Dorji Tandin, Tshomo Ugyen, Phuntsho Sangay, Tamang Tshewang Dorji, Tshokey Tshokey, Baussano Iacopo, Franceschi Silvia, Clifford Gary
Communicable Disease Division, Department of Public Health, Ministry of Health, Thimphu, Bhutan.
Department of Obstetrics & Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
Vaccine. 2015 Jul 17;33(31):3726-30. doi: 10.1016/j.vaccine.2015.05.078. Epub 2015 Jun 6.
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.
MoH 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.
During 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%.
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.
Bhutan'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.
宫颈癌是不丹女性中最常见的癌症。为帮助预防该疾病，卫生部制定了一项全国性人乳头瘤病毒（HPV）疫苗接种计划。
卫生部考虑的因素包括疾病发病率、宫颈癌筛查覆盖范围有限、疾病晚期诊断导致的不良后果以及不丹开展该计划的能力。为在全国推行，决定对12岁女孩实施四价HPV6/11/16/18（QHPV）疫苗常规免疫，并在该计划实施的第一年（2010年）对13 - 18岁女孩开展一次性补种活动。卫生工作者将在学校为女孩接种疫苗，校外女孩在医疗机构接种。从2011年起，HPV疫苗接种将通过医疗中心提供纳入常规免疫计划。
在2010年的首次补种活动中，超过13万剂QHPV疫苗被接种，估计12岁女孩的三剂次QHPV疫苗接种覆盖率约为99%，13 - 18岁女孩为89%。QHPV疫苗耐受性良好，未报告严重不良事件。在随后的三年里，主要通过医疗中心而非学校为12岁女孩常规接种QHPV疫苗，在此期间，人群层面的三剂次接种覆盖率降至67% - 69%，2012年的个体层面调查数据（73%）证实了这一估计。2014年，当HPV疫苗接种工作重新转回学校时，三剂次接种覆盖率再次升至90%以上。
不丹全国HPV疫苗计划的快速实施和高覆盖率在很大程度上归因于政治承诺的力度、初级卫生保健以及教育系统的支持。在12岁女孩中实现高覆盖率方面，基于学校的接种方式明显优于医疗中心。
不丹为其他低收入/中等收入国家提供的经验包括基于学校接种的优越性以及第一年广泛补种活动的可行性。
