Summary of the National Advisory Committee on Immunization (NACI) Statement: Updated guidance on human papillomavirus (HPV) vaccines.

BACKGROUND

Without vaccination, approximately 75% of people in Canada will acquire a human papillomavirus (HPV) infection in their lifetime. HPV vaccine coverage rates continue to fall short of the national goal of 90% coverage for two or more doses by 17 years of age. Recent evidence and World Health Organization (WHO) guidance now support a 1- or 2-dose schedule for younger age groups, which can simplify vaccination efforts and improve coverage rates compared to a multi-dose immunization program.

METHODS

The National Advisory Committee on Immunization (NACI) reviewed available evidence on the clinical benefits and risks of a 1-dose HPV vaccine schedule, as well as additional factors, including ethics, equity, feasibility and acceptability. The evidence and programmatic considerations were organized using a process informed by the Grading of Recommendations Assessment, Development and Evaluations (GRADE) framework and all of the information was used to facilitate NACI guidance development.

RESULTS

A 1-dose schedule is highly effective against HPV infection based on available evidence in younger female populations, with current follow-up of up to 11 years following vaccination. Infectious disease modelling shows that a 1-dose strategy in males and females in Canada is expected to have similar health outcomes over the short and long term compared to two doses.

CONCLUSION

NACI updated recommendations for individuals 9 to 20 years of age to receive one dose of 9vHPV (Gardasil-9, Merck) vaccine. For individuals 21 years of age and older, a 2-dose schedule should be administered. Individuals considered immunocompromised and individuals infected with HIV should receive a 3-dose series. NACI also issued a discretionary recommendation for HPV vaccination for individuals 27 years and older, and updated guidance to allow HPV vaccine during pregnancy.