Dorji Thinley, Nopsopon Tanawin, Tamang Saran Tenzin, Pongpirul Krit
Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan.
EClinicalMedicine. 2021 Apr 17;34:100836. doi: 10.1016/j.eclinm.2021.100836. eCollection 2021 Apr.
The proportion of incident cases of HPV-attributable cancers is highest in the low- and middle-income countries (LMICs) but many are yet to initiate HPV vaccination programs. This meta-analysis was performed to assess the uptake of HPV vaccination in LMICs at the beginning of the global strategy to eliminate cervical cancer and describes the gaps and challenges.
A systematic search was conducted in PubMed, EMBASE, Scopus, Web of Science, and CENTRAL databases for observational studies that reported the uptake of HPV vaccination until October 2020. The meta-analysis was done using a random-effects model to assess the pooled estimate of HPV uptake. CRD42021218429.
During 2008-2020, an estimated 3.3 million females received at least one dose of HPV vaccine with 61.69% of the target population vaccinated. In countries with high uptake, the pooled estimate of uptake was higher in females than males (45.48% vs 8.45%) and showed significant decline in 2015-2020 compared to 2006-2014 (89.03% vs 41.48%). In countries with low uptake, the estimate of uptake was low in both males and females (5.31% vs 2.93%) and showed increase in uptake in 2015-2020 compared to 2006-2014 (0.76% vs 5.22%). In countries with high uptake, compared to routine programs, the estimate was higher when delivered through demonstration programs (89.94% vs 59.74%).
The major concern was a significant drop in the uptake in countries that started with high uptake, challenges in the maintenance of vaccine uptake, sustainability of funding and the lack of standard monitoring and reporting.
低收入和中等收入国家（LMICs）中，人乳头瘤病毒（HPV）相关癌症的新发病例比例最高，但许多国家尚未启动HPV疫苗接种计划。本荟萃分析旨在评估在全球消除宫颈癌战略初期，LMICs中HPV疫苗的接种情况，并描述其中存在的差距和挑战。
在PubMed、EMBASE、Scopus、Web of Science和CENTRAL数据库中进行系统检索，查找截至2020年10月报告HPV疫苗接种情况的观察性研究。采用随机效应模型进行荟萃分析，以评估HPV疫苗接种的合并估计值。CRD42021218429。
在2008 - 2020年期间，估计有330万女性接种了至少一剂HPV疫苗，占目标人群的61.69%。在高接种率国家，女性的合并接种估计值高于男性（45.48%对8.45%），且与2006 - 2014年相比，2015 - 2020年显著下降（89.03%对41.48%）。在低接种率国家，男性和女性的接种估计值都很低（5.31%对2.93%），与2006 - 2014年相比，2015 - 2020年接种率有所上升（0.76%对5.22%）。在高接种率国家，与常规项目相比，通过示范项目实施时接种估计值更高（89.94%对59.74%）。
主要问题是高接种率国家的接种率显著下降、维持疫苗接种面临挑战、资金可持续性以及缺乏标准的监测和报告。
