1.
WHAT IS CERVICAL CANCER EXPERTS STAND ON
ONE DOSE RECOMMENDATION FOR
HPV VACCINES
FOR ADOLECENT GIRL OF 9-14 YEARS

2.
WHAT IS CERVICAL CANCER EXPERTS STAND ON
ONE DOSE RECOMMENDATION FOR HPV
VACCINES AS
ADVOCATED BY WORLD HEALTH
ORGANIZATION-STRATEGIC ADVISORY
GROUP OF EXPERTS ON IMMUNIZATION
(WHO-SAGE)?

3.
What has made
WHO-SAGE take this decision?
SAGE reviewed global progress on HPV
vaccination and expressed concern at the slow
pace of vaccination coverage rates, high
dropout rates between doses in many
countries, and the adverse impact of the
COVID-19 pandemic.

4.
What has made WHO-SAGE
take this decision?
As of March 2022, 117 countries had HPV
vaccine in their national immunization
programs, representing only one-third of the
global population of girls and 40% of the global
burden of cervical cancer but the estimated
global coverage with a 2nd dose in girls was
only 13%.

5.
What has made WHO-SAGE
take this decision?
• Hence WHO-SAGE opined that with the
current trends, the 2030 vaccination coverage
• Target of 90%, set in the Global Cervical
Cancer Elimination Strategy, is unlikely to be
met.
• Hence to boost coverage rate, they opined
for including an option for countries to
consider offering a single-dose regimen of
HPV vaccines for primary adolescent girls

6.
On what clinical evidence was their
recommendation based?
SAGE reviewed the evidence from an
updated systematic review on the
immunogenicity, efficacy, and effectiveness
of single-dose vaccination schedules
compared with no vaccination, and
multidose schedules.

7.
On what clinical evidence was their
recommendation based?
The review showed comparable efficacy and
effectiveness between single- and multi dose
schedules in preventing persistent infection with
HPV serotypes 16 and 18, lasting up to 10 years
following vaccination.
However, antibody levels following a single dose
were lower than those following multi-dose
schedules, but they remained stable and sero-
positivity against HPV 16 and 18 persisted up to 11
years following a single dose.

8.
On the basis of this data, WHO-SAGE opined
that national immunization programs can use
either a single-dose or a 2-dose vaccination
schedule with an interval between doses of at
least 6 months for 9–14-year-olds
On what clinical evidence was their
recommendation based?

9.
Has a one-dose study been
conducted in India?
• Basu P et al conducted a randomized study to
compare vaccine efficacy of single dose qHPV vaccine
to that of 2 and 3 in protecting against persistent HPV
16 and 18 infections at 10 years post vaccination.
• Unmarried girls (~17,729) aged 10–18 years were
allocated to different cohorts (1 dose, 2 dose or 3
dose qHPV vaccine).
• Vaccine efficacy against persistent HPV 16 and 18
infections was analyzed for single- dose recipients and
compared with that in 2 and 3-dose recipients.

10.
Has a one-dose study been
conducted in India?
• That at ten years a single dose of qHPV
vaccine provides similar protection against
persistent infection (from HPV 16 and 18) to
that provided by two or three doses.
• The results from this study (along with those
conducted in Australia, USA, Denmark and
Sweden) must have been considered by
WHO-SAGE when they drafted their
recommendations

11.
What are the
Take Home Messages for us?
There remain substantial uncertainties related to
the single dose use of HPV vaccines, including
limited data demonstrating long-term protection
against certain HPV-related cancers and diseases
and no randomized controlled trial data on its
efficacy against cervical and non-cervical HPV-
related pre cancers or cancers. In addition, there
are no data on efficacy in males and no
randomized-controlled clinical trial data in those
with immuno compromising conditions.

12.
What are the
Take Home Messages for us?
In addition, there are no data on efficacy in
males and no randomized-controlled clinical
trial data in those with
immuno-compromising conditions.

13.
What about the CERVAVAC -the
Indian vaccine
at present two dose should be given.
Once the data shows there is no decrease
in efficacy  decision may be taken in
future of single dose

14.
GOI is Committed

15.
No hurry to recommend single dose of CERVAVAC