Recommendations on a Human Papillomavirus Immunization Program

4. Immunization Strategies

Four options for publicly funded HPV immunization programs were considered initially for the disease modelling and the economic analysis. Under each option, estimations for coverage are included.

Option 1: One female cohort selected from grades 4 to 7 (aged 9-14)

1. To immunize 80% of school-aged girls in either grade 4, 5, 6 or 7 with the required doses of the HPV vaccine within 2 years of program introduction.
2. To immunize 90% of school-aged girls in either grade 4, 5, 6 or 7 with the required doses of the HPV vaccine within 5 years of program introduction.

Option 2: Two female cohorts from grades 4 to 12 (aged 9-18)

1. To immunize 80% of two cohorts of school-aged girls between grades 4 and 12 with the required doses of the HPV vaccine within 2 years of program introduction.
2. To immunize 90% of two cohorts of school-aged girls between grades 4 and 12 with the required doses of the HPV vaccine within 5 years of program introduction.

Option 3: School-based program, multiple female cohorts (at minimum one cohort from each elementary, junior and high school age group, i.e. a total of three cohorts)

1. To immunize 80% of school-aged girls within the cohorts vaccinated, at least one cohort from each of elementary, junior and high school grades, with the required doses of the HPV vaccine within 2 years of program introduction.
2. To immunize 90% of school-aged girls within the cohorts vaccinated, at least one cohort from each of elementary, junior and high school grades, with the required doses of the HPV vaccine within 5 years of program introduction.

Table 1 illustrates option 3, with immunization of grades 4, 7 and 12 females. It reflects the duration/number of years for which three cohorts, two cohorts and then only routine HPV immunization of one cohort would have to be continued.

Option 4: All females in the recommended range of 9-26 years (option 1 is included in this option; this is mostly a catch-up program)

1. To immunize 80%* of women aged 9 through 16 with the required doses of HPV vaccine within 2 years of program introduction.
2. To immunize 60% of women aged 17 through 26 with the required doses of HPV vaccine within 5 years of program introduction.

* Assumptions:

• Catch-up of all school-aged females will take place in 2 years.
• Opportunistic immunization of other cohorts aged 15-26 will occur outside school programs as these individuals visit a health care provider.