HPV vaccination in Colombia. From a nightmare to a bright and promising dawn
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C Castro et al. (2020). HPV vaccination in Colombia. From a nightmare to a bright and promising dawn. www.HPVWorld.com, 105 Lea este artículo en español
In August 2012 the HPV vaccine was introduced in the national immunization program. It was a school-based program directed to girls in 4th grade of primary school and aged 9 years and older. National coverage rates were over 80% until June 2014, when reports of adverse symptoms (headache, paresthesia, shortness of breath, chest pain and fainting) were reported from over 500 girls who have received the HPV vaccine months before and who were residing in Carmen de Bolivar. This is a small town in the north of Colombia suffering from socioeconomic deprivation and severely affected by intrafamilial and political violence. An epidemiological study concluded that the symptoms did not have a biological relationship with the HPV vaccine and could be due to a mass stress reaction or mass psychogenic illness. The national media, as well as social media, diffused videos of girls fainting, twitching, and arriving unconscious at emergency rooms; the response to the crisis was late and inappropriate and the public confidence on the vaccine dropped and national coverage rates fell to as low as 14% and 5% for the 1st and 2nd dose in 2016.
Figure 1 illustrates the tragic impact of this drop in the prevention of cervical cancer. In the cohort of girls born in 2003 and who received the HPV vaccine in 2012 (with a coverage rate of 88% for the 2nd dose), 4,300 new cases of cervical cancer and 1,900 deaths from this cancer will be avoided when these women have reached 75 years of age. On the other hand, in the cohort of girls born in 2007 and who received the vaccine in 2016 (with a coverage rate of 5% for the 2nd dose), only 220 new cases of cervical cancer will be avoided when these women have reached 75 years of age. In other words, it is estimated that 13 new cases of cervical cancer and 6 deaths from cervical cancer will be avoided in women reaching 75 years of age for every 1000 girls vaccinated against HPV.
Following the Carmen de Bolivar crisis, the school-based HPV vaccination was stopped and a “Mesa de Concertacion”, a roundtable for the elimination of HPV-related cancer in Colombia, was organized by the Colombian League Against Cancer, Profamilia, scientific societies, parent associations, and the Ministry of Health. The response to the HPV vaccination crisis was late and inappropriate and the public confidence on the vaccine dropped dramatically. National coverage rates fell to as low as 14% for the first dose and 5% for the second dose in 2016.
In addition, an e-course on efficacy and safety of the HPV vaccine was developed by the Catalan Institute of Oncology (ICO) and the Colombian Cancer Institute to educate medical and paramedical personnel. So far, over 5,000 participants have completed the course. International collaboration has also been established with the HPV Prevention and Control Board that convened a meeting in Bogota, Colombia in November 2018 to help regaining confidence on the HPV vaccine. The following activities have been performed in the last two years:
1. The Arauca project The Colombian League Against Cancer started a project in Arauca in June 2018 in collaboration with the Colombian Ministry of Health, the local health authorities, and the American Cancer Society and Johns Hopkins University to regain confidence on the HPV vaccine. Arauca is one of the Colombian departments with the highest political instability and violence and a very high mortality rate from cervical cancer (11.4 per 100,000) and one of the lowest HPV vaccination rates (4.7% in 2017). Girls to be vaccinated, parents of the girls, the teachers, the health care providers, and the local mass media were interviewed regarding the attitudes and beliefs towards the vaccine. Based on the information collected a new communication strategy was developed from a bio-psycho-social perspective to educate and sensitize all these groups on the benefits and safety of the HPV vaccine. Tailored leaflets and videos were developed, basic lectures were delivered and the ICO/NCI online course on the efficacy and safety of the HPV vaccine was taken by the health care providers. The target population, girls of 9 years of age, is 2,340 in 2019. Eighteen months after starting the project, the coverage rate for the 1st vaccine dose increased significantly from 4,7% in 2017 to 41% in 2018 and to 83% in 2019. Since most of the increase in the 1st dose occurred in the last 6 months of 2019, coverage for the 2nd dose will be best assessed in the first 6 months of 2020.
Table 1 summarizes the changes in the coverage rates from 2018 to 2019 in the departments of Arauca, Antioquia, Nariño and Valle del Cauca and their respective capital cities, Arauca, Medellin, Pasto, and Cali. In 2019, the HPV vaccine coverage rates in these departments are higher than the rates for the whole country (33% for the first dose and 11% for the second dose). To increase coverage of the 2nd dose a delayed second dose strategy is being discussed; currently the 2nd dose is being administered 6 months after the 1st dose. These data show that when there is political will, it is possible to recover the HPV vaccination program. These strategies should be repeated in all regions of the country.
DISCLOSURE
The authors declare nothing to disclose.
LEA ESTE ARTÍCULO EN ESPAÑOL:
C Castro et al. (2020). Vacunación contra el VPH en Colombia. De la pesadilla a un resplandeciente y prometedor amanecer