Introduction of a National HPV vaccination program into Bhutan |
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| Affiliation: | 1. Communicable Disease Division, Department of Public Health, Ministry of Health, Thimphu, Bhutan;2. Department of Obstetrics & Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan;3. Department of Laboratory Services, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan;4. International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France;1. Herman Deleeck Centre for Social Policy, University of Antwerp, St Jacobstraat 2, 2000 Antwerp, Belgium;2. Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium;3. Center for Statistics (CenStat), Hasselt University, Agoralaan, Building 3, 3590 Diepenbeek, Belgium;4. Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium;5. National Alliance of Christian Mutualities, Haachtsesteenweg 579, 1031 Brussel, Belgium;6. Department of Public Health and Primary Care, Environment and Health, KU Leuven, Kapucijnenvoer 35 blok D, Box 7001, 3000 Leuven, Belgium;7. Agency for Care and Health, Infectious Disease Control and Vaccinations, K. Albert II laan 35 Box 33, 1030 Brussels, Belgium;1. Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA;2. Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA;3. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia;4. Emory Vaccine Center, 954 Gatewood Road, Atlanta, GA 30329, USA;1. Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon;2. College of Medicine, Medical University of South Carolina, Charleston, SC, USA;1. University of Massachusetts Medical School, Worcester, MA, United States;2. Pathfinder International, Watertown, MA, United States;3. Northeastern University, Boston, MA, United States;4. Cameroon Baptist Convention Health Services, Bamenda, Cameroon;1. Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA;2. Center of Excellence for Health Disparities Research–El Centro, School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA;3. Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Program (CERP), Institut Català d’Oncologia – Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat (Barcelona), Spain;4. Uganda Cancer Institute; Makerere College of Health Sciences, Makerere University, Kampala, Uganda |
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| Abstract: | BackgroundCervical 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.MethodsMoH considerations included disease incidence, the limited reach of cervical screening, poor outcomes associated with late diagnosis of the disease, and Bhutan'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 one-time 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, with out-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.ResultsDuring the initial campaign in 2010, over 130,000 doses of QHPV were administered and QHPV 3-dose vaccination coverage was estimated to be around 99% among 12 year-olds and 89% among 13–18 year-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%.DiscussionThe 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.ConclusionsBhutan'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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| Keywords: | Cervical cancer Vaccination Human papillomavirus Bhutan |
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