Country recommendations about use of HPV vaccines

Background: By January 2008, two HPV vaccines (quadrivalent and bivalent) were licensed in >90 countries and >40 countries, respectively. Both vaccines prevent infection with HPV type 16 and 18 and cervical precancers due to these types. The quadrivalent vaccine also protects against HPV 6 and 11 and related genital warts.

Objectives: To analyze recommendations and/or funding proposals about HPV vaccine use finalized by national health authorities.

Methods: We reviewed data from government health authorities, WHO, national regulatory bodies, and industry from 2006 (when vaccines were first licensed) through January 2008.

Results: By January 2008, 12 European countries, Australia, Canada and the US had recommended and/or funded at least one HPV vaccine for national immunization programs based on safety and efficacy, disease burden, and cost-effectiveness. All recommended a female primary target population of various ages with the range of 9-17 years. 12 advised vaccinating older females of various ages within the range of 13-26 years. 2 countries indicated the value of vaccinating boys but neither country has allocated funding. 9 countries advised providing free vaccines to at least part of the primary target population. All recommendations stressed continued cervical cancer screening of vaccinated and non-vaccinated women.

Conclusions: The 12 countries with finalized recommendations on vaccine use have established cervical cancer screening programs and relatively low cervical cancer burden. Few recommendations detailed delivery, acceptability, or communication to prospective vaccinees, parents, or providers that would facilitate introduction. Most recommendations were consistent with WHO preliminary guidance on HPV vaccines and cervical cancer control.