Review
Copyright ©The Author(s) 2016.
World J Obstet Gynecol. Feb 10, 2016; 5(1): 5-15
Published online Feb 10, 2016. doi: 10.5317/wjog.v5.i1.5
Table 1 Phase III efficacy in women
Future IFuture IIPatriciaCVTBroad spectrum HPV vaccine study
VaccineGardasil®Gardasil®Cervarix®Cervarix®Gardasil9®
FundingMerck and Co., Inc.Merck and Co., Inc.GlaxoSmithKlineNational Cancer Inst.Merck and Co., Inc.
Number enrolled64631216718729746614215
Number of countries161314114
Duration of trial4 yr4 yr4 yr4 yr4 yr
Age (yr)16-2415-2615-2518-25
Lifetime sexual partners< 4< 4< 6No restriction< 4
ExclusionsPregnancy, history of abnormal Pap smear or genital wartsPregnancy, history of abnormal Pap smearPregnancy, breastfeeding, history of colposcopy, autoimmune disease/immunodeficiency, HPV 16/18-associated CIN2+ at enrollmentPregnancy, breastfeeding, history of immunosuppression, hysterectomy, hepatitis A vaccinationPrior abnormal Pap smear, > 4 lifetime sexual partners, no prior abnormal finding on cervical biopsy
Primary endpointIncidence of vaccine-type HPV associated CIN1-3, AIS or cancer, combined incidence of vaccine-type HPV associated anogenital warts, VIN/VaIN1-3 or cancerHPV 16 or 18 associated CIN2/3Incidence of HPV 16 or 18 CIN2 or greaterHPV 16 or 18 persistent infection (12 mos.) or HPV 16 or 18 associated CIN2+High-grade cervical, vulvar, and vaginal disease
Mean follow-up time3 yr3 yr14.8 mo
Immunogenicity99.5% seroconversion after 3 doses99% seroconversion to vaccine-associated HPV types99.5% seroconversion rates in women aged 15-25 yrNon-inferior to quadrivalent vaccine
Table 2 Worldwide vaccination protocols
CountryVaccine in schedule (as of December 31, 2014)Year of introduction in entire countryTarget populationSchedule
AfricaBotswanaNo2015Girls 9-13 yr3 doses
LesothoYes20129-14 yr3 doses
MalawiNo2015Girls 9-13 yr3 doses
RwandaYes20113 doses
SeychellesYes2014Girls 10-12 yr
South AfricaYes20149 yr2 doses
AmericasArgentinaYes201111 yr3 doses
BarbadosYes201411 yr2 doses
BrazilYes20149-14 yr2 doses
CanadaYes20093 doses
ColombiaYes20129-17 yr3 doses
EcuadorYes20149 yr2 doses
GuyanaYesNot availableSpecial groups3 doses
MexicoYes201210 yr2 doses
PanamaYes200810 yr3 doses
ParaguayYes201310 yr3 doses
PeruYes201110 yr3 doses
SurinameYes20139 yr
Trinidad and TobagoYes2013Females 11-45 yr, males 11-26 yr3 doses
United StatesYes200611-26 females, 11-21 males (26 if high risk)3 doses
UruguayYes201312 yr3 doses
Eastern MediterraneanBahrainNo
LibyaYes201315 yr3 doses
EuropeAndorraYes201412 yr
AustriaYes20089 yr3 doses
BelgiumYes201112 yr (13-14 in Wallonia)3 doses
Czech Republic (the)Yes201213 yr
DenmarkYes200712 yr3 doses
FinlandYes201311-12 yr
FranceYes2006Girls 11-14 yr3 doses
GermanyYes2007Girls 12-17 yr3 doses
GreeceYes200911-18 yr3 doses
HungaryYes201412 yr
IcelandYes201112 yr3 doses
IrelandYes2010Girls 12-13 yr3 doses
IsraelYes201013 yr (or women 9-45 yr)3 doses
ItalyYes2009Girls 12 yr3 doses
LatviaYes201012 yr3 doses
LuxembourgYes200812-18 yr
MaltaYes201312 yr3 doses
MonacoYes200614 yr3 doses
Netherlands (the)Yes201012 yr2 doses
NorwayYes2009Girls 12 yr3 doses
PortugalYes200810-13 yr3 doses
San MarinoYes200811 yr
SloveniaYes200911-12 yr2 doses
SpainYes200712 yr3 doses
SwedenYes2010Girls 10-12 yr3 doses
SwitzerlandYes2006Girls 11-14 yr3 doses
The former Yugoslav Republic of MacedoniaYes200912 yr3 doses
United KingdomYes200812-13 yr2 doses
UzbekistanNo2015
South-East AsiaBhutanYes2009Girls 12 yr3 doses
Western PacificAustraliaYes200710-15 yr
Brunei DarussalamYes201213 yr3 doses
Cook IslandsYes20119 yr
FijiYes201313 yr
JapanYes201113 yr3 doses
MalaysiaYes2010Girls 13 yr3 doses
Marshall Islands (the)Yes200911-12 yr
Micronesia (Federated States of)Yes20109 yr3 doses
New ZealandYes200912 yr (and other eligible individuals)3 doses
PalauYes20089-26 yr3 doses
Philippines (the)2 doses
SingaporeYes2010Girls 9-26 yr3 doses
Table 3 Possible interventions to increase human papillomavirus vaccine uptake
Ref.YearCountryObjectivesnOutcomeTarget populationEducational tools
Chapman et al[54]2010United StatesEvaluation of a video-based educational tool to increase HPV vaccine acceptability256Vaccine acceptability increased following interventionWomen aged 18-608 min video
Kennedy et al[55]2011United StatesImprovement of HPV vaccine educational materials and determination of efficacy411Increase in likelihood of vaccination of children and favorable view of HPV vaccineParents of girls 11-18 yr of ageEducational flyer
Kobetz et al[51]2011HaitiAssessment of women's knowledge and beliefs regarding cervical cancer and HPVNeed for culturally and linguistically appropriate educational initiativesHaitian immigrant women in Miami, FLFocus groups
Kester et al[56]2014United StatesEvaluation of the effects of a brief education session on HPV awareness131Higher vaccination intent among intervention group18-26 yr old females and males5-10 min education session
Kim[50]2015South KoreaAssessment of knowledge of HPV relation to cancer in children117HPV education at elementary school would be helpfulFifth-grade girls and boys2 h education session
Nodulman et al[57]2015United StatesEvaluation of feasibility of increased immunization rates through middle school vaccination programs117Low acceptance of middle school vaccination by adolescents, parents and stakeholdersMiddle school stakeholders, nurses, parents, adolescents, administratorsMiddle school vaccination program
Table 4 Evaluation of barriers to human papillomavirus vaccination
Ref.YearCountryTarget populationObjectivesnIdentified barriers to vaccination
Mortensen[46]2010DenmarkWomen aged 16-26Evaluation of reasons for acceptance or rejection of HPV vaccine following general vaccine availability794Cost, lack of information about the benefits of vaccination, and lack of knowledge about HPV
Ogilvie et al[58]2010CanadaParents with daughters in 6th gradeDetermination of parental factors associated with receipt of the HPV vaccine in a publicly funded school-based HPV vaccine program2025Lack of knowledge regarding the HPV vaccine
Kobetz et al[51]2011United StatesHaitian immigrant women in Miami, FLAssessment of women's knowledge and beliefs regarding cervical cancer and HPVLack of education
Jeudin et al[53]2014United StatesBlack and Latina populationsIdentification of barriers to uptake of HPV vaccination among low-income and minority girlsLack of access to primary care, lack of provider recommendation, lack of parental knowledge
Kim[50]2015South KoreaFifth-grade girls and boysAssessment of children’s knowledge regarding HPV and association with cancer117Lack of HPV knowledge, lack of HPV education in schools
Abudukadeer et al[47]2015ChinaWomen in Xinjiang provinceAssessment of knowledge and perception of cervical cancer5000Lack of knowledge about cervical cancer
Blake et al[48]2015United StatesNational Cancer Institute’s 2013 Health Information National Trends Survey DataAssessment of population knowledge regarding HPV and the HPV vaccine as well as socioeconomic disparities3185Lack of HPV awareness and knowledge
Nodulman et al[57]2015United StatesMiddle school stakeholders, nurses, parents, adolescents, administratorsIncrease of immunization rates through middle school vaccination programs117Lack of knowledge about HPV vaccine