CDC: National HPV Vaccine Programs Yet to Spread in Americas

From Medscape Medical News Emma Hitt, PhD October 14, 2011 — Human papillomavirus (HPV) vaccine is being used as part of national or regional immunization programs in only 4 of 35 countries in the Americas — the United States, Canada, Panama, and Mexico — according to a new report. The report was published by researchers with the Pan-American Health Organization in collaboration with the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, in the October 14 issue of the CDC's Morbidity and Mortality Weekly Report. Elissa Meites, MD, from the CDC's Division of Sexually Transmitted Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, and colleagues note that HPV vaccines are "among the most expensive vaccines available, and current prices in high-income countries are not affordable for low- and middle-income countries." "These data show that HPV vaccination programs are being implemented in more countries throughout the Americas, but we still have a long way to go," Dr. Meites told Medscape Medical News. "In many countries, the high cost of the vaccine is a barrier to implementing vaccination programs, since public health funds are stretched thin," she said. "Even in the United States, where the CDC recommends routine vaccination against HPV and most insurance covers HPV vaccine for adolescents, only 32% of 13- to 17-year-old girls have been fully vaccinated with 3 doses of HPV vaccine." In the United States, the authors report, coverage rates for HPV vaccine have increased since its introduction in 2006, although only a third of girls aged 13 to 17 years have received all 3 shots. Vaccine administration occurs mainly through primary care providers, but Vaccines for Children also provides the vaccine at no charge for eligible participants. In Canada, school-based HPV vaccination and other public programs beginning in 2007 have enabled from 51% to 85% of coverage (all 3 HPV vaccination doses), although rates vary by jurisdiction. In Panama, the Ministry of Health added bivalent HPV vaccine to the national immunization program in 2008; it is delivered in both clinics and schools for girls aged 10 years and older. "In 2009, 1-dose coverage among girls aged 10 years was 89%, and 3-dose coverage was 46%," the authors note. "In 2010, 3-dose coverage was 67%." In Mexico, the immunization program expanded nationally in September 2011 to include school-based vaccination for all girls aged 9 years. The most recent data of coverage in 182 municipalities (representing <10% of the population) in 2009 indicate that 1-dose coverage was 85%, and 2-dose coverage was 67%. Three-dose coverage at 60 months had yet to be measured. According to the authors, some countries are using an extended 3-dose schedule, but the Pan-American Health Organization, the World Health Organization, and the CDC "recommend a 3-dose schedule administered over 6 months." They add that "[a]dditional strategies are needed to overcome challenges to increasing HPV vaccine introduction, especially in regions with a disproportionate burden of cervical cancers." "These vaccines are safe and effective, and provide an opportunity to prevent cancer and save lives," Dr. Meites said. Morb Mort Wkly Rep. 2011;60:1382-1384. Full text