1Human papillomavirus vaccines: WHO position
paper (2022 update). Weekly Epidemiological Record. 2022; 97:645–672 (https://www.who.int/teams/immunization-vaccines-and-biologicals/policies/position-papers/human-papillomavirus-(hpv), accessed 18 February 2023).
2 de Martel C, Georges D, Bray F, Ferlay J, Clifford GM. Global burden of cancer attributable to infections in 2018: a worldwide
incidence analysis. Lancet Glob Health. 2020;8(2):e180-e190. doi: 10.1016/S2214-109X(19)30488-7.
3 World Health Assembly adopts global
strategy to accelerate cervical cancer elimination. WHO News, 19 August 2020 (https://www.who.int/news/item/19-08-2020-world-health-assembly-adopts-global-strategy-to-accelerate-cervical-cancer-elimination, accessed 27 October 2023).
4 HPV type-specific empty
shells named virus-like particles (VLPs) self-assemble spontaneously from
pentamers of the L1 major capsid protein.
5 WHO Prequalification (website) (https://extranet.who.int/pqweb/, accessed 27 October 2023).
6 Patel H,
Wagner M, Singhal P, Kothari S. Systematic review of the incidence and
prevalence of genital warts. BMC Infect Dis. 2013 Jan 25;13:39. doi:
10.1186/1471-2334-13-39.
7 Meeting of the Global Advisory Committee on
Vaccine Safety, 7–8 June 2017. Weekly Epidemiological Record. 2017; 92:398–401
( https://www.who.int/publications/i/item/WER9228, accessed 18 February 2023).
8 Placeholder for: Henschke N, Bergman
H, Villanueva G, Loke YK, Golder SP, Crosbie EJ et al. Effects of human
papillomavirus (HPV) vaccination programmes on community rates of HPV-related
disease and harms from vaccination. Cochrane Database of Systematic Reviews.
2022 – currently only the protocol available.
9 Safety of HPV vaccines.
WHO Global Advisory Committee on Vaccine Safety (GACVS), 7–8 June 2017 (online)
(report on HPV vaccine https://www.who.int/groups/global-advisory-committee-on-vaccine-safety/topics/human-papillomavirus-vaccines/safety,
accessed 27 October 2023).
10 Henschke N, Bergman H,
Villanueva G, Loke YK, Golder SP, Crosbie EJ, Kyrgiou M, Dwan K, Morrison J.
Effects of human papillomavirus (HPV) vaccination programmes on community rates
of HPV‐related disease and harms from vaccination. Cochrane Database Syst Rev.
2022 May 31;2022(5):CD015363. doi: 10.1002/14651858.
11 Immunization stress-related response: a
manual for program managers and health professionals to prevent, identify and
respond to stress-related responses following immunization. Geneva: World
Health Organization; 2019 (https://www.who.int/publications/i/item/9789241515948, accessed 18 February 2023).
12The age
extension of original licensure of HPV vaccines to pre-adolescent and
adolescent girls and boys – in whom efficacy trials were not deemed feasible
because of ethical considerations – was granted on the basis of immunobridging
studies demonstrating non-inferiority.
13 Watson-Jones D, Changalucha J, Whitworth H,
Pinto L, Mutani P, Indangasi J et al. Immunogenicity and safety of one-dose
human papillomavirus vaccine compared with two or three doses in Tanzanian
girls (DoRIS): an open-label, randomised, non-inferiority trial. Lancet Glob
Health. 2022;10(10):e1473–84. doi: 10.1016/S2214-109X(22)00309-6.
14 The FUTURE II Study Group. Quadrivalent
vaccine against human papillomavirus to prevent high-grade cervical lesions. N
Engl J Med. 2007;356:1915–27. doi: 10.1056/nejmoa061741.
15 Garland SM, Hernandez-Avila M, Wheeler CM,
Perez G, Harper DM, Leodolter S et al. Quadrivalent vaccine against human
papillomavirus to prevent anogenital diseases. N Engl J Med. 2007;356:1928–43.
doi: 10.1056/NEJMoa061760.
16 Paavonen J,
Jenkins D, Bosch FX, Naud P, Salmeron J, Wheeler CM et al.Efficacy of a prophylactic adjuvanted
bivalent L1 virus-like-particle vaccine against infection with human
papillomavirus types 16 and 18 in young women: an interim analysis of a phase
III double-blind, randomised controlled trial. Lancet. 2007;369(9580):2161–70.
doi: 10.1016/S0140-6736(07)60946-5.
17 Kreimer AR, Rodriguez AC, Hildesheim A,
Herrero R, Porras C, Schiffman M et al. Proof-of-principle evaluation of the
efficacy of fewer than three doses of a bivalent HPV16/18 vaccine. J Natl
Cancer Inst. 2011;103(9):1444–51. doi: 10.1093/jnci/djr319.
18Efficacy,
effectiveness and immunogenicity of one dose of HPV vaccine compared with no
vaccination, two doses, or three doses. Cochrane Response, March 2022 (https://cdn.who.int/media/docs/default-source/immunization/position_paper_documents/human-papillomavirus-(hpv)/systematic-review-of-1-dose-of-hpv-vaccinec14d7ee3-e409-4a1a-afd9-c3e7e0dd2bd9.pdf?sfvrsn=174858f6_1,
accessed 28 October 2023).
19 Drolet M, Bénard É, Pérez N,
Brisson M; HPV Vaccination Impact Study Group. Population-level impact and herd
effects following the introduction of human papillomavirus vaccination
programmes: updated systematic review and meta-analysis. Lancet. 2019 Aug
10;394(10197):497-509. doi: 10.1016/S0140-6736(19)30298-3.
20 Rosenblum HG, Lewis RM, Gargano JW, Querec
TD, Unger ER, Markowitz LE. Declines in prevalence of human papillomavirus
vaccine-type infection among females after introduction of vaccine – United
States, 2003–2018. MMWR Morb Mortal Wkly Rep. 2021;70(12):415–20. doi:
10.15585/mmwr.mm7012a2.
21 Palmer T, Wallace L, Pollock KG, Cuschieri
K, Robertson C, Kavanagh K et al. Prevalence of cervical disease at age 20
after immunisation with bivalent HPV vaccine at age 12–13 in Scotland:
retrospective population study. BMJ. 2019;365:I1161 (https://pubmed.ncbi.nlm.nih.gov/30944092/, accessed 28 October 2023).
22 Lei J, Ploner A, Elfström KM, Wang J, Roth
A, Fang F et al. HPV vaccination and the risk of invasive cervical cancer. N
Engl J Med. 2020;383(14):1340–8. doi: 10.1056/NEJMoa1917338.
23Falcaro M,
Castaño A, Ndela B, Checchi M, Soldan K, Lopez-Bernal J et al. The effects of
the national HPV vaccination programme in England, UK, on cervical cancer and
grade 3 cervical intraepithelial neoplasia incidence: a register-based
observational study. Lancet. 2021;398(10316):2084–92. doi:
10.1016/S0140-6736(21)02178-4.
24 WHO Prequalification (website) (https://extranet.who.int/prequal/vaccines/p/cecolinr, accessed 17 November 2023).
25 Lang Kuhs KA,
Porras C, Schiller JT, Rodriguez AC, Schiffman M, Gonzalez P et al. Costa Rica Vaccine Trial
Group. Effect of different human papillomavirus serological and DNA criteria on
vaccine efficacy estimates. Am J Epidemiol. 2014 Sep 15;180(6):599-607. doi:
10.1093/aje/kwu168.
26 Lehtinen M, Paavonen J,
Wheeler CM, Jaisamrarn U, Garland SM, Castellsagué et al. HPV PATRICIA Study
Group. Overall efficacy of HPV-16/18 AS04-adjuvanted vaccine against grade 3 or
greater cervical intraepithelial neoplasia: 4-year end-of-study analysis of the
randomised, double-blind PATRICIA trial. Lancet Oncol. 2012 Jan;13(1):89-99.
doi: 10.1016/S1470-2045(11)70286-8.
27 Kjaer SK, Sigurdsson K,
Iversen OE, Hernandez-Avila M, Wheeler CM, Perez G et al. A pooled analysis of
continued prophylactic efficacy of quadrivalent human papillomavirus (Types
6/11/16/18) vaccine against high-grade cervical and external genital lesions.
Cancer Prev Res (Phila). 2009 Oct;2(10):868-78. doi: 10.1158/1940-6207.CAPR-09-0031.
28 WHO Prequalification (website) (https://extranet.who.int/prequal/vaccines/p/gardasil-9, accessed 17 November 2023).
29 Phase 3 trial of a bivalent HPV vaccine
(Cecolin®) in young girls. CinicalTrials.gov. (https://clinicaltrials.gov/ct2/show/NCT04508309, accessed 28 October 2023).
30 Barnabas RV, Brown ER, Onono
M, Bukusi EA, Njoroge B, Winer RL et al. KEN SHE Study Team. Single-dose HPV
vaccination efficacy among adolescent girls and young women in Kenya (the KEN
SHE Study): study protocol for a randomized controlled trial. Trials. 2021 Sep
27;22(1):661. doi: 10.1186/s13063-021-05608-8.
31Baisley
K, Kemp TJ, Kreimer AR, Basu P, Changalucha J, Hildesheim A et al. Comparing
one dose of HPV vaccine in girls aged 9-14 years in Tanzania (DoRIS) with one
dose of HPV vaccine in historical cohorts: an immunobridging analysis of a
randomised controlled trial. Lancet Glob Health. 2022 Oct;10(10):e1485-e1493.
doi: 10.1016/S2214-109X(22)00306-0.
32Mariz FC,
Gray P, Bender M, Eriksson T, Kann H, Apter D et al. Sustainability of
neutralising antibodies induced by bivalent or quadrivalent HPV vaccines and
correlation with efficacy: a combined follow-up analysis of data from two
randomised, double-blind, multicentre, phase 3 trials. Lancet Infect Dis.
2021;21(10):1458–68. doi: 10.1016/S1473-3099(20)30873-2.
33 WHO Policy Statement: Multi-dose Vial
Policy (MDVP). Geneva: World Health Organization; 2014 (https://apps.who.int/iris/bitstream/handle/10665/135972/WHO_IVB_14.07_eng.pdf, accessed 18 February 2023).
34 WHO Health products policy and standards
(CTC) (https://www.who.int/teams/immunization-vaccines-and-biologicals/essential-programme-on-immunization/supply-chain/controlled-temperature-chain-(ctc), accessed by 30 October)
35The recommendations
contained in this paper are based on the advice of independent experts, who
have considered the best available evidence, a risk–benefit analysis and other
factors, as appropriate. This paper includes recommendations on the use of
medicinal products for an indication, in a dosage form, dose regimen,
population or other use parameters that are not included in the approved
labelling. Relevant stakeholders should familiarize themselves with applicable
national legal and ethical requirements. WHO does not accept any liability for
the procurement, distribution and/or administration of any product for any use.
36There is no
current evidence of waning efficacy over time.
37 HPV vaccine: session introduction and key
questions (PowerPoint presentation to the WHO Strategic Advisory Group of
Experts on Immunization, 6 April 2022). Geneva: World Health Organization; 2022
(https://cdn.who.int/media/docs/default-source/immunization/position_paper_documents/human-papillomavirus-(hpv)/hpv-vaccine-session-introduction-key-questions-april-2022.pdf, accessed 18 February 2023).
38 Market Information for Access to Vaccines
(MI4A) vaccine purchase database. Geneva: World Health Organization (Immunization, Vaccines and
Biologicals (who.int),
accessed 28 October 2023).
39 Gavi product menu. Copenhagen: UNICEF
Supply Division (https://www.unicef.org/supply/documents/gavi-product-menu, accessed 2 March 2023) .
40 WHO Cervical Cancer Prevention and Control
Costing tool (C4P): human papillomavirus vaccination module. Geneva: World
Health Organization (https://www.who.int/publications/m/item/WHO-Cervical-Cancer-Prevention-and-Control-Costing-tool-human-papillomavirus-vaccination-module, accessed 28 October 2023).
41 HPV Vaccine Cost Calculator. Seattle (WA):
PATH (https://www.path.org/resources/hpv-vaccine-cost-calculator/, accessed 28 October 2023).
42 Burger EA, Portnoy A, Campos NG, Sy S,
Regan C, Kim JJ. Choosing the optimal HPV vaccine: the health impact and
economic value of the nonavalent and bivalent HPV vaccines in 48 Gavi-eligible
countries. Int J Cancer. 2021;148(4):932–40. doi: 10.1002/ijc.33233.
43Abbas KM, van
Zandvoort K, Brisson M, Jit M. Effects of updated demography, disability
weights, and cervical cancer burden on estimates of human papillomavirus
vaccination impact at the global, regional, and national levels: a PRIME
modelling study. Lancet Glob Health. 2020;8(4):e536–44. doi:
10.1016/S2214-109X(20)30022-X.
44Global market
study: HPV. Geneva: World Health Organization; 2022 (https://cdn.who.int/media/docs/default-source/immunization/mi4a/who-mi4a-global-market-study-hpv.pdf?sfvrsn=649561b3_1&download=true,
accessed 18 February 2023).
45 The CAPACITI decision-support tool. Geneva:
World Health Organization (https://www.who.int/teams/immunization-vaccines-and-biologicals/immunization-analysis-and-insights/vaccine-impact-value/economic-assessments/vaccine-prioritization#:~:text=The%20decision%2Dsupport%20tool%20has,a%20legitimate%20and%20credible%20recommendation, accessed 28 October 2023).
46 WHO National Immunization Strategy (website).
Geneva: World Health Organization (https://www.who.int/teams/immunization-vaccines-and-biologicals/vaccine-access/planning-and-financing/nis, accessed 28 October 2023).