenicity of a single dose schedule in this group.
Further evidence must be generated on protection in immunocompromised individuals by reduced dose schedules. Until such evidence is available, persons from this population aged 9 years and older should be prioritized and receive at least two doses, though three doses would be considered optimal if programmatically feasible. Given the high incidence of HPV-related cancers in immunocompromised persons, those living with HIV, and girls who face sexual abuse, SAGE recommends that they be considered for vaccination against HPV both within and outside of standard eligibility age-range.
Summary:
SAGE recommends updating dose schedules for HPV as follows:
- Girls aged 9-14 years: one or two-dose schedule
- Young women aged 15-20 years: one or two-dose schedule
- Women older than 21 years: Two doses with a 6-month interval
Immunocompromised individuals, including those with HIV, should receive three doses if feasible, and if not at least two doses. There is limited evidence regarding the efficacy of a single dose in this group.
Useful Links:
Link to the related WHO news release:
Link to the WHO page on cervical cancer:
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