After 5 years of follow-up of a double-blind, randomised, controlled ESCUDDO study, a single dose of either a bivalent or nonavalent HPV vaccine provided similar protection to that of two doses, which is the standard regimen for adolescents. Assessment of the timing of the events over the 5-year study period indicated that protection persisted through at least 5 years.
The authors concluded that high-coverage HPV vaccination is a mainstay of cervical cancer control efforts, but to date not even one third of eligible adolescent girls worldwide have received the vaccine, which has been licensed for almost 20 years. The evidence from this study supports the WHO alternative recommendation for single-dose HPV vaccination to achieve higher coverage while maintaining sufficiently high efficacy.
In an era of sufficient vaccine supply, a broader view of equity in HPV vaccination can be taken. Although adolescent girls remain the highest priority, additional groups stand to benefit from vaccination in the near term, including young women who missed vaccination during adolescence (i.e., catch-up vaccination), persons with HIV, men who have sex with men, and persons in communities with a high prevalence of HPV. Expanding vaccination access in these populations, while maintaining focus on the 9 to 14 year old cohort, could have a substantial population level effect.
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