Introduction of a national HPV vaccination program into Bhutan

Journal of Cytology & Histology

ISSN: 2157-7099

Open Access

Introduction of a national HPV vaccination program into Bhutan

International Conference on Cytopathology

August 31-September 02, 2015 Toronto, Canada

Sangay Phuntsho

University of California, USA

Posters-Accepted Abstracts: J Cytol Histol

Abstract :

Background: Cervical cancer is the most common cancer in Bhutanese women. To help prevent the disease, the Ministry of Health (MoH) developed a national human papillomavirus (HPV) vaccine program. Methods: MoH considerations included disease incidence, the limited reach of cervical screening, poor outcomes associated with late diagnosis of the disease and Bhutanâ??s ability to conduct the program. For national introduction, it was decided to implement routine immunization for 12 year-old girls with the quadrivalent HPV6/11/16/18 (QHPV) vaccine and a onetime catch-up campaign for 13-18 year-old girls in the first year of the program (2010). Health workers would administer the vaccine in schools without-of-school girls to receive the vaccine at health facilities. From 2011, HPV vaccination would enter into the routine immunization schedule using health-center delivery. Results: During the initial campaign in 2010, over 130,000 doses of QHPV were administered and QHPV3-dose vaccination coverage was estimated to be around 99% among 12 year-olds and 89% among 13-18year-olds. QHPV vaccine was well tolerated and no severe adverse events were reported. In the three following years, QHPV vaccine was administered routinely to 12 year-olds primarily through health centers instead of schools during which time the population-level 3-dose coverage decreased to 67-69%, an estimate which was confirmed by individual-level survey data in 2012 (73%). In 2014, when HPV delivery was switched back to schools, 3-dose coverage rose again above 90%. Discussion: The rapid implementation and high coverage of the national HPV vaccine program in Bhutan were largely attributable to the strength of political commitment, primary healthcare and support from the education system. School-based delivery appeared clearly superior to health centers in achieving high-coverage among 12 year-olds. Conclusions: Bhutanâ??s lessons for other low/middle-income countries include the superiority of school-based vaccination and the feasibility of a broad catch-up campaign in the first year.

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