The European Centre for Disease Prevention and Control (ECDC) published an update to its 2008 guidance on human papillomavirus (HPV) vaccines in Europe “in light of the introduction of vaccination programmes in 19 European countries and new evidence from research studies in the past four years.” Randomised trials and observations from the field have demonstrated good safety profiles and efficacy against cervical cancer precursors. In spite of this, and that most of these countries are providing the vaccine for free, vaccination rates are lower than expected.
Vaccinating girls is shown to be more cost-effective than vaccinating boys. ECDC’s guidance is that public health initiatives should continue to focus on vaccinating girls.
Among the deterring factors for the slow uptake are the cost of the vaccine and the regime of three doses in six months. Routine vaccination targets girls between ages 10 to 14 years as the vaccines are clinically proven to be most effective when administered before the onset of sexual activity. These girls require parental permission to be vaccinated therefore the role of parents and healthcare workers is of utmost importance.
Nineteen countries out of the 29 EU/EEA countries have introduced HPV vaccination programmes following the authorisation of the vaccines but vaccination rates in EU countries range from only 17% to 84%. In 2010, only Portugal and the United Kingdom had full vaccination coverage rates above 80% for the target groups out of the seven countries reporting this data.
ECDC Director Marc Sprenger said: “We, public health authorities, frontline healthcare workers and parents alike, have a shared responsibility to protect thousands of women from cervical cancer. We need to work together to ensure that all girls between 10 and 14 years of age are vaccinated. European countries may need to examine why HPV vaccination coverage rates in their countries are not higher and strengthen their vaccination campaigns accordingly.”
Since its introduction by some European countries in 2006 the inclusion of boys in HPV vaccination programmes has been an open question. Only the quadrivalent HPV vaccine has been evaluated for men but current data shows that it gives the same, if not better, levels of efficacy for boys as girls of the same age groups. But the personal benefit of the vaccine for men in terms of cancer prevention is very low, most likely resulting in few boys being vaccinated and low vaccination coverage rates.
Marc Sprenger said “ECDC’s conclusion is that including boys in the current HPV vaccination programmes is unlikely to be cost-effective. A better investment of public resources is to focus on immunising all girls. This issue can be re-assessed when vaccination costs are significantly reduced.”…