Implementation of the quadrivalent vaccine against HPV in the Municipality of Campos dos Goytacazes, Brazil – A combination of strategies to increase immunization coverage and early reduction of genital warts

Abstract

IntroductionAmong the more than 100 types of human papillomavirus (HPV), about 90% of genital warts are caused by HPV types 6 and 11; types 16 and 18 cause 70% of cases of cervical cancer. Tracking through Pap associated with condom use are strategies in preventing this condition. Vaccination against HPV has been added to the portfolio of protection. In September 13, 2010, the quadrivalent vaccine against HPV was made available for resident girls between 11 and 15 years of age in the municipality of Campos dos Goytacazes, Rio de Janeiro, Brazil using a hybrid strategy of vaccination. ObjectivesAssess vaccination coverage in that municipality after adopting several strategies for active search and missed opportunities for vaccination against HPV. Evaluate acceptance for the vaccine and reasons for refusal the HPV vaccine. Evaluate the frequency and occurrence of adverse events to that vaccine. A survey of reduction of genital warts was also conducted. MethodsA survey of vaccination coverage for the chosen age group was carried out. By previous appointment, schools received vaccination on site; two “D-Days” for municipal vaccination were set along side with the creation of the project “Holidays HPV-free”. The vaccine was also offered in two public permanent sites on a daily basis; Vaccine adverse events were assessed in 1000 adolescents after 96 h of vaccine administration A survey on reduction of genital warts was studied 3 years before and 2 years after introduction of vaccine. ResultsThe 1st vaccine dose reached about 53%, 90.1% and 87.9% of coverage, respectively in 2010, 2011 and 2012. By using the same model, the complete scheme with 3rd dose reached 0%, 65.1% and 66.2% of coverage status. There were observed a total of 430 local and systemic events in 360 subjects (36% of 1000 girls), stratified by each dose received. No serious adverse events or any hospitalization were reported; We also observed a reduction of about 55% in the incidence of genital warts in women under 21 years old. ConclusionA hybrid strategy for HPV proved to be effective in vaccinating adolescents in this municipality. HPV vaccine was safe and effective in reducing genital warts, as demonstrated by international studies.