Abstract
Rwanda and Bhutan, 2 low- and middle-income countries, implemented primarily school-based national human papillomavirus (HPV) vaccination in 2011 (Rwanda) and 2010 (Bhutan). We estimated vaccination effectiveness through urine-based HPV prevalence surveys in schools in 2013–2014 and 2017. In Rwanda, 912 participants from baseline surveys and 1,087 from repeat surveys were included, and in Bhutan, 973 participants from baseline surveys and 909 from repeat surveys were included. The overall effectiveness against vaccine-targeted HPV types (i.e., HPV-6/11/16/18) was 78% (95% CI 51%–90%) in Rwanda, and 88% (6%–99%) in Bhutan and against other α-9 types was 58% (21–78) in Rwanda and 63% (27–82) in Bhutan. No effect against other HPV types was detectable. Prevalence of vaccine-targeted HPV types decreased significantly, as well as that of other α-9 types, suggesting cross-protection. These findings provide direct evidence from low- and middle-income countries of the marked effectiveness of high-coverage school-based, national HPV vaccination programs.
Highlights
Rwanda and Bhutan, 2 low- and middle-income countries, implemented primarily school-based national human papillomavirus (HPV) vaccination in 2011 (Rwanda) and 2010 (Bhutan)
By comparing type-specific HPV prevalence among young women in repeat surveys, we have assessed the early impact of HPV vaccination at the populationlevel in Rwanda and Bhutan, 2 low- and middle-income countries (LMICs) implementing a national HPV vaccination program
High-coverage in schools (≈90%) with quadrivalent vaccine has vastly decreased the prevalence of HPV types targeted by the vaccine (HPV-6, -11, -16, and -18), as well as significantly decreasing that of other α-9 HPV types (HPV-31, -33, -35, -52, and -58), suggesting cross-protection (58% in Rwanda and 63% in Bhutan)
Summary
Rwanda and Bhutan, 2 low- and middle-income countries, implemented primarily school-based national human papillomavirus (HPV) vaccination in 2011 (Rwanda) and 2010 (Bhutan). Prevalence of vaccine-targeted HPV types decreased significantly, as well as that of other α-9 types, suggesting cross-protection These findings provide direct evidence from low- and middle-income countries of the marked effectiveness of high-coverage school-based, national HPV vaccination programs. Both programs are primarily school-based, introduced a 3-dose schedule of quadrivalent vaccine targeting HPV-6/11/16/18, and switched to a 2-dose schedule in 2015 (Rwanda) and 2016 (Bhutan) In both countries, 12-year-old girls are the target age group for routine vaccination, but both countries had an initial expanded 3-dose catch-up campaign. We quantify HPV prevalence in repeated surveys, comparing it with the baseline HPV prevalence to estimate population-level impact of HPV vaccination in both countries [13]
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