WHO Updates HPV Vaccination Schedule Recommendations

Human Papillomavirus (HPV) is the most common sexually transmitted infection in the United States. The virus is transmitted through intimate skin-to-skin contact. HPV infection is very common, and almost all men and women will be infected with at least one type of HPV at some point in their lives. most infections are asymptomatic and become undetectable, but some infections may be persistent and may develop into cancer in women and men later in life.

HPV infections that do not go away can cause:

• Cervical, vaginal, and vulvar cancers (in women)

• Penile cancer (in men)

• Anal cancer

• Cancer of the back of the throat (oropharynx)

• Genital warts

In a new position paper published last week, WHO has updated its recommendations for human papillomavirus vaccines. Of particular note, the paper states that a single-dose schedule (known as an alternative, supra-indicated single-dose schedule) could provide comparable efficacy and durable protection to a two-dose regimen. The WHO Independent Expert Advisory Group SAGE originally proposed an alternative single-dose schedule in April 2022.

The position paper is timely in the context of a severe decline in global HPV vaccination coverage, which declines by 25% to 15% between 2019 and 2021 for the first dose of HPV vaccine. This means that more than 3.5 million girls miss out on HPV vaccination in 2021 compared to 2019.

Optimization of the HPV schedule is expected to improve access to the vaccine, provide countries with the opportunity to expand the number of girls who can be vaccinated, and reduce the burden of the often complex and costly follow-up required to complete the vaccination series. It is critical that countries strengthen their HPV vaccination planning to accelerate implementation and reverse the trend of declining coverage.

WHO now recommends :

One or two doses for girls aged 9-14 years

Girls and women aged 15-20 years need one or two doses

Two doses 6 months apart for women aged >21 years

The position paper emphasizes the importance of prioritizing vaccination for people who are immunocompromised or HIV-infected. Immunocompromised individuals should receive at least two doses and if possible three doses.

The primary target for vaccination is girls aged 9-14 years prior to the initiation of sexual activity. Where feasible and affordable, vaccination of secondary targets such as boys and older women is recommended.

Cervical cancer is the fourth most common cancer in women, and more than 95% of cervical cancers are caused by sexually transmitted HPV. Avoiding the development of cervical cancer by increasing access to an effective vaccine is a very important step in mitigating unnecessary disease and death.