Human Papillomavirus Vaccination Program Research Articles

The Ethical Paradox of Informed Consent in HPV Vaccination: Examining the Legal Boundaries and Ethical Considerations of Parental Consent, Public Health, and Individual Rights

Background and Objective: Effective communication is crucial in medical procedures, and informed consent is a key example of this. However, informed consent may face unique circumstances, such as in life support situations or government health programs. The Human Papillomavirus (HPV) vaccination, as part of a government initiative, raises the question of whether informed consent is still required. The study aims to explore whether informed consent is still necessary for the HPV vaccination and to analyze the legal implications if a citizen refuses to receive the vaccine. Patients have the right to refuse medical actions, making it essential to understand the legal consequences of rejecting the HPV vaccination. Methods: This study adopts a normative juridical approach with an analytic descriptive specification. Secondary data was gathered from primary, secondary, and tertiary legal sources through literature reviews, document studies, and archival research. The collected data was then analyzed qualitatively and presented in a descriptive format. Results: The study found that there are exceptions to the requirement for informed consent for vaccinations included in government programs. Specifically, informed consent is not necessary for individuals within the target age group of the government’s HPV vaccination program. In Indonesia, this program targets girls aged 9 to 14. Additionally, there are currently no legal penalties for individuals who refuse the HPV vaccination. Conclusion: Informed consent is not required for individuals within the targeted age group of the government’s HPV vaccination program in Indonesia. Furthermore, there are no legal penalties for rejecting the vaccination.

HPV-Related Cancers in Bosnia and Herzegovina: A Comprehensive Review.

This review assesses the burden of human papillomavirus (HPV)-related cancers in Bosnia and Herzegovina (BH), aiming to inform strategies for prevention and early detection. Despite the availability of highly effective HPV vaccines and screening programs, HPV-related cancers remain a significant public health burden worldwide. We conducted a comprehensive search of PubMed and GLOBOCAN to identify all available data on HPV prevalence/genotype and HPV-related malignancies in BH, including information on HPV vaccination and cervical cancer screening. A comprehensive literature search revealed limited data on HPV prevalence and HPV-related cancers, as well as the absence of a national HPV vaccination or cervical cancer screening program in BH. In the largest study with available data from BH, HPV prevalence was 43% among women undergoing routine gynecologic exams. HPV-16 was identified as the most common cause of cervical cancer. The HPV prevalence was 50% in head and neck cancer, with HPV-18 being the most prevalent subtype. HPV was detected in 80% of patients with colorectal cancer, and HPV-16 was the most common subtype. Conclusions. HPV-related cancers, particularly cervical cancer, represent a significant public health problem in BH. Implementation of a national HPV vaccination program, along with organized cervical cancer screening is essential to reduce HPV-related morbidity and mortality. Addressing systemic challenges, such as establishing a comprehensive cancer registry, is essential for effective HPV prevention and control. Raising public awareness about HPV infection, its consequences, and the importance of prevention is essential for vaccine acceptance and promoting healthy behaviors. By investing in HPV prevention, BH can significantly improve the health and well-being of its population, particularly women.

Cost-effectiveness of human papillomavirus (HPV) vaccination in Tunisia: a modelling study

ObjectivesThe objective of this study is to assess the cost utility of the implementation of the human papillomavirus (HPV) vaccination programme in Tunisia in addition to the current cytology screening...

HPV vaccine knowledge, attitude, and programme satisfaction among parents and caregivers of vaccine recipients in Ogun state Nigeria

IntroductionHuman Papillomavirus is responsible for about 5% of the global cancer burden. In Nigeria, cervical cancer is the second most common cancer among women. The Federal Government of Nigeria and partners recently introduced Human Papillomavirus (HPV) vaccination into routine immunization beginning with 15 States and the Federal Capital Territory. This study assesses HPV vaccine knowledge, attitude and program satisfaction among parents and caregivers of vaccine recipients in Ogun State, Nigeria.MethodsThis is a cross-sectional study with sample size of 1012 respondents, carried out during the 5-day HPV immunization campaign in all 20 Local Government Areas in Ogun State, Nigeria. Data was collected using interviewer-administered questionnaires. Univariate analysis was done using frequency tables and bivariate analysis using Chi-square test. Multivariate analysis was carried out to identify the determinants of knowledge of HPV, knowledge of cervical cancer and programme satisfaction.ResultsAll the respondents had heard of HPV vaccine and 67.5% had heard of cervical cancer. Eighty-two percent of the respondents heard of HPV vaccine for the first-time during the introduction programme. Eighty-two percent of respondents had good knowledge of HPV vaccine and 47.7% had good knowledge of cervical cancer. Forty-four percent of respondents heard about HPV vaccine via town/market announcers, 36.2% via radio, and 28.6% via social media. Common reasons respondents vaccinated their wards include, because there was a campaign (51.8%), to prevent cervical cancer (48.9%), and because it is free (38.3%). Twenty-nine percent were very satisfied with the HPV vaccination program and 63.2% were satisfied. All the respondents had positive attitude towards HPV vaccination, although 94.1% had heard messages discouraging people from vaccinating their wards. Respondents living in rural communities had higher odds of having good knowledge of HPV vaccine (aOR 2.232, 95% CI 1.527–3.263, p-value ≤ 0.001). Fathers with tertiary education were more likely to be satisfied with the programme (aOR 5.715, 95% CI 1.142–28.589, p-value = 0.034),ConclusionKnowledge of HPV vaccination was high and was informed by the HPV vaccination introduction programme. Use of outreaches, awareness drives, and provision of free vaccines should be intensified to further promote HPV vaccine uptake in Nigeria.

Analysis of Implementation Strategies for Nationwide HPV Vaccination Programs Across European Union Countries

Background/Objectives: Human papillomavirus (HPV) vaccination programs play a critical role in the primary prevention of HPV-related diseases, including cervical cancer. However, the principles governing the implementation of these programs vary across European Union (EU) countries. The objective of this study was to analyze and compare the strategies for implementing HPV vaccination programs across the EU, with a focus on access, vaccine selection, and procurement processes. Methods: This study utilized a comprehensive review of official websites from government bodies, public health organizations, and dedicated vaccination platforms in each of the 27 EU member states. Additionally, a search of Tenders Electronic Daily (TED) was conducted to examine the criteria used in tendering processes for vaccine suppliers involved in national HPV vaccination programs. Results: All 27 EU countries provide public funding for HPV vaccination, with 26 countries offering free vaccination for both girls and boys. In 22 of these countries, the nine-valent HPV vaccine is the only option available for free under national programs. Estonia and Ireland are exceptions, where a single dose of Gardasil 9 is administered. Most countries adhere to the approved vaccination schedules, though slight variations exist. The predominant criterion for selecting vaccine suppliers in national tenders is the lowest price offered. Conclusions: HPV vaccination programs across the EU are uniformly funded through public health systems, yet access to free vaccination and specific program details vary by country. These variations reflect the diverse healthcare systems and procurement strategies in place, which can impact the systemic approach to HPV prevention. Further harmonization of vaccine procurement and implementation strategies may enhance the effectiveness and equity of HPV vaccination across Europe.

Relationship between knowledge and attitude about human papillomavirus infection and vaccination in female nursing students

Introduction: Human papillomavirus (HPV) infection is the primary cause of cervical cancer, which is the second-leading cause of women’s death in Indonesia, and that is why a national HPV vaccination program is required to address this issue. A preliminary survey of 20 female nursing students revealed that 70% were unaware of the HPV virus, 80% were unaware of cervical cancer, and 80% were unaware that HPV could lead to cervical cancer. This study aimed to determine the relationship between knowledge and attitude about human papillomavirus infection and vaccination in female nursing students. Methods: This descriptive-quantitative study used a cross-sectional design and univariate and bivariate analysis.

Population-level health impact of hypothetical waning 1-dose human papillomavirus vaccination and 2-dose mitigation strategies in a high cervical cancer burden setting.

We simulated the impact of hypothetical waning scenarios of a 1-dose human papillomavirus (HPV) vaccination paired with switching to 2-dose mitigation strategies guided by empirical vaccine trial reporting timelines. Using 2 independent mathematical models fitted to a high-burden setting, we projected the cumulative cervical cancer cases averted over 85 years for alternative HPV vaccination scenarios under 2 program adoption timelines: 1) de novo introduction of a 1-dose HPV vaccination and 2) a switch from an existing 2-dose HPV vaccination program to a 1-dose vaccination. We assumed 80% vaccination coverage with the bivalent vaccine and an average duration of a 1-dose HPV vaccine protection of either 30 or 25 years with 100% efficacy. We varied the eligible age group(s) at program introduction and the 2-dose mitigation (single-age cohort or multi-age cohort). If needed for mitigation, reintroduction of 2-dose vaccination was assumed to occur in 2036 (ie, 30 years after initiation of the Costa Rica Vaccine Trial). Under both vaccine adoption timelines, the models projected that countries could achieve the same level of health benefits by switching to 2 doses in 2036 using a multi-age cohort approach as with initiating a 2-dose or 1-dose vaccination program with no waning. With only a single-age cohort 2-dose mitigation approach, 98%-99% of cases would be prevented compared with the health benefits of 2 doses or a noninferior, durable 1 dose. Countries hesitant to adopt a 1-dose HPV vaccination program may have opportunities to leverage the benefits and efficiency of a 1-dose schedule while awaiting longer-term reporting from 1-dose durability studies, including Costa Rica Vaccine Trial.

The Burden and Prevention of Human Papillomavirus (HPV) Infections and Cervical Cancer in India: A Literature Review.

Human papillomavirus (HPV) is a widespread viral infection affecting the reproductive tract and is associated with multiple types of cancer. It is a significant global health concern, with cervical cancer being one of the most common cancers affecting women worldwide. HPV infection has been found in both married and unmarried women.The burden of cervical cancer is particularly high in middle- and low-income countries, where HPV vaccination and screening programs are often limited. India faces a substantial challenge with cervical cancer and HPV infection. Cervical cancer ranks as one of the leading cancers among women in India. Studies over recent decades have indicated varying levels of HPV prevalence in the general female population in India. Recognizing the importance of addressing this issue, the Government of India has prioritized cervical cancer elimination as a national public health goal. A strategic plan has been launched to increase cervical cancer screening coverage in adult women and HPV vaccination coverage in girls. This review examines literature published from 2000 to 2023 on the epidemiology of cervical cancer and HPV in India. It also explores the development of prevention strategies, focusing on cervical screening and HPV vaccination programs. Government policy documents were analyzed to understand the national strategic vision and targets. The review concludes by discussing ongoing challenges and future directions for cervical cancer elimination efforts in India.

The Effect of Cervical Cancer Education Given to Women in Turkey on Knowledge, Attitudes, and Health Beliefs: A Randomized Controlled Study.

The objective of this study was to ascertain the impact of cervical cancer education provided to women in Turkey on their knowledge, attitudes, and health beliefs. The study was conducted in accordance with the pretest-posttest randomized controlled trial model. The participants were randomly assigned to either the experimental or the control groups. The study was completed with a total of 105 women, 51 of whom were in the experimental group and 54 of whom were in the control group. The personal information form, the human papillomavirus (HPV) knowledge scale, and the health belief model scale for cervical cancer and Pap smear test were employed as data collection instruments. The data were analyzed using the SPSS 25.0 package program, and the number, percentage, independent samples t-test, and paired t-test were utilized for data analysis. Upon completion of the training program, the mean scores of the experimental group demonstrated a statistically significant increase in knowledge related to general HPV information, HPV screening tests, general HPV vaccines, and HPV vaccine programs when compared to the control group (p<0.001). Upon conclusion of the educational intervention, it was determined that the mean scores of cervical cancer sensitivity, caring, health motivation, Pap smear utility, and motivation of women in the experimental group exhibited an increase, while their general perception of Pap smear demonstrated a decrease (p<0.05). The findings of this study indicate that educational initiatives targeting women regarding cervical cancer have a beneficial impact on their knowledge, attitudes, and health beliefs. NCT05990270 registered on https://clinicaltrials.gov/.

The effect of digital storytelling on women's human papilloma virus awareness: Randomized controlled experimental study.

This study aims to determine the effectiveness of the digital storytelling (DS) method in increasing human papilloma virus (HPV) awareness. The study was conducted in the gynecology and obstetrics outpatient clinic of a state hospital between April and December 2023. The universe of the study consisted of women who applied to the outpatient clinic between these dates and volunteered. A total of 80 women who met the inclusion criteria were included in the study (n = 40 for each group). Data for the study were gathered using Personal Introduction Form and Human Papilloma Virus Knowledge Scale. Repeated measures ANOVA method was used to determine the difference between the pre-training, post-first training and post-second training measurement scores according to the intervention and control groups. For significant ANOVA results, measurements with differences were compared pairwise using Bonferroni correction. All statistical analyses were examined at the p < 0.05 significance level. Socio-demographic characteristics and HPV awareness levels of women in the intervention and control groups were similar before training (p > 0.05). After the activity conducted with the digital story method in the intervention group, the HPV awareness levels of women in this group increased significantly (p < 0.05). Considering the development in each group, an increase in posttest scores is observed in both groups. However, when the increase amounts in each group in the intervention and control groups were examined, it was determined that all awareness levels increased more in the intervention group. In the intergroup comparison, it was determined that the mean measurements of general HPV knowledge, general HPV vaccine knowledge, and knowledge of the current HPV vaccination program of women in the intervention group at the first and second follow-ups after the training were higher than those in the control group. The DS method was effective in raising HPV awareness given to the intervention group. Health professionals and researchers can benefit from DS in providing health education and consultancy services such as HPV awareness.

Sexual Function and Quality of Life in Iranian Women With Human Papillomavirus Infection.

Considering the prevalence of Human Papillomavirus (HPV) infection and the lack of HPV vaccination program in Iran among young women and the importance of quality of life and sexual performance in women, we decided to conduct a study to examine the relationship between HPV infection and sexual dysfunction and quality of life in Iranian women. In this cohort study, 250 married women who infected with HPV were recruited via convinence sampling from colposcopy clinic of Arash women hospital (Tehran, Iran) from April 2020 to May 2022.They were evaluated concerning their sexual function in the domains of desire, arousal, lubrication, orgasm, satisfaction and pain with the female sexual function index (FSFI) questionnaire (the total FSFI score is calculated by the sum of the nineteen items). Sexual quality of life-female (SQOL-F) items (Likert-type scale with a cut-off of 65 points) were organized into four sub-scales: psychosexual feelings, sexual and relationship satisfaction, self-worthlessness, and sexual repression. All patients filled out the female sexual function index (FSFI) and sexual quality of life (SQOL) questionnaires. Variables were analysed via correlation coefficient and linear regression tests. Mean age and mean marriage duration were 38.5±4.5 and 12.2±7.2, respectively. There was a weak correlation between FSFI and SQOL (r=0.15, p=0.001).Time of marriage and genital warts were the predictors on the FSFI and SQOL. The findings suggest that HPV infection can impair sexual function and quality of life. This research contributes valuable insights, especially considering the prevalence of HPV.

Switching from a 2-dose to a 1-dose program of gender-neutral routine vaccination against human papillomavirus in Canada: a mathematical modelling analysis.

Worldwide, countries are examining whether to implement 1-dose human papillomavirus (HPV) vaccination instead of using 2 doses. To inform policy, we sought to project the population-level impact and efficiency of switching from 2-dose to 1-dose gender-neutral routine HPV vaccination in Canada. We used HPV-ADVISE, an individual-based transmission-dynamic model of HPV infections and diseases, to mathematically model vaccination programs in 2 provinces, Quebec, a province with high HPV vaccination coverage (around 85%), and Ontario, which has lower coverage (around 65%). We examined non-inferior and pessimistic scenarios of the efficacy (vaccine efficacy of 98% or 90%) and average vaccine duration (lifelong, 30 yr, or 25 yr) of 1 dose compared with 2 doses (98% vaccine efficacy, lifelong vaccine duration). Our main outcomes were the relative reduction in HPV-16 (by sex) and cervical cancers, and the number of doses needed to prevent 1 cervical cancer. Our model projected that 1-dose HPV vaccination would avert a similar number of cervical cancers as 2 doses in Canada, under various scenarios. Under the most pessimistic scenario (25-yr vaccine duration), 1-dose vaccination would avert fewer cervical cancers than 2 doses, by about 3 percentage points over 100 years. All 1-dose scenarios were projected to lead to elimination of cervical cancer (< 4 cervical cancers/100 000 female-years) and to be a substantially more efficient use of vaccine doses than a 2-dose scenario (1-dose v. no vaccination = 800-1000 doses needed to prevent 1 cervical cancer; incremental doses for 2-dose v. 1-dose vaccination > 10 000 doses needed to prevent 1 additional cervical cancer). If the average duration of 1-dose protection is longer than 25 years, a 1-dose HPV vaccination program would protect those vaccinated during their peak ages of sexual activity and prevent a similar number of HPV-related cancers as a 2-dose program, while being a more efficient use of vaccine doses.

The AOFOG recommendations on human papillomavirus vaccination in the Asia-Pacific region.

Cervical cancer remains a disease burden in Asia. The Asia and Oceania Federation of Obstetrics and Gynecology envisages a need to produce a set of recommendations on the implementation of human papilloma virus vaccination program for both lower-middle-income countries (LMICs) and high-income countries (HICs), with an attempt to harmonize the practices yet allow flexibility to cater for different cultures, religions, needs and background of individual countries/cities. International guidelines and literature were sought, and recommendations were made in seven selected areas, including (i) the target groups for vaccination, (ii) the doses of vaccination including the use of single-dose vaccination, (iii) the types of vaccines, (iv) suggestions for special populations including those with previous HPV infection, human immunodeficiency virus carriers, and lesbian, gay, bisexual, transgender, questioning/queer group, (v) inter-changeability and the need of revaccination/booster, (vi) novel technologies and vaccines, and (vii) public education.

Pediatric Oncology Providers' HPV Vaccine Knowledge, Attitude, Self-Efficacy, and Practice after Communication Training: A Comparison with a National Survey.

Human papillomavirus (HPV) vaccinations prevent HPV infection and related cancers. Despite being at higher risk of secondary cancers linked to HPV, childhood cancer survivors (CCS) are undervaccinated. This study aimed to compare pediatric oncology providers' knowledge, attitudes, self-efficacy, and practices regarding HPV vaccination among those who participated in a multilevel educational HPV vaccine program with those of a national sample of oncology providers. Between February and March 2023, 39 providers from five pediatric oncology clinics in Texas completed online surveys, assessing knowledge about CCS risk for HPV-related cancers, attitudes towards the HPV vaccine, and confidence in recommending the vaccine to CCS. The results were compared with a national survey of providers conducted in 2019 (n = 195). The findings showed that providers who participated in our program had greater knowledge of CCS increased risk for HPV-related cancers (96% vs. 38%; p < 0.001); greater confidence in discussing and recommending the HPV vaccine (100% vs. 66%, p < 0.001) and addressing parental concerns (100% vs. 69%, p < 0.001); and a more positive attitude about oncology providers than general pediatricians, recommending (96% vs. 71%; p = 0.006) and administering the HPV vaccine to CCS (96% vs. 53%, p < 0.001). This study underscores the importance of educating oncology providers about the increased risk of CCS and improving their self-efficacy to recommend the HPV vaccine, promoting vaccination in the oncology setting.

Developing films to support vaccine-hesitant, ethnically diverse parents’ decision-making about the human papillomavirus (HPV) vaccine: a codesign study

ObjectiveTo illustrate an evidence-, theory- and person-based approach to codesign the COMMUNICATE films that support parental decision-making about the human papillomavirus (HPV) vaccine for their teenagers.DesignCodesign study.SettingLocalities covered by two...

Human papillomavirus (HPV) vaccination in a privately funded program in Ghana: A qualitative case study

ABSTRACT HPV vaccination is one of the safest and most effective interventions against HPV-related cancers. From 2013 to 2018, HPV vaccination was piloted in Ghana in preparation for a national program. Yet, at the time of this study, there was no publicly funded HPV vaccination program in Ghana. We explored an existing privately funded HPV vaccination program in Ghana to identify challenges and gaps and to gather insights to inform vaccination practice and national policy. This study used a qualitative case study research design. We conducted semi-structured interviews on experiences, barriers, and challenges in HPV vaccination at the Greater-Accra Regional Hospital between October 1 and November 26, 2023. Participants (N = 16) included HPV vaccinators (n = 8) and program/policy leaders (n = 8). Our thematic analysis focused on HPV vaccination processes, practice challenges, and policy interests. Four main themes emerged from our analyses. Our findings revealed many challenges faced by the HPV vaccination program. These include a lack of guiding policy/framework for the HPV vaccination program, an emphasis on sexual history, cervical screening, and HPV DNA test in determining vaccination eligibility by vaccinators, and a lack of formal provider and recipient HPV education programs. Although many vaccinators advocated for a universal HPV program, some policy/program leaders were reluctant to prioritize HPV vaccination advocacy due to their focus on acute health concerns. A vaccination program without a policy can be limited in quality and efficiency, as there will be no accountability and sustainability measures. We recommend the need to develop standardized guidelines to support evidence-based HPV vaccination practice.

Evaluating the effectiveness of the HPV vaccination programme in England, using regression discontinuity design

Objective and ApproachIn England, the National human papillomavirus (HPV) HPV Immunisation Programme was introduced for young girls in 2008. Whilst clinical trials have shown high vaccine effectiveness, real-world evidence is still accruing. Estimating vaccine effectiveness based on real-world data without randomised control trials is challenging, but critical for policy makers. Using Census 2011 data and a population level linked dataset, we exploit a regression discontinuity design (RDD) to assess the impact of the catch-up vaccination programme on cervical dysplasia and cancer diagnoses as recorded in hospital and mortality data in girls born between 1987 and 1992. ResultsWe estimate that vaccination reduces the incidence of cervical dysplasia diagnoses by 27% and cervical cancer diagnoses by 75% respectively. Girls were followed for a 7-year period between ages 23 and 30 years in girls who were offered vaccination at ages 17 to 18 years as part of the catch-up cohort compared to those who were not eligible for HPV vaccination. Conclusions and ImplicationsOur work demonstrates how pivotal the HPV vaccination programme has been for reducing adverse cervical outcomes in young women. Additionally, it shows that the estimates of the effectiveness of HPV vaccination obtained using a RDD are comparable to those based on more classic observational studies. This work shows real world vaccination effectiveness and demonstrates how pivotal the national HPV campaign has been in young girls.

SEOM-GEICO Clinical Guidelines on cervical cancer (2023)

Cervical cancer (CC) is the fourth most common cancer and the fourth leading cause of mortality in women worldwide. It is strongly associated with high-risk human papillomavirus infection. High-income countries that have implemented human papillomavirus (HPV) vaccination and screening programs have seen dramatic reductions in CC incidence, while developing countries where these programs are not available continue to experience high rates of CC deaths. In early-stage CC, the primary treatment is surgery or radiotherapy, whereas concurrent chemo-radiotherapy (CRT) remains the conventional approach in locally advanced stages until the upcoming approval of immunotherapy. The incorporation of immunotherapy in combination with chemotherapy (with or without bevacizumab) in first line and as monotherapy in second line after platinum-based chemotherapy, has significantly increased overall survival (OS) in recurrent or metastatic CC. The purpose of this guideline is to summarize the most relevant evidence in the diagnosis, treatment, and follow-up of CC and to provide evidence-based recommendations for clinical practice.

Human Papillomavirus Vaccination in the Postpartum Period: A Systematic Review.

To assess whether routine postpartum human papillomavirus (HPV) vaccination is acceptable and feasible and to identify key themes and strategies that can be used to increase postpartum HPV vaccination rates. PubMed and ClinicalTrials.gov were queried from inception to July 2024 for postpartum and HPV vaccination. Studies were limited to human subjects and the English language. Screening was performed for studies of any method that evaluated HPV vaccination in the postpartum period (N=60). Only original research that reported either uptake or acceptability of the HPV vaccine was included. Thirty-nine studies were eliminated after abstract review because they did not meet the inclusion criteria. Nine studies were categorized according to the primary aim of the study (defining the problem, assessing patient perspectives, or testing interventions to increase vaccination) and demonstrated that postpartum HPV vaccination programs can significantly increase HPV vaccination rates and are feasible and acceptable to patients. Incorporating HPV vaccination into standard postpartum care provides an opportunity to reach vulnerable patient populations, reduces cost for patients, and has the ability to prevent HPV-related cancers.

The role of mental illness and neurodevelopmental conditions in human papillomavirus vaccination uptake within the Swedish school-based vaccination programme: a population-based cohort study

Despite documented mental illness-related disparities in cervical cancer screening and incidence, insufficient data exist on differences in cervical cancer prevention strategies, such as human papillomavirus (HPV) vaccination. We aimed to investigate the association of mental illness and neurodevelopmental conditions among girls and their parents with uptake of HPV vaccination in Sweden. This population-based cohort study was based on the Swedish school-based HPV vaccination programme, which offers the first vaccine dose to girls aged 10-13 years, with a second dose offered within 12 months. We identified all girls born between Jan 1, 2002, and March 1, 2004, using the Swedish Total Population Register-ie, those eligible for two vaccine doses in the vaccination programme from its initiation in autumn 2012, to March, 2019. Nationwide Swedish register data (National Patient Register, Prescribed Drug Register, HPV Vaccination Register, National Vaccination Register, Total Population Register, Multi-Generation Register, Longitudinal Integrated Database for Health Insurance and Labour Market Studies, Education Register, National Cervical Screening Registry, and Cancer Register) were used to define individual and parental mental health conditions, including mental illness and neurodevelopmental conditions (defined by a clinical diagnosis and prescribed psychotropic medication use), HPV vaccine uptake (first and second dose), and sociodemographic and clinical characteristics. The two outcomes were uptake of the first HPV vaccine dose by the girl's 14th birthday and uptake of the second dose by the 15th birthday in relation to individual and parental mental health conditions, calculated using multivariable Poisson regression models. 115 104 girls were included in the study population. 2211 girls (1·9%) had a specialist diagnosis of any mental health condition. Uptake of the first HPV vaccine dose was 80·7% (92 912 of 115 104) and was lower among girls with versus without any mental health condition (adjusted relative risk 0·89 [95% CI 0·87-0·91]). The diagnosis of autism (0·79 [0·75-0·85]) or intellectual disability (0·78 [0·73-0·83]) were most strongly associated with lower HPV vaccine uptake. Vaccine uptake was also lower among girls with versus those without prescribed use of psychotropic medication (0·93 [0·92-0·95]), with the strongest association observed for antipsychotics (0·68 [0·56-0·82]). Uptake of the second dose was 95·0% (88 308 of 92 912), with no strong associations between uptake and mental health conditions in girls or their parents. Our findings suggest disparities in cervical cancer prevention among girls with mental health conditions, and call for further research to ensure equitable protection. Swedish Cancer Society.