Abstract
Abstract Background Human Papillomavirus (HPV) is responsible for the development of several pathologies besides the cervical cancer and HPV vaccination is a key strategy for primary prevention. The aim of this research was to identify strategies adopted to increase HPV vaccination coverage among the adolescents. Methods A systematic review was carried-out by searching electronic databases (Pubmed, Scopus, and Web of Science) using selected keywords as “papillomavirus vaccine”, “vaccination strategy” and “efficacy”. Articles conducted in high-income countries and evaluating the impact of one or more strategies on vaccination coverage (initiation e/o completion) in adolescents were included. Results Out of 3571 single citations screened, 42 papers (2011-2018) were included. Study size ranged from 50 to 325229 individuals. The major part of the studies was from the United States (n = 35; 83,3%) and conducted with an experimental design (n = 17; 40,5%). The evaluated outcomes included first dose uptake, schedule completion, vaccination timeliness and the number of administered doses. Identified strategies included reminds (9), education activities (9), multicomponent strategies (22) and others (2) and were focused on adolescents/parents and/or healthcare providers. Significant positive results were reported in seven studies (77,8%) evaluating the impact of reminds, four studies (44,4%) on education strategies, and in 12 studies (54,5%) on multicomponent strategies. Offering vaccination in “bundle” or during any medical visit was also reported as significantly effective. Conclusions Increasing the vaccination coverage is essential to achieve HPV-related diseases control. Several types of strategies are available and showed a positive impact on vaccination uptake, in particular those relied on reminds. Nonetheless, the heterogeneity of interventions suggests the importance to adapt such initiatives to the specific context in order to maximize the improvement in vaccination uptake. Key messages Several types of strategies to increase vaccination uptake are available at international level and showed a positive impact among adolescents. These interventions are heterogeneous suggesting the importance of their adaptation to the specific context in order to gain the maximum improvement in vaccination uptake.
Highlights
Human papillomavirus (HPV) is one of the most frequent sexually transmitted infections [1].More than 80% of sexually active women and men are expected to be infected by at least one Human Papillomavirus (HPV) type by the age of 45 years [2]
In order to collect scientific evidence related to the aim of the study, a systematic review of the literature was performed through the consultation of scientific databases and grey literature
(I) Every kind of strategy implemented in order to increase HPV vaccination coverage among the adolescent population (9–18 years) according to the World Health Organization (WHO) definition of adolescents [26] and the WHO recommendation of HPV-vaccination was included [27]
Summary
More than 80% of sexually active women and men are expected to be infected by at least one HPV type by the age of 45 years [2]. In Europe, the prevalence of a detectable HPV infection in women is 14% but varies widely across countries and age groups, with a large peak during adolescence in many countries [1]. In most of the cases, HPV infections are transient and clear up within few months, but sometimes they can persist and progress to cancer. This may happen, in particular, if the infection is due to the so-called high-risk oncogenic HPV genotypes [3]. It is estimated that the vast majority of detected infection (over 70%) is due to these high-risk HPV genotypes, namely, HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82 [4], that are classified as “carcinogenic to humans” by
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