Percent of girls vaccinated with 2 doses of HPV vaccine by age 15 years
The percent of 15 year old girls in target population who have completed the full two dose vaccination schedule for the human papillomavirus (HPV).
This indicator is calculated as:
(Number of girls aged 15 in target population who have received two doses of the HPV vaccine / Total number of 15 year old girls in target population) x 100
Depending on the type of HPV vaccine, WHO recommends vaccinating girls ages 9-14. The key point is that the girl receives two doses before she becomes exposed to HVP through sexual contact. Although this can occur before 15 years of age, this is the most commonly used lower age limit for when girls typically become sexually active.
Only girls who have completed both doses of the HPV vaccines should be counted in this indicator.
Total number of girls in target population; age of girl; response to survey questions on HPV vaccination; vaccine program service statistics
Population-based surveys; service statistics; vaccine registers
In 2010 alone, approximately 200,000 women died from cervical cancer with the majority of these deaths having occurred in low-income countries, where HPV vaccinations and comprehensive cervical cancer screening programs are lacking (IHME, 2011). Nearly all cervical cancer cases are linked to HPV which is the most common sexually transmitted infection (WHO, 2006). The bivalent vaccine, which protects against HPV types 16 and 18, and the quadrivalent vaccine, which protects against HPV types 6, 11, 16, and 18 – the most common cancer-causing strains of HPV – have both been proven to be safe and effective in preventing cervical cancer, with the quadrivalent vaccine also effective in preventing genital warts in women and men.
HPV is highly transmissible through sexual contact, so vaccinating girls before sexual activity is initiated is a key strategy to prevent cervical cancer. The peak of HPV incidence occurs between the ages of 16 and 20 years old (GAVI 2007).
Although addressing cervical cancer is still in the initial stage in developing countries due to lack of resources for prevention, screening, and treatment, the HPV vaccine is slowly being added to national immunization programs. This indicator can be used to track the impact of comprehensive HPV and cervical cancer prevention programs and marketing campaigns aimed at increasing the use and coverage of the vaccine in girls under 15 years of age.
Based on a pilot program in Uganda, PATH found it challenging to identify eligible girls based on their age. Selecting girls based on grade/class in school was more feasible, but presented challenges for age focused reporting and evaluation (PATH, 2011).
If this data is being collected through population-based surveys, girls may not know if they have received the full three doses for HPV, nor may they recall if it was an HPV vaccine they received.
Service statistics have the disadvantage that they may be incomplete or inaccurate (WHO, 1999). They are also subject to a selection bias and are not representative of the general population. However, they provide the only way of monitoring coverage on an annual basis and may be more reliable than self-reported data.
Girls who are 15 or older at the time of first dose should receive 3 doses of HPV. A 3-dose schedule remains necessary, even for those under the age of 15, if known to be immunocompromised and/or HIV-infected. This indicator does not capture that population of girls.
access, adolescent, cervical cancer
School-based immunization programs have had some success with achieving widespread vaccination coverage. However in many parts of the world, girls from poorer households are more likely to no longer be in school by the time they reach early adolescence (Kane, 2006). It is common in many parts of Africa for girls to stay home when they are menstruating. In both cases, young women will be at a disadvantage for getting fully or even partially vaccinated against the HPV vaccine.
Because HPV is a sexually transmitted virus, more conservative countries have shown some resistance to vaccinating young girls, saying that giving the vaccination will give them permission for sexual promiscuity or that it is unnecessary since sexual activity is “not supposed to” take place outside of marriage. In other cases, the myth that the HPV vaccine is designed to sterilize young women has also been cited (Kane, 2006).
Agosti JM, Goldie SJ (2007). Introducing HPV vaccine in developing countries–key challenges and issues. N Engl J Med 356:1908–1910.
Institute for Health Metrics and Evaluation (IHME). The Challenge Ahead: Progress and setbacks in breast and cervical cancer. Seattle, WA: IHME, 2011. http://www.healthdata.org/policy-report/challenge-ahead-progress-and-setbacks-breast-and-cervical-cancer
GAVI Alliance. HPV (Human papillomavirus) Fact Sheet. GAVI alliance in collaboration with PATH.
Kane, M.A., Sherris, J., Coursaget, P., Aguado, T. and Cutts, F. (2006). Chapter 15: HPV vaccine use in the developing world. Vaccine, 24 (Suppl. 3), S132–S139.
PATH. HPV Vaccination in Africa Lessons Learned From a Pilot Program in Uganda. January 2011. http://www.rho.org/files/PATH_HPV_lessons_learned_Uganda_2011.pdf
WHO Position Paper: Weekly epidemiological record. p. 118-132 April 2009. http://www.who.int/wer/2009/wer8415.pdf?ua=1
WHO, 2006. Preparing for the Introduction of HPV vaccines: policy and programme guidance for countries.