Supplementary appendix - The Lancet · Supplementary appendix ... Barrionuevo-Rosas L, et al....

Supplementary appendixThis appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors.

Supplement to: Bruni L, Diaz M, Barrionuevo-Rosas L, et al. Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis. Lancet Glob Health 2016; 4: e453–63.

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Supplementary appendix

Index

Methods S1. Treatment of missing coverage data ....................................................................................... 1

S1.1) Estimation of missing dose-specific coverage from the available data .......................................... 1

S1.2) Stepwise imputation algorithm for birth cohorts with missing coverage data ................................ 1

S1.3) Validation of the algorithm ............................................................................................................. 1

1. Impact of imputations in the final results .................................................................................... 1

2. Assessment of imputations derived from coverages from adjacent birth cohorts (Steps 1-5) .... 2

3. Sensitivity analysis for steps 6 to 8 of the imputation algorithm ................................................ 2

Methods S2. Prediction of the expected reduction in cervical cancer burden .............................................. 3

Figure S1. Flow diagram of the systematic review ...................................................................................... 5

Figure S2. Methodology for global HPV vaccination coverage calculation ................................................ 6

Figure S3. Regression imputation to predict dose-specific missing data from complete dose coverage data

...................................................................................................................................................................... 7

Figure S4. Final coverage dataset by country and imputation method ......................................................... 8

Figure S5. Correlation between imputed data and original data in 50 simulations .................................... 11

Figure S6. Correlation between imputed data and original data for selected countries .............................. 12

Figure S7. Sensitivity analysis of the global estimate of number of vaccinated girls (full-course) ............ 13

Figure S8. Sensitivity analysis of the global estimate of number of vaccinated girls (full-course) by

income level ............................................................................................................................................... 14

Figure S9. Age distribution of women targeted by national HPV vaccination programmes worldwide .... 15

Figure S10. Number of countries having initiated a National HPV vaccination program by year,

development level and cervical cancer incidence ....................................................................................... 16

Table S1. National HPV Immunization programs worldwide: date of introduction, targets, strategy,

schedule and historical changes (up to October 2014) ............................................................................... 17

Table S2. Data available by birth cohort on National Immunization’s programme HPV vaccination

coverage by country ................................................................................................................................... 30

Table S3. Sources for HPV vaccination coverage data .............................................................................. 32

Table S4. Description of the methods, assumptions and outcomes ........................................................... 36

ii

Table S5. Stepwise algorithm to impute missing specific birth-cohort data coverage ............................... 38

Table S6. Impact of the imputation algorithm in the estimations ............................................................... 39

Table S7. Sensitivity analysis of the global estimate of number of vaccinated girls (full-course) by income

and development level and geographical region......................................................................................... 40

Table S8. Calculation of expected number of cervical cancer cases and deaths up to the age of 74 years

for Denmark’s cohort born in 2000 ............................................................................................................ 41

Table S9. Estimated full-course HPV vaccine coverage and number of vaccinated women as of October

2014 by region ............................................................................................................................................ 43

Table S10. Estimated full-course HPV vaccine coverage and number of vaccinated women as of October

2014 by age group and region .................................................................................................................... 44

Table S11. Estimated one-dose HPV vaccine coverage and number of vaccinated women as of October

2014 by region ............................................................................................................................................ 45

Table S12. Estimated one-dose HPV vaccine coverage and number of vaccinated women as of October

2014 by age group and region .................................................................................................................... 46

References .................................................................................................................................................. 47

1

Methods S1. Treatment of missing coverage data

From 80 countries and territories identified as having implemented a HPV vaccination program through

2014, for five (Bahamas, Belize, French Polynesia, Liechtenstein and Niue) it was no possible to identify

neither targeted birth cohorts nor to obtain vaccination coverages and they were excluded from the

analysis. Coverage data from National HPV immunization programs was retrieved for 39 countries out of

75. Four hundred eighty one (481) point estimates were available for one dose, 369 for 2 doses and 602

for three doses. Combined, 645 birth cohorts had at least one coverage data point estimate and 444 (69%)

both one-dose coverage and full-course coverage.

S1.1) Estimation of missing dose-specific coverage from the available data

First treatment of missing data consisted on the derivation of missing dose-specific coverage from

existing one-dose, two-dose or three-dose coverage data in birth cohorts with incomplete data (197 out of

645). Imputation by linear regression (Figure S3) was performed to calculate missing full-course

coverage from available one-dose coverage (29 birth cohorts), from two-dose coverage (7 birth cohorts).

One-dose coverage was derived from available full-course coverage (2 or 3 doses depending on the

schedule) in 165 birth cohorts). As example, for observed one-dose HPV vaccination coverage of 80%,

73% 3-dose coverage was predicted (a ratio of 1.09). Whereas for a lower one-dose coverage of 10%,

predicted 3-dose coverage was 6.6% (ratio of 1.51). Models satisfied regression assumptions. Through the

analysis of residuals and computation of some dedicated statistics we checked the assumptions of

linearity, normality, homoscedasticity and independence. We also checked for influential observations

(e.g., outliers and observations with high leverage) and collinearity.

S1.2) Stepwise imputation algorithm for birth cohorts with missing coverage data

Second treatment of missing data consisted on the imputation algorithm for targeted birth cohorts without

coverage data (1297 out of 1922. Table S5 shows the stepwise process.1078 birth cohorts out of 1297

where from countries or territories with at least one coverage available from another birth cohort from the

same country or territory. In 45 birth cohorts coverages were derived through linear interpolation from

coverages between two distant birth cohorts with data (Step 1, Table S5). In Canada, Italy and

Switzerland, 106 regional birth cohorts without data were imputed with the national estimate (Table S5,

Step 2). 921 birth cohorts were assigned with the same coverage of the most recent estimation period

from the same country or territory, following WHO’s methodology1 (Table S5, Steps 3-5). In the case of

birth cohorts with an opportunistic strategy, the coverage imputed was reduced 60% when derived from

previous or subsequent organized/catch-up coverages (Table S5, Step 5). The 60% reduction factor was

computed from original data. In Canada, the weighted average from other regions was applied to 5

regional birth cohorts where there was no national data available to impute (Table S5, Step 6). In Brazil,

Lesotho, Mexico, Peru and Uganda there was no coverage data on current HPV vaccination programs, but

coverage was derived from demonstration projects or partial implementations previous to the introduction

of the nation-wide program (Table S5, Step 7). Nevertheless, in 32 countries or territories (corresponding

to 200 birth cohorts) we couldn’t retrieve any information on coverages, 15 (half of them) had introduced

the vaccine in the last two years and hadn’t coverage results published. For all these 199 birth cohorts we

assumed the average coverage of the rest of the countries of the same geographical region and/or income

level with the same year and age at vaccination (Table S5, Step 8).

Figure S4 shows the final coverage dataset by country and imputation method (Table S5). Original

coverage data points are reported in darker green. The rest of estimates are derived following the

imputation algorithm and the figure shows how original data influenced the rest of imputed data.

S1.3) Validation of the algorithm

Missing data imputation has many assumptions and may produce biased estimates. To address this, we

performed a comprehensive sensitivity analysis of our missing data treatment, including sensitivity

analyses, simulations and an assessment of the impact of imputations on the final estimates.

1. Impact of imputations in the final results

Table S6 shows the impact of the different imputation steps in the global estimates.

2

As birth cohorts have different weights depending on the population, the impact in the global estimates

differs considerably. We could directly obtain coverage data for 625 birth cohorts (33%) from original

sources. But it is important to note that when population weights are taken into account the 625 cohorts

represented in fact 54% of the targeted women (instead of 33%) and 52% of the number of vaccinated

females (see tables S5 and S6). 56% of birth cohorts, that represented 35% of targeted population, were

derived from subsequent or previous birth cohorts with original data (steps 1-5, tables S5 and S6). They

could be considered to introduce a “moderate” bias based upon the assumption that coverages do not

differ substantially from those from adjacent birth cohorts. Similar methodology is used by WHO for

global estimates of immunization coverage. However, the further the distance between the imputed

estimation and the original data point, more chances exist to increase bias. Imputation from previous

pilots involved 1% of birth cohorts representing 8% of targeted women. Coverage were imputed from

previous demonstration projects in the country, particularly large studies conducted in collaboration with

the ministries of health; however demonstration projects do not necessarily mimic the performance of a

wider national programme. The last step (Step 8 in Table S5) was the one with more associated

uncertainty, which is the imputation of coverages from the average of the rest of the countries. 10% of

birth cohorts representing 2% of targeted population were imputed through this methodology.

2. Assessment of imputations derived from coverages from adjacent birth cohorts (Steps 1-5)

To assess the validity of deriving data from or first available previous or subsequent birth cohorts (Steps

1-5 Table S5) we performed two distinct analyses: a) simulations and b) updated European birth cohorts

with newly retrieved data.

a) Simulations

We performed 50 simulations in which we took a random sample of 100 birth cohorts with

original data and ran the imputation algorithm treating this data as missing. Afterwards, we

compared the imputed data with the original data not used. The mean correlation coefficient was

0.84: ranging from 0.70 to 0.94. Figure S5 compares the resulting 5000 imputed coverages from

the 50 simulations combined to the original estimate. With all simulations combined, correlation

coefficient was 0.81and 670 imputations out of 5000 (13.4%) differed by more than 15% from

the original data. Linear interpolation (step 1) had the highest correlation (0.96), followed by in

imputations from adjacent birth cohorts (steps 3 and 4, Table S5, correlation coefficient of 0.70).

Step 2 (subnational estimates imputed with national estimates) had very poor correlation (-0.24)

although the analysis was based in two countries (Italy and Switzerland) with limited national

data and the impact in the global estimates was very small (1% of the targeted population).

b) Comparison with new retrieved data.

For a set of European countries, we reviewed available data sources through November 2015.

We were able to retrieve new data for 11 countries and 144 birth cohorts. Sixty-one coverages

from 10 countries replaced previously imputed coverages with new original data. Figure S6

shows the correlation between previously imputed and new original data. Most of these

coverages were derived from the original coverage of adjacent birth cohorts (steps 3 and 4, Table

S5). Although there were a few estimates that diverged more than 15 points, the correlation

coefficient was 0.79. The imputation slightly tended to overestimate coverage.

3. Sensitivity analysis for steps 6 to 8 of the imputation algorithm

Additionally, we performed a sensitivity analysis of most uncertain assumptions (the imputation steps

from previous demonstration projects and from the average of combining similar countries). We

considered a set of scenarios ranging from extreme impossible scenarios where all coverages from these

steps were set to 0% to another scenario were these coverages were set to 100%. Figures S7 and S8 show

the results. Intermediate scenarios are the combination of setting coverages to 0%, reducing the imputed

coverage to 50% or setting it at 100%.

The global estimate of 47 million of vaccinated women ranged from 39 to 51 million in the most extreme

scenarios. The impact of these imputations was more prominent in upper-middle income countries where

the number of vaccinated females could be 51% lower to 19% higher (a range of 7 to 16 millions).

However, in high-income countries, which provide the largest number of vaccinated women (70%), the

impact was almost negligible ranging from 31 to 33 million (see Figure S8).

Table S7 presents this same analysis detailed for all geographical regions and development level.

3

Methods S2. Prediction of the expected reduction in cervical cancer burden

Our predictions on the expected cervical cancer cases averted by vaccination are exclusively based on

current cancer estimates and population prospects. By using population projections, we control for overall

mortality and we assume that current cohorts of vaccinated girls will maintain at the same lifetime cancer

risk as estimated by current 2012 estimations. Studies comparing projections with actual data found that

the average absolute country error was 21%2. Country errors tended to cancel under aggregation and at

worldwide level was only 3%2. However, projections of country aggregations at lower level than for the

world, as in our case, may not have cancellation of error under aggregation and uncertainty of forecast

could be much higher.

The expected number of new cervical cancer cases or deaths up to the age of 74 years was computed

using contemporary age-specific incidence and mortality rates by the corresponding expected annual

population for 2013, 2014..., until the year of the 75th

birthday by birth cohort, age and country.

Female population data by country were obtained annually for the years 2010-2100 from United Nations

(UN) Population Division3, or U.S. Census Bureau

4 when unavailable from UN. The population by birth

cohort was calculated by subtracting the single age from the year of the estimation (i.e., the 15-year olds

who will have their birthday in 2014 were those born in 1999). For subnational regions we applied the

regional population weight to the national estimate5–10

.

Population projections are produced using a cohort-component projection method. This method assumes

three demographic components of change: births, deaths and international migration11

. Both population

sources provide de facto population by single age and sex. de facto population includes all persons who

are physically present in the country at the reference date. Therefore, the approximated populations by

birth cohort that we use hereby include migration assumptions and may not exactly correspond to the

population born in the country at a given year.

Estimates of cervical cancer incidence and mortality rates by 5-year age groups and country were

obtained from IARC’s GLOBOCAN 201212

. The project uses a standardized and hierarchical approach to

estimation using real data of quality wherever possible, to provide contemporary estimates (presently for

the year 2012) of incidence and mortality for 27 cancer sites by sex in 184 countries13

.

The calculation is illustrated in Table S8 for Denmark’s cohort born in 2000. Age is indexed by the

subscript i, yi is the

female population aged i at year y, and rj is the corresponding age-specific incidence

rate for age group j in 2012. Therefore the cumulative number of expected cervical cancer cases is

calculated as follows:

𝑁𝑡𝑜𝑡𝑎𝑙 𝑒𝑥𝑝𝑒𝑐𝑡𝑒𝑑 = ∑(𝑝𝑦𝑖

𝑖,𝑗

× 𝑟𝑗)/105

In this example (Table S8) the expected cumulative number of cases by the age of 75 years is 348 cervical

cancer cases for Denmark’s cohort born in 2000, assuming that cancer rates will remain the same as

estimated in 2012.

Once obtained the expected number of cases, the number of prevented cases by vaccination is calculated

by multiplying the cumulative number of expected cases by the HPV vaccination coverage (full-course or

one-dose coverage) of the birth cohort and 70% effectiveness. Both for full-course and one-dose HPV

vaccination we assumed a 70% of effectiveness and long-life protection (100% efficacy against HPV 16

and 18, that are the cause of 70% of the cervical cancer burden worldwide). Following the example of

Table S8, HPV vaccination coverages for Danish 2000 birth cohort was 90%, 86% and 81% for one-,

two- and three- doses respectively. Therefore with full course coverage of 81% and assuming 70%

effectiveness, we expect to prevent 197 cases out of 348 in the 2000’ Danish birth cohort.

𝑁𝑝𝑟𝑒𝑣𝑒𝑛𝑡𝑒𝑑 = 𝑁𝑒𝑥𝑝𝑒𝑐𝑡𝑒𝑑 × 𝐶𝑜𝑣𝑒𝑟𝑎𝑔𝑒 × 0.70 = 348 × 0.81 × 0.70 = 197

The cumulative number of cases due to non-16/18 HPV types in vaccinated women resulted from

multiplying the cumulative number of expected cases by the HPV vaccination coverage (full-course or

one-dose coverage) of the birth cohort and 30% (100% minus 70% assumed effectiveness).

4

𝑁𝑛𝑜𝑛 𝐻𝑃𝑉 16/18 𝑖𝑛 𝑣𝑎𝑐𝑐𝑖𝑛𝑎𝑡𝑒𝑑 = 𝑁𝑒𝑥𝑝𝑒𝑐𝑡𝑒𝑑 × 𝐶𝑜𝑣𝑒𝑟𝑎𝑔𝑒 × 0.30 = 348 × 0.81 × 0.30 = 85

The cumulative number of cases in unvaccinated women resulted from subtracting the cumulative

number of cases prevented by vaccination and cumulative number of cases due to non-16/18 HPV types

in vaccinated women to the total number of expected number of cases

𝑁𝑖𝑛 𝑢𝑛𝑣𝑎𝑐𝑐𝑖𝑛𝑎𝑡𝑒𝑑 = 𝑁𝑒𝑥𝑝𝑒𝑐𝑡𝑒𝑑 − 𝑁𝑝𝑟𝑒𝑣𝑒𝑛𝑡𝑒𝑑 − 𝑁𝑛𝑜𝑛 𝐻𝑃𝑉16/18 𝑖𝑛 𝑣𝑎𝑐𝑐𝑖𝑛𝑎𝑡𝑒𝑑 = 348 − 197 − 85 = 66

5

Figure S1. Flow diagram of the systematic review

This diagram is an adaptation of the PRISMA flowchart for systematic review or meta-analysis14

. Records excluded due to lack of age-stratified coverage (N=49) group

different cases for which we could not reliably derive the age of vaccination. For example, official national estimates for Spain report global coverages for 11-14 years old for

a given year (i.e 73.1% in 2014). However, the age interval is a recommendation and subnational programmes define the specific vaccination age (some at 11 years, other at

13, etc). Therefore, in this case this estimate is excluded as we cannot derive the specific coverages for 11, 12, 13 and 14 years old separately.

6

Figure S2. Methodology for global HPV vaccination coverage calculation

See in Methods S1 the treatment of missing data * 20 birth cohorts out of 645 corresponded to national data in three countries reporting coverages regionally (Canada, Italy and Switzerland). These estimations were only used to estimate 106 regional coverages (see Table S5, step 2). Data sources: HPV vaccination programs and coverage: systematic review of the literature and official data from Governments; Population statistics: United Nations3; Cervical cancer statistics: IARC Globocan 201212

7

Figure S3. Regression imputation to predict dose-specific missing data from complete dose

coverage data A) 3-dose vs 1-dose coverage B) 3-dose vs 2-dose coverage

Quadratic linear regression models were fit to complete missing data when not all dose-specific coverages were available. Models met the underlying regression assumptions. Line: fitted values curve. Dots: observed values. X: values excluded from the model behaving as outliers. Outliers and influential observations were identified through leverage prediction and exam of studentized residuals.

C) 1-dose vs 2-dose coverage

0

20

40

60

80

100

3-d

ose

HP

V v

acci

nat

ion

co

ver

age

(%)

0 20 40 60 80 100

1-dose HPV vaccination coverage (%)

0

20

40

60

80

1003

-do

se H

PV

vac

cin

atio

n c

ov

erag

e (%

)

0 20 40 60 80 100


0

20

40

60

80

100

1-d

ose

HP

V v

acci

nat

ion

co

ver

age

(%)

0 20 40 60 80 100


Adj R-squared: 0.97 Adj R-squared: 0.98

Adj R-squared: 0.99

8

Figure S4. Final coverage dataset by country and imputation method

The figure below presents the 1922 targeted birth cohorts and their assigned HPV vaccination coverage (either data retrieved from

the numerous original data sources or imputed coverages). Darker green squares denote original coverages. The rest of estimates result from the different steps of the imputation algorithm. See also Table S5 for color code of the different imputation algorithm

steps.

Figure S4 (Continued)

9


10


11

Figure S5. Correlation between imputed data and original data in 50 simulations

We ran 50 simulations in which in every simulation we drew a random sample of 100 birth cohorts from

the 625 birth cohorts with data, to be treated as missing data and assigned with imputed data following the

established algorithm. The plot shows 5000 datapoints resulting from all simulations combined. 670

imputations out of 5000 (13.4%) had distances greater than 15%.

12

Figure S6. Correlation between imputed data and original data for selected countries

61 birth cohorts (1996-2003) from Switzerland, Spain, Finland, Ireland, Iceland, Italy, the Netherlands,

Norway, Portugal and Sweden.

13

Figure S7. Sensitivity analysis of the global estimate of number of vaccinated girls (full-

course)

There are seven scenarios, number 5 is the reference and represents the final analysis presented in the manuscript.

The estimated number of vaccinated females worldwide ranges from 39 to 51 million (scenarios 1 and 7, a decrease

of the overall estimate of 18% to an increase of 9% respectively).

Assumptions of the scenarios:

Scenario 1 Scenario 2 Scenario 3 Scenario 4 Scenario 5 Scenario 6 Scenario 7

Coverages imputed from

demonstration projects (step 7, Table S5)

All

coverages

as 0%

Imputed

coverages

reduced a

50%

Imputed

coverages

reduced a

50%

Same as

scenario 5

Reference.

Present

analysis

Same as

scenario 5

All

coverages

as 100%


the weighted average of other countries with same

implementation strategy,

age at vaccination, and income level and/or

geographical region (step 8

Table S5)

All

coverages as 0%

All

coverages as 0%

Imputed

coverages reduced a

50%

Imputed

coverages reduced a

50%

Reference.

Present analysis

All

coverages as 100%

All

coverages as 100%

14

Figure S8. Sensitivity analysis of the global estimate of number of vaccinated girls (full-

course) by income level

There are seven scenarios, number 5 is the reference and represents the final analysis presented in the manuscript.

The estimated number of vaccinated females in high income countries ranges from 31 to 33 million (scenarios 1 and

7,a decrease of the overall estimate of 3% to an increase of 3% respectively). In middle income countries, the

variation is wider; in upper-middle income countries, the number of vaccinated females ranges from 7 to 16 million

and in lower-middle ranges ranges from 0.07 to 0.49 million. In low income countries, it ranges from 0.90 to 1

million.

Assumptions of the scenarios:

Scenario 1 Scenario 2 Scenario 3 Scenario 4 Scenario 5 Scenario 6 Scenario 7


demonstration projects (step 7, Table S5)

All

coverages as 0%

Imputed

coverages reduced a

50%

Imputed

coverages reduced a

50%

Same as

scenario 5

Reference.

Present analysis

Same as

scenario 5

All

coverages as 100%


the weighted average of other countries with same

implementation strategy,

age at vaccination, and

income level and/or

geographical region (step 8

Table S5)

All

coverages as 0%

All

coverages as 0%

Imputed

coverages reduced a

50%

Imputed

coverages reduced a

50%

Reference.

Present analysis

All

coverages as 100%

All

coverages as 100%

15

Figure S9. Age distribution of women targeted by national HPV vaccination programmes worldwide

A) Globally B) By development level

More developed regions comprise Europe, Northern America, Australia/New Zealand and Japan. Less developed regions comprise all regions of Africa, Asia (except Japan),

Latin America and the Caribbean plus Melanesia, Micronesia and Polynesia. (UN Classification15

)

16

Figure S10. Number of countries having initiated a National HPV vaccination program by

year, development level and cervical cancer incidence

In some territories or countries without cervical cancer incidence information, the regional estimate was

used (American Samoa, Bermuda, Cayman Islands, Cook Islands, Gibraltar, Greenland, Kiribati,

Marshall Islands, Micronesia, FS, Monaco, N Mariana Islands, Palau, San Marino, Seychelles and US

Virgin Islands).

* A territory is a geographical area that do not possess full political independence or sovereignty but

remain politically outside of the controlling state's integral area

Age-standardized incidence rate (world standard) from IARC Globocan 201212

.

Table S1. National HPV Immunization programs worldwidea: date of introduction, targets, delivery strategy, schedule and historical changes (up to October 2014)

Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa

Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa

American Samoa 2013 11-14 - - 11-14 - - Sch. (grades 6,7,8) 3-doses standard 1

Angola 2015 9 - - - - - - - 2

Argentina 2011 11 - - - - - Health C. 3-doses standard 3

Australia 2007 12-13 - - 12-13 14-15 (2013-14) - Sch. (1st year of secondary sch.) 3-doses standard 4

Austria 2014 9-12 13-15 (PF) - 9-12 13-15 (PF) - Sch. (4th grade). Public vaccination

centres for the rest.

2-doses 5

Bahamas 2014 - - - - - - - - 2

Barbados 2014 11-12 - - - - - Sch. - 2

Belgium 2007 - - - - - - - -

Brussels 2007 13-14 - 12-18 (PF) - - - 3-doses standard 6

Flanders 2007 12-13 - 12-18 (PF) - - - 7

Wallonia 2007 13-14 - 12-18 (PF) - - - 3-doses standard 6

Belize 2014 - - - - - - - - 2

Bermuda 2011 11-12 - - - - - - 3-doses standard 8

Bhutan 2010 12 - - - - - Sch. and Health C. 3-doses standard 9

Brazil 2014 9-13 - - - - - Sch. and Health C. 3-doses extended (0-6-60m) 10

Brunei Darussalam 2012 12-13 15-16 - - - - Sch. (Year 7) and Health C. (catch-up) 3-doses standard 11

Bulgaria 2012 12 - - - - - Health C. - 12

Canada - - - - - - - - -

Source idSchedulebDelivery strategyCountry or territoryYear of

introduction

FEMALES: CURRENT AGE TARGETS IN YEARS MALES: CURRENT AGE TARGETS IN YEARS

Partial implementation

The National HPV Vaccination Program initially provided quadrivalent HPV vaccine for all females aged 12-26 years as at mid 2007 (school program commenced April 2007 and GP/community program in July 2007) until end December 2009. From

2009 the Program offered HPV vaccination routinely to females in the first year of high school (usually at 12-13 years). From 2013, males were also offered HPV vaccination routinely in the first year of high school (age 12-13 years), with a catch-up

program available for males aged 14-15 years in 2013 and 2014.

The HPV vaccine has been available since February 2014 for all children living in Austria in the fourth grade (consummate ninth years of age) free of charge. Before 2014 the vaccine was recommended but not publicy financed. The children will be

vaccinated at school, in some Länder, also in public vaccination and established pediatricians. In addition, the HPV vaccine to the public vaccination centers of the Länder for children from the age of 9 will be offered free of charge until the age of 12. The

states provide for children up to the age of 15 also catch-up vaccinations at a reduced cost price.

HPV vaccination is not included in the National Immunization schedule. The vaccination is voluntary, but free of charge for 12-year-old girls.

Varies by region (see below)

Sch. (2nd year of secondary sch.) and

Health C.

Sch. (1st year of secondary sch.) and

Health C.

Sch. (2nd year of secondary sch.) and

Health C.

Since 2011, free-school vaccination for 13-14 year old girls



2-doses <14/15 (since 2014)

3-doses standard the rest

The launch of the vaccination programme started with a catch-up mass campaign covering all girls aged 12-18 years (2010)

In 2014 only girls aged 11-13 will be vaccinated, in 2015 girls aged 9-11 years and from 2016 girls 9 year old.

Table S1 (Continued) 17

Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa

Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa


introduction


Alberta 2008 10-11 - - - - - Sch. (grade 5) 3-doses standard 16

British Columbia 2008 11-12 - ≤ 26 years old

and born before

1994

- - - Sch. (grade 6) 3-doses extended (0-6-36m, since 2010) 13, 14

Manitoba 2008 11-12 - 9-26 at high risk

hpv infection

(2012-2014)

- - - Sch. (grade 6) 3-doses standard 13, 15

New Brunswick 2008 12-13 - - - - - Sch. (Grade 7) 3-doses standard 16

Newfoundland 2007 11-12 - - - - - Sch. (Grade 6) 3-doses standard 16

Nova Scotia 2007 12-13 - - - - - Sch. (Grade 7) 3-doses standard 13, 17

North West Territories 2009 9-10 - - - - - Sch. (Grade 4) 3-doses standard 13, 17

Nunavut 2010 11-12 - - - - - Sch. (Grade 6) 3-doses standard 16

Ontario 2007 13-14 - - - - - Sch. (Grade 8) 3-doses standard 13, 18

Prince Edward Island 2007 11-12 - - 11-12 - - Sch. (Grade 6) 3-doses standard 13, 19

Quebec 2008 9-10 - <18 years and 18-

26

immunosupress

ed or HIV

positives

- - 9-26

(immunosupres

sed or HIV

positive)

Sch. (Grade 4) 2-doses 13, 17, 20

Saskatchewan 2008 11-12 - - - - - Sch. (Grade 6) 3-doses standard 13, 17

Yukon 2009 11-12 - - - - - Sch. (Grade 6) 3-doses standard 16, 21

Girls or women with increased risk of HPV infection who started the 3-dose series before March 31st 2014 will be eligible to finish the series free-of-charge

Catch-up program for grade 8 during 2008-9 (girls 13-14)


BC is currently providing the HPV2 vaccine at no cost to young women who are 26 years old and younger and born before 1994. This is a limited time program. Catch-up program for grade 9 during 2008-11 (girls 14-15). The HPV vaccine program

started in September 2008 in a 3-dose series, with all 3 doses given in grade 6. In September 2010, it was changed to an ‘extended’ dose schedule with 2 doses given 6 months apart in grade 6 and a planned 3rd dose to be given 60 months after the 1st

dose in grade 11. In 2013 the extended schedule changed: 3rd dose of HPV vaccine to be offered in grade 9.


Catch-up program for 15-16 girls in Grade 10 (2009-2010 only),and 13-14 girls in Grade 8 (2010-2011 only)

Catch-up program for girls in Grades 11 and 12 (2009-2010), Grades 10 and 11 (2010-2011), Grades 9 and 10 (2011-2012), Grade 9 (2012-2014)

Starting in 2012, girls in Grades 9–12 who didn't receive or didn't complete the three-dose HPV immunization in Grade 8 can now get their vaccines free of charge, until the end of Grade 12.

Catch-up program for grade 9 during 2009-10 (girls 14-15). HPV vaccination program expanded to boys since 2013.

Since 2008, Québec has used a 0, 6 and 60 month school based extended HPV vaccine schedule for girls in grade 4. The provision of the 3rd dose of the HPV vaccine to grade 9 girls was to commence in 2013. However, Québec’s HPV vaccine schedule was

updated to 2 doses in grade 4 only, without a 3rd dose. Catch-up program for grade 9 during 2009-13 (girls 14-15).



Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa

Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa


introduction


Cayman Islands 2011 11-17 - - - - - Sch. and Health C. 3-doses standard 22, 23

Chile 2014 9 - - - - - Sch. (Grade 4) 2-doses 24

Mandatory vaccination

Colombia 2012 9-17 - 9-17

(unschooled)

- - - Sch. (Grades 4 to 11) + special campaigns

for unschooled/remote areas

3-doses extended (0-6-60m) 25

Cook Islands 2011 9-13 - - - - - - - 26

Czech Republic 2012 13 - - - - - Health C. 12, 27

Denmark 2009 12 <=18 18-21 until 2015 - - - Health C. 2-doses <14/15 (since mid-2014)


28, 29

Dominican Republic 2014 9-10 - - - - - Sch. - 30

Fiji 2013 13 - - - - - Sch. (Class 8) - 31

Finland 2013 11-12 12-16 (until

2015)

- - - - Sch. 3 doses standard 61

France 2007 11-14 - <20 - - - Health C. 2-doses <14/15 (since mid-2014)


32-34

French Polynesia NA NA - - - - - - -

Germany 2007 9-14 - <18 - - - Health C. 2-doses <14/15 (since mid-2014)


35

Gibraltar 2008 12-13 - - - - - - -

Greece 2008 12-15 16-26 - - - - Health C. 3 doses standard 36

Greenland 2008 12-27 - - - - - - 3 doses standard 37, 38

Catch-up program for grades 7 and 8 during 2009-10 (girls 12-14). Free to girls 9-18 from 2011 to 2013.

As part of the Danish childhood vaccination programme, girls aged around 12 years are offered HPV vaccine (since 2009, girls born in 1996 or later). However, the HPV vaccination is free of charge for targeted girls until the age of 18 (previously to 15-

year age). Girls born in 1993, 1994 or 1995 were offered free HPV vaccination as part of a catch-up programme which ran from October 2008 to the end of 2010. From 27 August 2012 to 31 Dec 2013, women born in 1985-92 have been offered free HPV

vaccination. From 1 Jan 2014 to 31 Dec 2015 HPV vaccination will be offered to any girl or woman born 1993-1997.

Until September 2012, French guidelines recommended the 3-dose vaccine regimen be administered routinely to all girls aged 14 years and catch-up vaccination to women aged 15–23 without sexual activity or with a sexual debut in the

year before vaccination. In 2012 the recommendation expanded to girls aged 11-14 years old with a catch-up vaccination until 20 years. The reimbursement rate for these vaccines is 65% of their price.

Since 2007 to 2014, the German routine immunization schedule offered free vaccination to 12-17 year-old girls. In 2014 the calendar has changed targeting primarely 9-14 aged girls with a 2-dose schedule (0-6m) , complemented by a catch-up

vaccination of girls aged 15-17 years with a 3-dose regimen. There is a well-child visit at 12-14 years of age.

Greece introduced HPV vaccines to its National Vaccination Program in January 2008 and the vaccine is delivered free of charge to females between 12 and 26. The vaccination is given on demand through healthcare providers (GP).

The recommendation is to vaccinate women between the 12–15 year age range, and a catch up strategy is also provided for those aged 16–26 years

2-doses <14/15 (since 2014)

3-doses standard the restRecommended vaccination only

The target age group is 11 to 12 year old students. However, the vaccine will also be available to young women between the ages of 11 and 17 years at the various Health Services Authority facilities.

Initially (2012) the program started targeting 4th year graders. In 2013, the program expanded vaccination to schooled girls from grades 4 to 11 (9-17 years old). Unschooled girls aged 9-17 or from remote areas are reached by means of special

campaigns.


Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa

Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa


introduction


Guam 2012 9-18 - - 9-18 - - - 3 doses standard 39

Guyana 2011 11 - - - - - - -

Iceland 2011 12 - - - - - Sch. (Grade 7) 3 doses standard 40

Ireland 2010 12-13 - - - - - Sch. (1st year of second level) 2-doses <14/15 (since mid-2014)

3-doses modified (0-6-9m) for the rest

41

Israel 2013 13-14 - - - - - Sch. (Grade 8) 3 doses standard 42

Italy 2008 12 - - - - - 43

Abruzzo 2008 12 - 13-45 - - -44

Basilicata 2007 12, 15, 18, 25 -

13-14, 16-17,19-

24 - - -44

Calabria 2008 12 - 14-25 - - -44

Campania 2008 12 - - - - -44

Emilia-Romagna 2008

12 , HIV positive

(<=45) - <=45

HIV positive

(<=26) - <=2644

Friuli-Venezia Giulia 2008 12 and 15 - 16-17 - - -44

Lazio 2008 12 - >=13 - - -44

All girls in 1st year in second level schools will be offered the HPV vaccine each year. From September 2014 all girls less than 15 years of age require two doses of the HPV vaccine given at 0 and 6 months. All girls aged 15 years and older require three

doses of the HPV vaccine given at 0 and 6 months and the third dose will be given at least three months after the second dose. The HPV catch-up vaccination programme for 6th year girls (17-18 years) run from the school year 2011/12 to the end

2013/2014.

In general, Greenland follows a similar programme to the Danish childhood vaccination programme, but the Greenland HPV vaccination programme started later. As of 2007, vaccination with the quadrivalent vaccine (Gardasil) for both genders was

planned, but a re-evaluation in 2008 changed the decision to include only girls; the programme that was initiated in 2008 was directed at girls aged 12 years with a catch-up vaccination for girls aged 13–15 years. In Greenland, the HPV vaccine is

currently administered, free of charge, only to girls aged 12–27 years.

Health C. 2-doses <14/15 (since mid-2014)


The vaccine is actively offered free of charge to girls aged 12 and to individuals HIV positive (males <=26 years and females <=45 years). Gratuity of the vaccine is

maintained to actively targeted cohorts until their 19th birthday. The vaccine is offered at a subsidized price (pagamento agevolato) to women aged <=45 years

and men aged <=26 years.

The vaccine is actively offered free of charge to girls aged 12 and 15. Gratuity of the vaccine is maintained to actively targeted cohorts until their 19th birthday.

The vaccine is offered at a subsidized price (pagamento agevolato) to girls aged 16-17 years.

The HPV vaccination is actively offered free of charge to girls in the twelfth year of life in all Italian regions. Some regions have extended the offer of vaccination

girls in other age groups; the Emilia-Romagna also offers vaccines to individuals, male and female, HIV positive. Most regions also consider a facilitated payment

for ages not included in the active call. See regional variations below.

Gratuity of the vaccine is maintained to actively targeted cohorts.The vaccine is offered at a subsidized price (pagamento agevolato) to women aged 13-45 years .

The vaccine is actively offered free of charge to girls aged 12, 15, 18 and 25. Gratuity of the vaccine is maintained to 12 and 15 years old targeted cohorts during 3

years until their convergence with subsequent cohorts, and for 2 years for 18 and 25 years olds. The vaccine is offered at a subsidized price (pagamento

agevolato) for girls at intermediate ages.

Gratuity of the vaccine is maintained to actively targeted cohorts.The vaccine is offered at a subsidized price (pagamento agevolato) to women aged 14-25 years

in the ASP Reggio Calabria .

Gratuity of the vaccine is maintained to actively targeted cohorts until their 19th birthday.


Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa

Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa


introduction


Liguria 2008 12 and 16 - 17-45 - - 12-26 44

Lombardia 2008 12 - <26 - - - 44

Marche 2008 12 -

13-18 (free); 19-

26 (subsidized) - - -44

Molise 2008 12 - 17-45 - - 11-2644

PA Bolzano 2008 12 - 13-25 - - - 44

PA Trento 2008 12 15 13-25 - - -44

Piemonte 2008 12 - - - - - 44

Puglia 2008 12 and 18 - 13-17 and <=25 - - -44

Sardegna 2008 12 - 13-25 - - -44

Sicilia 2008 12 - 13-45 - - 11-26 44

Toscana 2008 12 and 16 - 13-15, 17-18

(free), >=19

(subsidized)

- - - 44

Gratuity of the vaccine is maintained to actively targeted cohorts until their 19th birthday.The vaccine is offered at a subsidized price (pagamento agevolato) to

women aged >=13 years .


Cohorts between those with active free offer (Girls from the 13th to 15th year of life and from the 17th to 18th year life) are being offered free vaccination

opportunistically. The vaccine is offered at a subsidized price (pagamento agevolato) to women aged >=19 years



The vaccine is actively offered free of charge to girls aged 12 and a catch-up at 15 years of age since 2012 for unvaccinated girls previously targeted at 12 years.

Gratuity of the vaccine is maintained to actively targeted cohorts until their 17th birthday. The vaccine is offered at a subsidized price (pagamento agevolato) to

women aged 13-25 years .

Until 2014 the HPV vaccine was actively offered to 12 and 16 years old girls, when converged the two cohorts, and currently is only offered to 12 years old.

Gratuity of the vaccine is maintained to actively targeted cohorts during their lifetime.

The vaccine is actively offered free of charge to girls aged 12 and since 2010 also to girls aged 18. Gratuity of the vaccine is maintained to actively targeted

cohorts until their 26th birthday. The vaccine is offered at a subsidized price (pagamento agevolato) to intermediate ages and to women aged <=15 years.

Gratuity of the vaccine is maintained to targeted cohorts until their 19th birthday.The vaccine is offered at a subsidized price (pagamento agevolato) to women

aged 13-25 years .

Gratuity of the vaccine is maintained to actively targeted cohorts until their 26h birthday. Since 2012, the vaccine is offered at a subsidized price (pagamento

agevolato) to women aged 13-45 years and men aged 11-26 years.

The vaccine is actively offered free of charge to girls aged 12 and 16 (since 2010). Gratuity of the vaccine is maintained to actively targeted cohorts during their

lifetime. For women aged 17-45 years and men aged 12-26 years the vaccine is offered at a subsidized price (pagamento agevolato).

Gratuity of the vaccine is maintained to actively targeted cohorts until their 16th birthday. Since 2010, the vaccine is offered at a subsidized price (pagamento

agevolato) to women aged 16-26 years .

The vaccine is actively offered free of charge to girls aged 12 and opportunistically to girls aged 13-18 years. Gratuity of the vaccine is maintained to actively

targeted cohorts until their 26th birthday. The vaccine is offered at a subsidized price (pagamento agevolato) to women aged 19-26 years .

Gratuity of the vaccine is maintained to actively targeted cohorts until their 17th birthday.The vaccine is offered at a subsidized price (pagamento agevolato) to

women aged 17-45 years and men aged 11-26 years

The vaccine is offered at a subsidized price (pagamento agevolato) to women aged 13-25 years .


Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa

Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa


introduction


Umbria 2008 12 - 13-25 - - -44

Val d'Aosta 2007 12 and 16 - >=17 - - -44

Veneto 2008 12 - 14-25 - - -44

Japan 2011,

partially

suspended in

June 2013

- - - - - - - - 45, 46

Kazakhstan 2013 11-12 - - - - - - - 47

Kiribati 2011 10-12 - - - - - - - 48

Latvia 2010 12 - - - - - Health C. 3 doses standard 49, 50

Lesotho 2012 9-13 - - - - - Sch. - 51, 52

Libya 2013 15 - - - - - - - 2

Liechtenstein - 11-14 15-19 - - - - - 2-doses <14/15


62

Luxembourg 2008 12 - 13-18 - - - Health C. 2-doses <14/15 (since mid-2014)


53

Macedonia FYR 2009 12 - 13-26 - - - Sch. and Health C. - 49

Malaysia 2010 13 - - - - - Sch. and Health C. for unsch.ed girls 3 doses standard 54

Malta 2012 12 - - - - - Health C. 3 doses standard 55, 56

Marshall Islands 2008 11-12 - - - - - Health C. - 57

Vaccination in the first phase will be conducted in four regions of the country - in Atyrau, Pavlodar regions, Almaty and Astana

Gardasil Access Program, GAVI?

Demonstration projects were conducted in 2008 (target: girls 9-18 years old) and 2011 (target: girls 9-13 years old) through the Gardasil Access Program

Girls aged 12 receive a personal letter of invitation. Girls aged between 13 and 18 do not receive a personal invitation, but the vaccine will be issued for free in pharmacies under medical prescription.

From 2009, the bivalent HPV vaccine was partly funded by the Suginami local government. By April 2010, 32 of 1,747 local governments had decided to provide funding for the HPV vaccine. In October 2010, the central and local governments launched a

temporary funding program and in April 2013, the HPV vaccine was included in the National Immunization Program (but was optional) and given for free.

The Japanese Ministry of Health, Labour, and Welfare (MHLW) partially suspended the human papillomavirus (HPV) vaccination programme in June, 2013. Due to fears of adverse events, especially complex regional pain syndrome, the MHLW issued a

nationwide notice that while the HPV vaccine could still be given for free to girls aged 12 to 16, it should neither be proactively recommended nor promoted. In suspending its recommendation, the MHLW declared that it would investigate the reported

cases, but as of April 2014, no conclusion has been reached.

Gratuity of the vaccine is maintained to actively targeted cohorts.The vaccine is offered at a subsidized price (pagamento agevolato) to women aged 13-25 years .


From 17 years of age the vaccine is offered at a subsidized price (pagamento agevolato)

Gratuity of the vaccine is maintained to actively targeted cohorts until their 26h birthday.The vaccine is offered at a subsidized price (pagamento agevolato) to

women aged 14-25 years .



By a decision of the Ministry of Health from 2008, HPV vaccination was introduced into the national immunization program in October 2009 as obligatory for 12-year-old girls. The quadrivalent vaccine has been used in the national immunization

program and is delivered through a school-based program. The catch-up vaccination is provided for 13- to 26-year old girls and women, and is also free of charge and is delivered through healthcare facilities.


Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa

Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa


introduction


Mexico 2012 9-10 (schooled),

11 (unschooled)

- - - - - Sch. (Grade 5) and Health C. 3 doses extended (0-12-60m) 58, 59

Micronesia (Federated States of) 2009 11-12 - - - - - Health C. - 57

Monaco 2011 14 - - - - - Health C. 3 doses standard 60

Netherlands 2010 12-13 - - - - - Health C. 2-doses <14/15 (since jan-2014)


64,65

New Caledonia 2011 12 - - - - - Health C. 3 doses standard 66

New Zealand 2008 12 - 13-19 - - - Sch. (Grade 8) and Health C. 3 doses standard 67

Niue - - - - - - - - -

Northern Mariana Islands 2008 11-12 - - - - - Sch. (Grade 6) - 68

Norway 2009 12 - - - - - Sch. (Grade 7) 3 doses standard 69

Palau 2009 11-12 - - - - - Health C. - 57

Panama 2008 10-11 - - - - - Sch. and health centers 3 doses standard 59,70

Paraguay 2013 10 - - - - - Sch. 3 doses standard 71

Peru 2011 9-10 - - - - - Sch. (grade 5) 3 doses standard 72

Portugal 2008 13 - - - - - Health C. 2-doses (since oct-2014) 73, 74

Romania 2010 11-14 - - - - - Health C. 3 doses standard 75, 76

Russian Federation 2009 12-13 (Moscow) - - - - - Sch. and health centers 3 doses standard 77

HPV vaccine was introduced in 2008 to 125 targeted municipalities (comprising approximately 5% of Mexico's population) to girls aged 12-16 years using a 0-2-6 m schedule. In 2009, Mexico expanded its HPV vaccination program to include 182

municipalities with the lowest human development index and changed to an extended dosing schedule that targets girls aged 9--12 years for the first 2 doses, delivered 6 months apart, followed by the third dose 60 months later. In 2011, Mexico's

National Immunization Council approved a nationwide expansion of its HPV vaccination program to include school-based vaccination of all girls aged 9 years and to unschooled girls aged 11 years.

In 2008, the Romanian Ministry of Health rolled out a schoolbased immunization campaign providing free vaccines for 10- to 11-year-old girls. Coverage statistics revealed that only a 2.57% girls received vaccination. In 2009 an information campaign

was launched, followed by a second vaccination programme, targeting 12- to 14-year-old girls. A catch-up programme was also launched, where adult women were given the opportunity to get the vaccine free of charge through their health provider.

Despite the accessibility of the vaccine, initiation remained low and the schoolbased programme was discontinued.

Since 2010, 12 year-old girls are invited to receive the HPV vaccination within the National Immunization Program and includes girls who were born in 1997 or thereafter. All the girls get an invitation in the year they reach 13 years. The invitation

states exactly where to go and whom to call for more information. The vaccination is free and is not mandatory. In 2009, a HPV vaccination catch-up campaign was organized for girls born between 1993 and 1996 (at that time, 13 to 16 years of age).

The HPV immunisation in New Zealand is free for girls and young women up to their 20th birthday. It is free for non-residents who are under the age of 16 and are living in New Zealand for nine months or more. It is available through participating

schools or from family doctors, local health centres and some Family Planning clinics. All girls who are in year 8 at school are offered the vaccine either through a school-based immunisation programme or through their family doctor if a school

programme is not available. The programme started on 1 September 2008 for young women born in 1990 and 1991. In 2009 the programme was extended to girls born from 1992 onwards.

During the year of introduction of the vaccine, 2013, the vaccine was offered to two cohorts of girls born between January 1, 2002 and December 31, 2003 ( aged 10 and 11 years in 2013 respectively). From 2014 onwards, the vaccine will be

administered to a single cohort of girls at 10 years of age.

In October 2008 the HPV vaccination was introduced in the National Immunization Program (NIP) for girls 13 years old, born from 1995. From 2009 to 2011 ran a catch-up vaccination campaign for girls <=17 years old (born between 1992 and 1994).

Vaccination was temporarily suspended in 2012, but resumed in 2013


Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa

Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa


introduction


Rwanda 2011 11-12 - - - - - Sch. and special campaigns for unsch.ed 3 doses standard 78, 79

San Marino 2008 11 - - - - - Health C. 3 doses standard 80

Seychelles 2014 11 - - - - - Sch. - 81

Singapore 2010 - - 9-26 - - - Health C. 3 doses standard 82

Slovenia 2009 11-12 - - - - - Sch. (grade 6) 2-doses (since sep-2014) 83

Slovakia - 12 - - - - - - - 63

South Africa 2014 9 - - - - - Sch. (grade 4) 2 doses 84

Spain 2007-8 - - - - - - - 85, 86

Andalucia 2008 14 - - - - - Health centers 85

Aragon 2008 14 - - - - - Health centers 87

Asturias 2008 13 - - - - - Health centers 85

Baleares 2008 14 - - - - - Sch. 85

C. Valenciana 2008 14 - - - - - Sch. 85

Canarias 2008 14 - - - - - Health centers 85

Cantabria 2008 14 - - - - - Health centers 85

Castilla La Mancha 2008 14 - - - - - Health centers 85

Castilla Leon 2008 14 - - - - - Health centers 88

Cataluña 2008 11-12 - - - - - Sch. (grade 6) 85

Ceuta 2008 14 - - - - - Sch. 85

2-doses <14/15 (since mid-2014)


HPV vaccines have been incorporated in some regional immunization programs. Programs have started in the following regions: Moscow (2009), Moscow Region (2009), Ekaterinburg, Khanty-Mansiysk Okrug (2009), Perm (2009–2010), Smolensk

(2010), Tyumen, Novosibirsk, Tomsk, Sakha, and Primorski Kray (2010–2011). In 2012, the programs were extended to Altay, Sakhalin and Kemerovo.

Through a 3-year donation of the HPV Vaccine, all girls in Primary 6 (ages 11 and 12 years) were vaccinated starting April 2011. Out-of-school girls were targeted through community health workers. In 2012, the campaign targeted secondary school

girls. In 2014, GAVI Alliance announced that it will support Rwanda vaccination programme.

The vaccine is approved and recommended for females aged 9 years to 26 years. With effect from 1 November 2010, patients can use up to $400 per Medisave account per year under the Medisave400 scheme to pay for HPV vaccination. Patients can use

their own Medisave or that of their immediate family members (e.g. parents or spouse) to help pay for the vaccination. Medisave is a national medical savings scheme.

Recommended only. Not included in the national immunization schedule. Partial reimbursement by the national healthcare system

Age of the primary target will switch to 12 years old in 2015 with a complementary catch-up program for 13-14 years old.

Vaccination programmes vary by region (see below). The Inter-Territorial Council of the National Health System, the coordination body for the different Health services from the Autonomous Communities of

Spain, approved in 2007 the general recommendation to initiate routine HPV vaccination in Spain, with a cohort of girls to choose between 11-14 years of age, but with preference for age 14, and a deadline

for implementation until 2010. Afterwards, each Autonomous Community designed its own implementation program starting in 3 of them in 2007, and the rest in 2008. In 2014 the Inter-Territorial Council

approved the recommendation to switch from a 3 to a 2-dose scheme following the approved manufacturer recommendations. By fall of 2014, most of the Autonomous Communtities of Spain have changed to

a 2-dose regime when applicable.

In 2011 switched from a "intensive" strategy where all targeted girls were vaccinated massively at once to a stepwise strategy, were girls are vaccinated when they reach 14 years of age

Despite using health centers for vaccine delivery, there is a school-based awareness campaign at the begining of each school year.


Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa

Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa


introduction


Extremadura 2008 14 - - - - - Sch. 85

Galicia 2008 14 - - - - - Health centers 85

La Rioja 2007 11-12 - - - - - Sch. (grade 6) 85

Madrid 2008 14 - - - - - Health centers 85

Melilla 2008 14 - - - - - Sch. 85

Murcia 2008 11-12 - - - - - Sch. (grade 6) 85

Navarra 2007 12-13 - - - - - Sch. (1st year secondary sch.) 85

Pais Vasco 2007 12-13 - - - - - Sch. (1st year secondary sch.) 85

Suriname 2013 9-13 - - - - - Sch. - 89

Sweden 2009 10-12 - - - - - Sch. (grades 5-6) 2 doses since 2014 90

Switzerland 2008 11-14 15-19 (until

2017)

20-26 (until

2017)

- - - Vary by region 2-doses <15 (since feb 2012), 3 doses

standard for the rest

91

Trinidad and Tobago 2013 11-12 - - - - - Sch. 3 doses standard 92

Uganda 2012 9-12 - - - - - Sch. 3 doses standard 79, 93

United Arab Emirates 2008 15-17 (Abu

Dhabi)

18-26 (Abu

Dhabi, since

2013)

- - - - Sch. (Grade 11), Health C. for the rest 3 doses standard 94

United Kingdom 2008 12-13 - - - - - Sch. (Grade 8) 2-doses <14/15 (since sep-2014)


95

In 2015 primary target will change to girls aged 11-12 (School grade 6).

2-doses <14/15 (since mid-2014)


In 2012 primary targeted cohort switched from 14 years (2nd year secondary school) to 12 years olds.

Age of the primary target will switch to 12 years old in 2015. Catch-up at 14 years of age.

In 2015 primary target will change to girls aged 13 and 14 years. In 2016 girls aged 12 and 13 years, and from 2017 onwards 12 years old.

In March 2008, HPV vaccination was introduced for all female students, grade 11, 15-17 years, in all the schools of Abu Dhabi Emirate. In 2013, the program was expanded to include young women 18-26 years old as a catch up cohort

Girls who missed HPV vaccination first time around, can receive a catch up HPV vaccination up to age of 18. At the start of the programme there was a catch-up for girls born between 1991-1995.

Since January 1, 2010 the HPV vaccine was included in the childhood vaccination program and given to girls born in 1999 or later who are in grades 5 or 6. The county councils also conduct a free extended vaccination (catch-up) of girls born in 1993 or

later.

Vaccination implementation strategies vary by region (cantons). The Federal Office of Public Health (FOPH) and the Federal Commission for Vaccination (FCV) recommend general vaccination for all girls aged 11 to 14, and catch-up vaccination for

girls aged 15 to 19. Vaccination is also recommended for women up to the age of 26 as well, but needs to be decided with the physician on an individual basis. Vaccination adhering to these guidelines is free of charge within the framework of the

cantonal vaccination programmes. For 15- to 26-year-olds, coverage is limited up to 2017. Vaccination programs are organized by the cantonal authorities and implemented by the school medical services and / or medical practitioners. These programs

vary depending on the canton and are subject to cantonal monitoring.

Through a 3-year donation of the HPV Vaccine, girls aged 9-12 years from 12 districts were vaccinated starting 2012. In 2014, GAVI Alliance announced that it will support National Uganda vaccination programme as of 2015.

Catch-up program for the 4th year of secondary school during 2007-9 (girls 15-16)

Catch-up program for the 2nd year of secondary school during school years 2007/08 to 2009/10 (girls 13-14 years old)


Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa

Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa


introduction


United States of America 2006 11-12 - 13-26 11-12 - 13-21 or <26

(MSM,

Immunocompro

mised)

Health C. 3 doses standard 96

United States Virgin Islands 2006 11-12 - 13-26 11-12 - 13-21 or <26

(MSM,

Immunocompro

mised)

Health C. 3 doses standard

Uruguay 2013 12 13-14 (until

2014)

- - - - Health C. 3 doses standard 97

Uzbekistan 2015 12 - - - - - Sch. - 79

PF: Partially funded; Sch.: School; Health C.: Health Centres

Definitions

a

b

Sources12345

67

8

HPV Immunization programme: Public national/subnational HPV immunization programme in place. Publicly mandated programmes have a law, official regulation, decision, directive or recommendation that provides the public mandate to implement the

programme with an authorized vaccine, target group and funding/co-payment determined. Countries can have immunization guidelines and HPV vaccine administration through the private sector, but without a public national programme.

Primary target: Age group prioritized to receive the vaccine and main objective of the HPV Immunization programme.

Catch-up: Complementary strategies to expand vaccination to other groups not included in the primary target population. It can also refer to an alternative strategy to complete a course of vaccination at later ages if the person missed previous vaccination

opportunities.

Organized: Targeted groups are actively reached within an organized plan.Opportunistic: Targeted groups should seek vaccination by themselves at designated centres.

3-doses standard: administration of three doses following the standard vaccination schedule as 0-2-6 months for the quadrivalent vaccine or 0-1-6 months for the bivalent vaccine.

2 doses: 0-6m if not otherwise stated.

Since 2014, based on clinical trials results several agencies responsible for the scientific evaluation of medicines, like the European Medicines Agency, approved a two-dose schedule for girls aged less than 15 or 14 depending on the vaccine (Cervarix or

Gardasil).

Chen B. HPV Immunization Clinics scheduled for this month. Samoa News [Internet]. 2013 Aug 4; Available from: http://samoanews.com/node/76581. WHO vaccine-preventable diseases: monitoring system. 2014 global summary. Available at: http://apps.who.int/immunization_monitoring/globalsummary/schedules.Ministerio de Salud. Presidencia de la Nación. República Argentina. Vacuna contra el Virus del Papiloma Humano (VPH) [Internet]. Available from: http://www.msal.gov.ar/index.php/programas-y-planes/185-vphAustralian government. Immunise Australia Program. National Human Papillomavirus Vaccination Program [Internet]. Available from: http://hpv.health.gov.au/

Recommendations for HPV vaccination have evolved since HPV4 was first licensed in 2006. In June 2006, HPV4 was licensed for use in females and recommended for routine vaccination of females aged 11 or 12 years and for those aged 13 through 26

years not previously vaccinated. In 2009, HPV2 was licensed for use in females and ACIP updated recommendations to state that either HPV vaccine is recommended for females. In 2009, HPV4 was licensed for use in males and in late 2011, HPV4 was

recommended for routine vaccination of males aged 11 or 12 years and for those aged 13 through 21 years not previously vaccinated. The recommendations for females and males state that the vaccination series can be started beginning at age 9 years.

Almost all HPV vaccinations are delivered by primary care providers or health clinics (191). In the United States, there is both public and private financing for vaccines. The Vaccines for Children Program (VFC) supplies enrolled private and public health-

care providers with federally purchased vaccines for use among uninsured, Medicaid-eligible and other entitled children through age 18 years. Under the Patient Protection and Affordable Care Act of 2010, nongrandfathered private health plans must

offer, at no cost to beneficiaries, vaccines that are recommended by ACIP. Similarly, qualified health plans on the new health insurance exchanges that went into effect starting in 2014 must offer ACIP-recommended vaccines at no cost to beneficiaries.

Catch-up campaign up to April 2014 for girls born in 2000

In 2014, GAVI Alliance announced that it will support National Uganda vaccination programme as of 2015.

Austrian HPV vaccination program. Impfplan Österreich 2014. Evidenz-basierter Impfplan des Bundesministeriums für Gesundheit basierend auf wissenschaftlichen Empfehlungen des Nationalen. Impfgremiums.

http://bmg.gv.at/cms/home/attachments/8/9/4/CH1100/CMS1389365860013/impfplan2014.pdf

Fédération Wallonie-Bruxelles. Direction générale de la santé. Vaccination [Internet]. 2012. Available from: http://www.sante.cfwb.be/index.php?id=4259Flemish Ministry for Welfare, Public Health and Family. Agentschap Zorg en Gezondheid. Vaccinatie tegen HPV. [Internet]. Available from: http://www.zorg-en-gezondheid.be/Ziektes/Vaccinaties/Info-vaccinatoren/Vaccinatie-tegen-HPV/

Department of Health. Bermuda Advisory Committee on Immunization Practices. (BACIP). Recommended Immunization Schedule for Healthy Infants, Children and Adolescents – Bermuda, 2011


Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa

Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa


introduction


9

101112

13

141516

17

181920

21222324252627

28

29303132

333435

36

37

38

39

4041

Brazilian Government. Postos de saúde e escolas iniciam vacinação contra HPV — Portal Brasil [Internet].Available from: http://www.brasil.gov.br/saude/2014/03/postos-de-saude-e-escolas-iniciam-vacinacao-contra-hpvHABB R, Begawan AS. Free HPV vaccination [Internet]. The Brunei Times. 2012. Available from: http://www.bt.com.bn/news-national/2012/01/05/free-hpv-vaccinationPoljak M, Seme K, Maver PJ, Kocjan BJ, Cuschieri KS, Rogovskaya SI, et al. Human papillomavirus prevalence and type-distribution, cervical cancer screening practices and current status of vaccination implementation in Central and Eastern Europe. Vaccine. 2013

Dec 31;31 Suppl 7:H59–70.

Government of Canada, Public Health Agency of Canada. Publicly funded Immunization Programs in Canada - Routine Schedule for Infants and Children including special programs and catch-up programs (as of March 2014) [Internet]. Available from:

http://www.phac-aspc.gc.ca/im/ptimprog-progimpt/table-1-eng.php#fn_2

British Columbia Centre for Disease Control. Immunize BC. HPV (Human Papillomavirus) [Internet]. Immunize BC. Available from: http://www.immunizebc.ca/diseases-vaccinations/hpv

Royal government of Bhutan. Ministry of Health. Memorandum of understanding between the Ministry of Health of the Royal Government of Bhutan, the Australian Cervical Cancer Foundation (ACCF) and Merck &Company to undertake the Human Papilloma

Virus vaccination programme in Bhutan for the prevention of cervical cancer. Available at www.health.gov.bt/downloads/MoUHPV.pdf

Direction des communications du ministère de la Santé et des Services sociaux. Protocole d’immunisation du Québec - Avril 2014 [Internet]. Available from: http://publications.msss.gouv.qc.ca/acrobat/f/documentation/piq/html/web/Piq.htm

Government of Yukon, Health and Social Services. Yukon’s HPV immunization program is changing... [Internet]. Available from: http://www.hss.gov.yk.ca/hpv_change_2012.phpVilla LL. Cervical cancer in Latin America and the Caribbean: the problem and the way to solutions. Cancer Epidemiol Biomarkers Prev. 2012 Sep;21(9):1409–13. Cayman Island Government. HPV Vaccine Soon Available [Internet]. Available from: http://www.gov.ky/portal/page?_pageid=1142,7185572&_dad=portal&_schema=PORTALGobierno de Chile, Ministerio de Salud. Vacunación contra el Virus del Papiloma Humano [Internet]. Available from: http://web.minsal.cl/vacunavph

Manitoba Communicable Disease Control. Public Health. Human Papillomavirus [Internet]. Available from: http://www.gov.mb.ca/health/publichealth/diseases/hpv.htmlCanadian immunization commitee, Public Health Agency of Canada. Recommendations for human papillomavirus immunization programs [Internet]. 2014. Available from: http://publications.gc.ca/collections/collection_2014/aspc-phac/HP40-107-2014-

eng.pdf

Government of Canada, Public Health Agency of Canada. Update On Human Papillomavirus (HPV) Vaccines - Canada Communicable Disease Report Monthly - Public Health Agency of Canada [Internet]. 2012. Available from: http://www.phac-

aspc.gc.ca/publicat/ccdr-rmtc/12vol38/acs-dcc-1/index-eng.php#a4-4

Government of Ontario. Ministry of Health and Long-Term Care. Ontario’s HPV Vaccination Program [Internet]. Available from: http://www.health.gov.on.ca/en/ms/hpv/Prince Edward Island Department of Health and Wellness. Immunization [Internet]. Available from: http://www.gov.pe.ca/health/immunizationschedule

Ministerio de Salud Pública. MSP introducirá vacuna del Papiloma Humano en el 2014 [Internet]. 2013. Available from: http://www.sespas.gov.do/MSP-introducira-vacuna-del-Papiloma-Humano-en-el-2014Australian government, Department of Foreign Affairs and Trade. Australian Aid. Where we give aid. Fiji [Internet]. Available from: http://aid.dfat.gov.au/countries/pacific/fiji/Pages/default.aspxBertaut A, Chavanet P, Aho S, Astruc K, Douvier S, Fournel I. HPV vaccination coverage in French girls attending middle and high schools: a declarative cross sectional study in the department of Côte d’Or. Eur J Obstet Gynecol Reprod Biol. 2013

Oct;170(2):526–32.

Haut Conseil de la Santé Publique. Infections à HPV : nouveau schéma vaccinal du vaccin Cervarix® [Internet]. 2014. Available from: http://www.hcsp.fr/explore.cgi/avisrapportsdomaine?clefr=411Haut Conseil de la Santé Publique. Infections à HPV : nouveau schéma vaccinal du vaccin Gardasil® [Internet]. 2014. Available from: http://www.hcsp.fr/explore.cgi/avisrapportsdomaine?clefr=416

Gobierno de Colombia, Ministerio de Salud y Protección Social. Vacuna contra el cáncer de cuello uterino [Internet]. Available from: http://www.minsalud.gov.co/Paginas/ABC-de-la-vacuna-contra-el-cancer-cuello-uterino.aspxTiraa-Passfield P. HPV vaccination to be administered in the Cook Islands. Cook Islands Herald [Internet]. 2011 Feb 2; Available from: http://www.ciherald.co.ck/articles/h549c.htmCzech Republic’s Ministry of Health, Institute of Public Health. Očkovací kalendář v ČR. The vaccination schedule in the Czech Republic as of 01/01/ 2014. [Internet]. 2014. Available from: http://www.szu.cz/tema/vakciny/ockovaci-kalendar-v-cr

Danish Ministry of Health, Statens Serum Institut. Tema om vaccination mod livmoderhalskræft [Vaccination against cervical cancer] [Internet]. Available from:

http://www.ssi.dk/Aktuelt/Temaer/Generelle%20temaer/Vaccination%20mod%20livmoderhalskraft.aspx

Danish Health and Medicines Authority. Change of the HPV vaccination programme to a 2-dose programme [Internet]. 2014. Available from: http://sundhedsstyrelsen.dk/en/news/2014/change-of-the-hpv-vaccination-programme

Icelandic government, Directorate of Health. HPV vaccination - Embætti landlæknis [Internet]. 2014. Available from: http://www.landlaeknir.is/english/hpv-vaccination/Ireland’s Health Service Executive. National Immunisation Programme - HPV Vaccination Programme [Internet]. 2014. Available from: http://www.immunisation.ie/en/SchoolProgramme/HPV/HPVVaccinationProgramme/#d.en.17475

Robert Koch Institut. Humane Papillomaviren (HPV). Empfehlungen der Ständigen Impfkommission [Recommendations of the Standing Committee on Vaccination] [Internet]. Available from:

http://www.rki.de/DE/Content/Infekt/Impfen/ImpfungenAZ/HPV/HPV.html;jsessionid=BA438FF3F430A7D0E5B4B5CE79C535B0.2_cid372

Donadiki EM, Jiménez-García R, Hernández-Barrera V, Carrasco-Garrido P, López de Andrés A, Velonakis EG. Human papillomavirus vaccination coverage among Greek higher education female students and predictors of vaccine uptake. Vaccine. 2012 Nov

19;30(49):6967–70.

Dunne EF, Koch A. HPV vaccines for circumpolar health: summary of plenary session, “Opportunities for Prevention: Global HPV Vaccine” and “Human Papillomavirus Prevention: The Nordic Experience.” Int J Circumpolar Health [Internet]. 2013 Jun 19;72(0).

Available from: http://www.circumpolarhealthjournal.net/index.php/ijch/article/view/21070/html

Avnstorp MB, Jensen RG, Garnaes E, Therkildsen MH, Norrild B, Specht L, et al. Human papillomavirus and oropharyngeal cancer in Greenland in 1994-2010. Int J Circumpolar Health [Internet]. 2013 Nov 6;72. Available from:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820918/

Guam government, Department of Health and Social Services. Pre-teens/Adolescent and Adults Immunization Outreach [Internet]. 2012. Available from: http://dphss.guam.gov/article/2012/09/23/pre-teensadolescent-and-adults-immunization-outreach


Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa

Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa


introduction


4243444546

47484950515253

5455

565758

596061626364

656667686970

71727374

757677

78

79

State of Israel, Ministry of Health. Vaccine against Papilloma Virus - HPV [Internet]. Available from: http://www.health.gov.il/English/Topics/Vaccination/HPV/Pages/default.aspxGoverno italiano, Ministero della Salute. Vaccinazione contro il Papillomavirus umano [Internet]. Available from: http://www.salute.gov.it/portale/salute/p1_5.jsp?lingua=italiano&id=31&area=VaccinazioniGiambi C. Stato di avanzamento della campagna vaccinale per l’HPV: dati di copertura vaccinale al 31/12/2013 – Rapporto Semestrale [Internet]. Available from: http://www.epicentro.iss.it/problemi/hpv/pdf/Aggiornamento_HPV_31122013.pdf

Latvian Republic Ministry of Health. Vakcinācija pret cilvēka papilomas vīrusa infekciju [Internet]. Available from: http://www.vm.gov.lv/lv/tava_veseliba/vakcinacija/vakcinacija_pret_cilveka_papilomas_virusa_hpv_infekciju/Kingdom of Lesotho. PM launches HPV campaign [Internet]. 2012. Available from: http://www.gov.ls/articles/2012/pm_launches_hpv_campaign.phpLadner J, Besson M-H, Rodrigues M, Audureau E, Saba J. Performance of 21 HPV vaccination programs implemented in low and middle-income countries, 2009-2013. BMC Public Health. 2014;14:670. Grand-Duché de Luxembourg. Portail Santé - Vaccinations: Lettre d’invitation “Vaccination HPV” [Internet]. 2014. Available from: http://www.sante.public.lu/fr/catalogue-publications/rester-bonne-sante/vaccinations/lettre-invitation-vaccination-hpv-fr-de-

pt/index.html

Garland SM, Bhatla N, Ngan HYS. Cervical cancer burden and prevention strategies: Asia Oceania perspective. Cancer Epidemiol Biomarkers Prev. 2012 Sep;21(9):1414–22.

Gilmour S, Kanda M, Kusumi E, Tanimoto T, Kami M, Shibuya K. HPV vaccination programme in Japan. Lancet. 2013 Aug;382(9894):768. Wilson R, Paterson P, Larson HJ. The HPV vaccination in Japan. Issues and Options. A report of the CSIS Global Health Policy Center. Center for Strategic & International Studies. [Internet]. 2014 May. Available from: http://csis.org/publication/hpv-vaccination-

japan

Nakipova Z. Kazakhstan starts vaccination against HPV for the first time. Kazakhstan news today [Internet]. 2013 Mar 29; Available from: http://bnews.kz/en/news/post/130947/Government of the Republic of Kiribati, Ministry of Health. National Multi-Year Plan For Immunization in 2011-2015 [Internet]. 2010. Available from: http://www.nationalplanningcycles.org/planning-cycle/KIRSeme K, Maver PJ, Korać T, Canton A, Částková J, Dimitrov G, et al. Current status of human papillomavirus vaccination implementation in central and eastern Europe. Acta Dermatovenerol Alp Pannonica Adriat. 2013;22(1):21–5.

Principauté de Monaco, Ministère d’Etat. Press releases. Archives Health. Human Papillomavirus vaccination campaign (Gb) [Internet]. 2011. Available from: Finnish Ministry of Social Affairs and Health, National Institute for Health and Welfare. HPV-rokote - Rokottaminen [Internet]. Available from: http://www.thl.fi/fi/web/rokottaminen/rokotteet/hpv-rokoteEuropean Centre for Disease Prevention and Control. Recommended immunisations from birth in Liechtenstein [Internet]. 2014. Available from: http://vaccine-schedule.ecdc.europa.eu/Pages/Scheduler.aspxEuropean Centre for Disease Prevention and Control. Recommended immunisations from 2 months old of age in Slovakia [Internet]. 2014. Available from: http://vaccine-schedule.ecdc.europa.eu/Pages/Scheduler.aspxMinistry of Health, Welfare and Sport, National Institute for Public Health and the Environment. Rijksvaccinatieprogramma-Baarmoederhalskanker [Internet]. Available from:

http://www.rivm.nl/Onderwerpen/R/Rijksvaccinatieprogramma/De_ziekten/Baarmoederhalskanker

Malta government, Ministry for Health. National Immunisation Schedule 2013 [Internet]. Available from: https://ehealth.gov.mt/HealthPortal/health_institutions/primary_healthcare/the_primary_child_health_and_immunisation_unit/the_schedule.aspx

Ameen J. Cervical virus jab available for 12-year-olds. Times of Malta [Internet]. 2013 Sep 5; Available from: http://www.timesofmalta.com/articles/view/20130509/local/Cervical-virus-jab-available-for-12-year-olds.468959Markowitz LE, Tsu V, Deeks SL, Cubie H, Wang SA, Vicari AS, et al. Human papillomavirus vaccine introduction--the first five years. Vaccine. 2012 Nov 20;30 Suppl 5:F139–48. Gobierno Mexicano, Secretaría de Salud, Subsecretaría de Prevención y Promoción de la Salud. Centro Nacional Para la Salud de la Infancia y la Adolescencia. Programa de Vacunación Universal. Lineamientos generales 2014. [Internet]. Available from:

http://www.censia.salud.gob.mx/contenidos/descargas/vacunas/LINEPVU2014SF.pdfCenters for Disease Control and Prevention (CDC). Progress toward implementation of human papillomavirus vaccination--the Americas, 2006-2010. MMWR Morb Mortal Wkly Rep. 2011 Oct 14;60(40):1382–4.

Ministerio de Salud de la República de Panamá. Programa Ampliado de Inmunización. Esquema Nacional de Vacunación. Revisado Marzo 2013 [Internet]. Available from:

http://www.minsa.gob.pa/sites/default/files/programas/esquema_de_vacunacion_revisado_marzo_2013.pdf

Ministerio de Salud Pública y Bienestar Social, Programa Ampliado de Immunizaciones de Paraguay. Vacunacion contra Virus de Papiloma Humano [Internet]. Available from: http://www.mspbs.gov.py/pai/images/enfermedades/vph_2013.pdfMinisterio de Sald de Perú. Este año se fortalece la inmunización contra el virus papiloma humano [Internet]. 2013. Available from: http://www.minsa.gob.pe/portada/prensa/nota_completa.asp?nota=12803Ministério da Saúde. Portal da Saúde - Programa Nacional de Vacinação Em vigor a partir de 1 de outubro de 2014 [Internet]. Available from: http://www.portaldasaude.pt/portal/conteudos/informacoes+uteis/vacinacao/vacinasLeça A, Calé E, Castelão I, Valente P, Fernandes T. A vacinação contra o vírus do papiloma humano (HPV) em Portugal. Boletim Vacinação Ediçao Especial. [Internet]. Direção-Geral da Saúde; 2014 Apr. Report No.: 8. Available from:

http://www.dgs.pt/documentos-e-publicacoes/boletim-vacinacao-edicao-especial-abril-2014-pdf

Keulen HM van, Otten W, Ruiter RA, Fekkes M, Steenbergen J van, Dusseldorp E, et al. Determinants of HPV vaccination intentions among Dutch girls and their mothers: a cross-sectional study. BMC Public Health. 2013 Feb 6;13(1):111. Direction des Affaires Sanitaires et Sociales de Nouvelle-Calédonie. Vaccinations [Internet].Available from: http://www.dass.gouv.nc/portal/page/portal/dass/programme_actions_contre_maladies/vaccinationsMinistry of Health. HPV immunisation programme [Internet]. Available from: http://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/hpv-immunisation-programmeSablan M. Report on the HPV Camapign in the high schools of the Northern Mariana Islands (CNMI). Available from: https://cdc.confex.com/cdc/nic2008/techprogram/P15449.HTM Public Health Institute - Folkehelseinstituttet. Vaccine against cervical cancer (HPV vaccine) [Internet]. Available from: http://www.fhi.no/artikler/?id=90946

Penţa MA, Băban A. Mass media coverage of HPV vaccination in Romania: a content analysis. Health Educ Res. 2014 Jun 2;cyu027. European Centre for Disease Prevention and Control. Recommended immunisations from birth in Romania [Internet]. 2014. Available from: http://vaccine-schedule.ecdc.europa.eu/Pages/Scheduler.aspxRogovskaya SI, Shabalova IP, Mikheeva IV, Minkina GN, Podzolkova NM, Shipulina OY, et al. Human papillomavirus prevalence and type-distribution, cervical cancer screening practices and current status of vaccination implementation in Russian Federation, the

Western countries of the former Soviet Union, Caucasus region and Central Asia. Vaccine. 2013 Dec 31;31 Suppl 7:H46–58.

Gavi Vaccine Alliance. 1.5 million girls set to benefit from vaccine against cervical cancer - 2014 - Press releases [Internet]. Available from: http://www.gavi.org/library/news/press-releases/2014/1-5-million-girls-set-to-benefit-from-vaccine-against-cervical-

cancer/

Government of Rwanda. Rwanda focuses on preventing cervical cancer through pushing early HPV vaccination for girls [Internet]. 2013. Available from: http://www.gov.rw/Rwanda-focuses-on-preventing-cervical-cancer-through-pushing-early-HPV-vaccines-

for-girls?lang=en


Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa

Primary

targeta

Organized

catch-upa

Opportunistic

catch-upa


introduction


80

81

82838485

8687

88899091929394959697

Istituto Sicurezza Sociale Repubblica di San Marino. Vaccino contro l’HPV: San Marino si allinea all’Europa [Internet]. 2008. Available from: http://www.iss.sm/on-line/home/notizie-dalla-sanita/articolo3000451.html?comeback=/on-line/home/artCatnotizie-

dalla-sanita.3000175.1.10.2.1.html

Republic of Seychelles, Ministry of Health. “Seychelles will be free of cervical cancer,” says Minister- 07-April-2014 [Internet]. 2014. Available from: http://www.health.gov.sc/index.php?option=com_content&view=article&id=263:seychelles-will-be-free-of-

cervical-cancer-says-minister-07-april-2014&catid=47:latest-news

Singapore Government, Health Promotion Board. FAQs on Human Papilloma Virus (HPV) and HPV vaccination [Internet]. 2013. Available from: http://www.hpb.gov.sg/HOPPortal/health-article/8768Nacionalni Inštitut za javno zdravje. Cepljenje proti okužbam s humanimi papilomskimi virusi (HPV) [Internet]. 2014. Available from: http://www.ivz.si/cepljenje/splosna_javnost/bolezniRepublic of South Africa, National Department of Health. Human Papilloma Virus (HPV) Vaccination Campaign [Internet]. Available from: http://www.health.gov.za/hpvarchv.php

National Health Service. Human papilloma virus (HPV) cervical cancer vaccine [Internet]. Available from: http://www.nhs.uk/Conditions/vaccinations/Pages/hpv-human-papillomavirus-vaccine.aspxMarkowitz LE, Dunne EF, Saraiya M, Chesson HW, Curtis CR, Gee J, et al. Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2014 Aug 29;63(RR-05):1–30. Republica Oriental del Uruguay, Ministerio de Salud Publica. Vacuna contra el virus del Papiloma Humano [Internet]. Available from: http://www.msp.gub.uy/noticia/vacuna-contra-el-virus-del-papiloma-humano

Public Health Agency of Sweden - Folkhälsomyndigheten. Humant papillomvirus (HPV) [Internet]. Available from: http://www.folkhalsomyndigheten.se/amnesomraden/smittskydd-och-sjukdomar/vaccinationer/vacciner-a-o/humant-papillomvirus-hpv/Office fédéral de la santé publique. Papillomavirus humains (HPV) [Internet]. Available from: http://www.bag.admin.ch/themen/medizin/00682/00684/03853/index.html?lang=frThe Ministry of Health - Trinidad and Tobago. HPV Vaccination Begins [Internet]. 2013. Available from: http://www.health.gov.tt/news/newsitem.aspx?id=403Gulland A. Uganda launches HPV vaccination programme to fight its commonest cancer. BMJ. 2012 Sep 10;345(sep10 1):e6055–e6055. Health Authority Abu Dhabi. Cervical Cancer Prevention - Launch of the HPV Vaccination for Young Women [Internet]. 2013. Available from: http://www.haad.ae/simplycheck/tabid/58/ctl/Details/Mid/387/ItemID/7/Default.aspx

Ministerio de Sanidad, Política Social e Igualdad. Grupo de trabajo VPH 2012. Ponencia de Programa y Registro de Vacunaciones. Revisión del Programa de Vacunación frente a Virus del Papiloma Humano en España. Comisión de Salud Pública del Consejo

Interterritorial del Sistema Nacional de Salud. [Internet]. 2013 Jan. Available from: http://www.msssi.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/docs/PapilomaVPH.pdf

Ministerio de Sanidad, Servicios Sociales e Igualdad. Calendario Vacunación 2014 [Internet]. Available from: https://www.msssi.gob.es/ciudadanos/proteccionSalud/infancia/vacunaciones/programa/vacunaciones.htmGobierno de Aragón, Departamento de Sanidad, Bienestar Social y Familia. Programas de salud - Vacunaciones - Vacuna virus del papiloma humano (VPH) [Internet]. Available from:

http://www.aragon.es/DepartamentosOrganismosPublicos/Departamentos/SanidadBienestarSocialFamilia/AreasTematicas/SanidadProfesionales/SaludPublica/ProgramasSalud/ci.mas_completo_01_Programa_de_Vacunaciones.detalleDepartamento?channe

lSelected=9c6a126a7cdcb210VgnVCM100000450a15acRCRD#section13Junta de Castilla y León. Vacunación frente al Virus del Papiloma Humano (VPH) [Internet]. Available from: http://www.saludcastillayleon.es/profesionales/es/vacunaciones/vacunacion-frente-virus-papiloma-humano-vph Bureau voor Openbare Gezondheidszorg. HPV Vaccinatie [Internet]. Available from: http://www.bogsur.sr/index.php/ct-menu-item-5/ct-menu-item-7


30

Table S2. Data available by birth cohort on National Immunization’s programme HPV

vaccination coverage by country

Country Birth cohorts with coverage data

Last observed HPV vaccination coverage available

Full course

(birth cohort)

One dose

(birth cohort)

Argentina 2000 50.0% (2000) 80.0% (2000)

Australia 1981-1997 72.0% (1997) 83.0% (1997)

Belgium 1993-1996 44.0% (1996) -

Brussels 1990-1997,1999 35.7% (1999) -

Flanders 1990-1999 81.6% (1999) 87.8% (1999)

Wallonia 1990-1997,1999 29.3% (1999) -

Bhutan 1992-1998 92.0% (1998) -

Canada 1994 43.4% (1994) -

Alberta 1998-2002 69.3% (2002) -

British Columbia 1994-2001 69.1% (2001) -

Manitoba 1997-1998,2000 43.4% (2000) -

New Brunswick 1996-1999 75.8% (1999) -

Newfoundland 1996-2000 90.8% (2000) -

Nova Scotia 1994-1999 76.1% (1999) 92.3% (1999)

North West Territories 2001 47.0% (2001) 54.0% (2001)

Ontario 1994-1998 70.2% (1998) -

Prince Edward Island 1996-1997 85.0% (1996) 80.0% (1997)

Quebec 1997-1997,1999-2000,2002 77.0% (2002) -

Saskatchewan 1997-1999 68.0% (1999) -

Yukon 2000 - 67.0% (2000)

Colombia 2003 87.1% (2003) 97.5% (2003)

Denmark 1993-2000 81.0% (2000) 90.0% (2000)

Fiji

2000 - 92.0% (2000)

Finland 1997-2001 - 45.0% (2001)

France 1993-1997 20.0% (1997) 32.0% (1997)

Germany 1990-1992,1995-1997 37.7% (1997) 54.5% (1997)

Greece 1985-1993 27.6% (1993) -

Guam 1995-2000 33.6% (2000) 69.1% (2000)

Iceland 1999-2001 88.0% (2001) 93.0% (2001)

Ireland 1994-1995,1998-2001 84.2% (2001) 87.0% (2001)

Italy 1990-2001 56.6% (2001) 70.3% (2001)

Piemonte 1993-2000 66.1% (2000) 71.4% (2000)

Val d'Aosta 1991-2000 67.2% (2000) 72.4% (2000)

Lombardia 1997-2001 65.0% (2001) 78.4% (2001)

PA Trento 1997-2001 62.5% (2001) 65.3% (2001)

PA Bolzano 1996-2001 24.9% (2001) 33.4% (2001)

Veneto 1996-2001 57.4% (2001) 73.9% (2001)

Friuli-Venezia Giulia 1993-2001 62.5% (2001) 68.0% (2001)

Liguria 1982-2001 65.8% (2001) 73.0% (2001)

Emilia-Romagna 1990-2001 69.3% (2001) 77.1% (2001)

Toscana 1993-2001 75.6% (2001) 81.9% (2001)

Umbria 1996-2001 72.3% (2001) 83.1% (2001)

Marche 1996-2001 59.0% (2001) 69.6% (2001)

Lazio 1996-2001 51.0% (2001) 64.8% (2001)

Abruzzo 1996-2001 62.6% (2001) 77.2% (2001)

Molise 1996-2001 33.6% (2001) 68.4% (2001)

Campania 1996-2001 51.4% (2001) 61.4% (2001)

Puglia 1993-2001 67.0% (2001) 79.4% (2001)

Basilicata 1983-1987,1990-2000 77.9% (2000) 84.8% (2000)

Calabria 1996-2001 59.3% (2001) 68.8% (2001)

Sicilia 1996-2001 33.5% (2001) 54.1% (2001)

Sardegna 1996-2001 41.4% (2001) 65.1% (2001)

Japan 1994-2001 - 8.0% (2001)

Latvia 1998-1999 60.6% (1999) 61.4% (1999)

Luxembourg 1990-1996 17.0% (1996) -

Macedonia, TFYR 1997-1999 65.0% (1999) -

Malaysia 1998 87.1% (1998) -

Mexico 1992-2000 67.0% (2000) 85.0% (2000)

Netherlands 1993-1999 58.9% (1999) 61.5% (1997)

New Zealand 1991-2000 54.0% (2000) 60.0% (2000)

Norway 1997-2001 76.0% (2001) 85.0% (2001)

Panama 1999-2000 67.0% (2000) 89.0% (1999)

Portugal 1992-1999 88.0% (1999) 94.0% (1999)

Romania 1995-1999 5.0% (1999) -

Rwanda 1997-1997,1999-2001 96.6% (2000) 98.8% (2000)

Slovenia 1998-2001 48.9% (2001) -

31

South Africa 2004 - 87.0% (2004)

Spain

Andalucia 1994-1998 51.3% (1998) 51.4% (1996)

Aragon 1994-1998 89.3% (1998) 85.0% (1996)

Asturias 1995-1999 72.3% (1999) -

Cantabria 1994-1999 85.0% (1999) 88.6% (1997) Ceuta 1995-1999 88.1% (1999) 63.7% (1997)

Castilla Leon 1994-2000 91.5% (2000) 93.9% (2000)

Castilla La Mancha 1994-1999 69.7% (1999) 74.7% (1997) Canarias 1994-1999 86.5% (1999) -

Cataluña 1997-2001 81.6% (2001) 84.8% (1999)

Extremadura 1994-1999 81.0% (1999) 84.7% (1996) Galicia 1994-1999 73.8% (1999) 85.2% (1997)

Baleares 1994-1998 70.9% (1998) 63.6% (1996)

Murcia 1994-2000 83.7% (2000) 82.5% (1998) Madrid 1994-1999 79.6% (1999) 84.0% (1997)

Melilla 1995-2000 74.2% (2000) 83.7% (1998)

Navarra 1995-2001 84.2% (2001) 91.8% (1999) Pais Vasco 1995-2000 90.2% (2000) -

La Rioja 1993-2001 93.4% (2001) 96.1% (1999)

C. Valenciana 1994-1999 73.5% (1999) 76.7% (1997)

Sweden 1986-2001 - 83.0% (2001)

Switzerland 1995-1997 50.7% (1997) 55.6% (1997)

Aargau 1995 59.0% (1995) 62.5% (1995)

Appenzell Ausserrhoden 1994-1994,1997 24.2% (1997) 28.5% (1997)

Bern 1995 37.3% (1995) 43.7% (1995)

Basel-Landschaft 1995 64.4% (1995) 65.6% (1995)

Basel-Stadt 1994-1994,1997 52.4% (1997) 56.2% (1997)

Fribourg 1994-1994,1997 71.5% (1997) 73.1% (1997)

Geneve 1989-1996 78.1% (1996) 79.3% (1996)

Glarus 1994-1994,1997 47.1% (1997) 56.1% (1997)

Graubünden 1994-1994,1997 44.2% (1997) 52.4% (1997)

Jura 1997 62.9% (1997) 64.1% (1997)

Luzern 1993-1993,1997 49.6% (1997) 56.1% (1997)

Neuchâtel 1995 59.4% (1995) 64.8% (1995)

Nidwalden 1994-1994,1997 60.8% (1997) 60.8% (1997)

Obwalden 1993-1993,1996 31.3% (1996) 33.9% (1996)

Sankt Gallen 1993-1993,1996 58.5% (1996) 64.2% (1996)

Schaffhausen 1995 40.2% (1995) 47.2% (1995)

Solothurn 1995 52.6% (1995) 58.3% (1995)

Schwyz 1995 27.4% (1995) 31.3% (1995)

Thurgau 1994-1994,1997 34.8% (1997) 43.2% (1997)

Ticino 1994-1994,1997 37.9% (1997) 45.1% (1997)

Uri 1993-1993,1996 40.0% (1996) 46.3% (1996)

Vaud 1995 66.5% (1995) 69.5% (1995)

Valais 1994-1994,1997 74.8% (1997) 78.5% (1997)

Zug 1993-1993,1996 17.1% (1996) 24.4% (1996)

Zürich 1995 43.5% (1995) 48.6% (1995)

US Virgin Islands 1995-2000 9.5% (2000) 33.2% (2000)

United Arab Emirates

Abu Dhabi 1992-1995 59.0% (1995) -

United Kingdom

England 1991-2001 79.7% (2001) 89.5% (2001)

Northern Ireland 1996-1998 84.6% (1998) 87.4% (1998)

Scotland 1991-2001 81.4% (2001) 93.6% (2001)

Wales 1991-1991,1996-2000 86.0% (2000) 89.6% (2000)

United States of America 1982-1998 32.1% (1998) 55.1% (1998)

For sources see Table S3

32

Table S3. Sources for HPV vaccination coverage data

Type of sources

Number %

Official vaccination statistics published in governmental websites as reports or browsable databases.

33 47%

Scientific publications 22 31%

Epidemiological bulletins 5 7%

Statistics embedded in press releases from governmental websites or WHO

5 7%

Statistics extracted from scientific communications in conferences by experts in the field or government officers

5 7%

Total 70 100%

Sources by country

Argentina Presidencia de la Nación, Instituto Nacional del Cáncer. Aseguran que Argentina tiene mejores coberturas de vacunación contra el VPH que los Estados Unidos [Internet].. Available from:

http://www.msal.gov.ar/inc/index.php/comunicacion/archivo-de-noticias/431-aseguran-que-argentina-

tiene-mejores-coberturas-de-vacunacion-contra-el-vph-que-los-estados-unidos

Australia Australian government, Department of Health and Ageing. National HPV Vaccination Program Register

- Coverage Data 2014. http://www.hpvregister.org.au/research/coverage-data

Brotherton JML, Liu B, Donovan B, Kaldor JM, Saville M. Human papillomavirus (HPV) vaccination

coverage in young Australian women is higher than previously estimated: independent estimates from a

nationally representative mobile phone survey. Vaccine 2014;32:592–7.

Belgium Arbyn M. HPV vaccination of teenage girls in Belgium. Flemish Society of Gynaecology and Obstetrics

Annual Congress. 18-19 October 2012, Bredene (Belgium)

Ministère de la Fédération Wallonie-Bruxelles. Secrétariat général. Direction de la Recherche. La

Fédération Wallonie-Bruxelles en chiffres. Edition 2014. Available at:

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88a221cf1b6698b7

Simoens C, Sabbe M, Van Damme P, Beutels P, Arbyn M. Introduction of human papillomavirus (HPV) vaccination in Belgium, 2007-2008. Euro Surveill 2009;14.

Top G, Paeps A. HPV-vaccinatie in Vlaanderen – Resultaten van de eerste twee vaccinatiejaren 2010-2012. Vlaams Infectieziektebulletin 2012;81.

Bhutan Tshomo U, Franceschi S, Dorji D, Baussano I, Tenet V, Snijders PJ, et al. Human papillomavirus infection in Bhutan at the moment of implementation of a national HPV vaccination programme. BMC

Infect Dis 2014;14:408. doi:10.1186/1471-2334-14-408.

Canada BC Centre for Disease Control. Immunization Programs & Vaccine Preventable Diseases Service. Immunization Uptake in Grade 6 Students. 2002-13

BC Centre for Disease Control. Immunization Programs & Vaccine Preventable Diseases Service. Immunization Uptake in Grade 9 Students. 2002-13

Canadian immunization commitee, Public Health Agency of Canada. Recommendations for human

papillomavirus immunization programs. 2014.

LaJeunesse C. HPV vaccine: Exploring less than favourable uptake. Western Canada Immunization

Forum Mar 5 & 6 2014.

Nova Scotia Department of Health and Wellness. Population Health Assessment and

Surveillance.School-based immunization coverage in Nova Scotia: 2008-09 to 2011-12

Ontario Agency for Health Protection and Promotion. Lim GH, McIntyre MA, Wilson S. Immunization

coverage and exemptions among Ontario’s school pupils for 2011–12: Findings and implications for

future information systems. PHO Ground Rounds August 20, 2013

Public Health Agency of Canada. Vaccine Coverage in Canadian Children: Results from the 2011

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33

Shearer BD, HPV Vaccination: Understanding the Impact on HPV Disease. National Collaborating

Centre for Infectious Diseases. Purple Paper Dec 2011; Issue 34.

Wilson SE, Harris T, Sethi P, Fediurek J, Macdonald L, Deeks SL. Coverage from Ontario, Canada’s school-based HPV vaccine program: the first three years. Vaccine 2013;31:757–62.

Colombia Gobierno de Colombia, Ministerio de Salud Pública y Bienestar Social. Colombia cuenta con las mejores coberturas de vacunación contra VPH del mundo 2013.

http://www.minsalud.gov.co/Paginas/Colombia-cuenta-con-las-mejores-coberturas-de-vacunacion.aspx

Denmark Danish Ministry of Health, Statens Serum Institut. Human papillomavirus-vaccine (HPV) 3, vaccinationstilslutning n.d.

http://www.ssi.dk/Smitteberedskab/Sygdomsovervaagning/VaccinationSurveillance.aspx?vaccination=7&sex=0&landsdel=100&xaxis=Cohort&yaxis=Total&show=Table&datatype=Vaccination&extendedfil

ters=True#HeaderText

Finland Nohynek H, Pitkanen S, Baum U. HPV-rokotukset Suomessa: TYTTÖJEN JUTTU. SIC LÄÄKETIETOA FIMEASTA 3/2014

Fiji Australian government, Department of Foreign Affairs and Trade. Australian Aid. Where we give aid.

Fiji n.d. http://aid.dfat.gov.au/countries/pacific/fiji/Pages/default.aspx

France Haut Conseil de la santé publique. Vaccination contre les infections à papillomavirus humains. Collection avis et Rapports. 10 Juillet 2014

Germany Poethko-Müller C, Buttmann-Schweiger N, KiGGS Study Group. [HPV vaccination coverage in German girls?: Results of the KiGGS study: first follow-up (KiGGS Wave 1)]. Bundesgesundheitsblatt

Gesundheitsforschung Gesundheitsschutz. 2014 Jul;57(7):869–77.

Deleré Y, Böhmer MM, Walter D, Wichmann O. HPV vaccination coverage among women aged 18-20 years in Germany three years after recommendation of HPV vaccination for adolescent girls: Results

from a cross-sectional survey. Hum Vaccin Immunother. 2013 Aug 1;9(8):1706–11.

Greece Donadiki EM, Jiménez-García R, Hernández-Barrera V, Carrasco-Garrido P, López de Andrés A,

Velonakis EG. Human papillomavirus vaccination coverage among Greek higher education female

students and predictors of vaccine uptake. Vaccine. 2012 Nov 19;30(49):6967–70.

Guam Elam-Evans LD, Yankey D, Jeyarajah J, Singleton JA, Curtis RC, MacNeil J, et al. National, regional,

state, and selected local area vaccination coverage among adolescents aged 13-17 years - United States,

2013. MMWR Morb Mortal Wkly Rep. 2014 Jul 25;63(29):625–33.

Iceland Icelandic government, Directorate of Health. Participation in children’s vaccinations in Iceland.

Bólusetningar - Embætti landlæknis [Internet]. Available from: http://www.landlaeknir.is/smit-og-sottvarnir/bolusetningar/

Ireland HSE- Health Service Executive of Ireland. HPV Cervical Cancer Vaccination Programme [Internet].

Available from: www.hse.ie/eng/services/news/newsarchive/2012archive/jan2012/hpvcervicalcancervaccination.html+&

cd=1&hl=en&ct=clnk&gl=es&client=firefox-a

Health Protection Surveillance Centre. HPV Immunisation Uptake Statistics [Internet]. Available from: http://www.hpsc.ie/A-

Z/VaccinePreventable/Vaccination/ImmunisationUptakeStatistics/HPVImmunisationUptakeStatistics/

Italy Giambi C. Campagna vaccinale anti-HPV: dati di copertura e strategie vaccinali. Convegno “Infezione da HPV: dalla diagnosi precoce alla prevenzione primaria” ISS, Roma 27 giugno 2012

Giambi C. Stato di avanzamento della campagna vaccinale per l’HPV: dati di copertura vaccinale al 31/12/2013 – Rapporto Semestrale [Internet]. Available from:

http://www.epicentro.iss.it/problemi/hpv/pdf/Aggiornamento_HPV_31122013.pdf

Lugarini J, Maddalo F. Results of a vaccination campaign against human papillomavirus in the province

of La Spezia, Liguria, Italy, March-December 2008. Euro Surveill [Internet]. 2009 ;14(39)

Paolucci C, Pascucci MG, Finarelli AC, Bedeschi E. Coperture Vaccinali HPV, Servizio Sanità Pubblica, Assessorato Politiche per la Salute, Regione Emilia-Romagna. Dati al 31 dicembre 2013 .

Japan Konno R. The Japanese Expert Board for the Eradication of Cervical Cancer. HPV Vaccine safety and the crisis in Japan.14 August 2014.

Latvia Seme K, Maver PJ, Korac T, Canton A, Cástková J, Dimitrov G, et al. Current status of human

papillomavirus vaccination implementation in central and eastern Europe. Acta Dermatovenerol Alp Pannonica Adriat. 2013;22(1):21–5.

Luxembourg Dorleans F, Giambi C, Dematte L, Cotter S, Stefanoff P, Mereckiene J, et al. The current state of

introduction of human papillomavirus vaccination into national immunisation schedules in Europe: first results of the VENICE2 2010 survey. Euro Surveill [Internet]. 2010;15(47).

Macedonia,

TFYR Poljak M, Seme K, Maver PJ, Kocjan BJ, Cuschieri KS, Rogovskaya SI, et al. Human papillomavirus

prevalence and type-distribution, cervical cancer screening practices and current status of vaccination

34

implementation in Central and Eastern Europe. Vaccine. 2013 Dec 31;31 Suppl 7:H59–70.

Seme K, Maver PJ, Korac T, Canton A, Cástková J, Dimitrov G, et al. Current status of human papillomavirus vaccination implementation in central and eastern Europe. Acta Dermatovenerol Alp

Pannonica Adriat. 2013;22(1):21–5.

Malaysia Ezat SWP, Hod R, Mustafa J, Mohd Dali AZH, Sulaiman AS, Azman A. National HPV immunisation programme: knowledge and acceptance of mothers attending an obstetrics clinic at a teaching hospital,

Kuala Lumpur. Asian Pac J Cancer Prev. 2013;14(5):2991–9.

Mexico Centers for Disease Control and Prevention (CDC). Progress toward implementation of human papillomavirus vaccination--the Americas, 2006-2010. MMWR Morb Mortal Wkly Rep. 2011 Oct

14;60(40):1382–4.

Netherlands Lier EA van, Oomen PJ, Giesbers H, Conyn- van Spaendonck MAE, Drijfhout IH, Zonnenberg-Hoff IF, et al. Vaccinatiegraad Rijksvaccinatieprogramma Nederland. Verslagjaar 2014. RIVM-rapport nr.

150202003. Bilthoven: Rijksinstituut voor Volksgezondheid en Milieu (RIVM)2014.

Oomen P, Zonnenberg I, de Hoogh P. Opkomst HPV-vaccinaties per 1 januari 2012, geboortecohorten 1997 en 1998. Rijksinstituut voor Volksgezondheid en Milieu. RIVM/RCP&IOD, 28- 1 2012. Available

at http://rivm.nl/dsresource?type=pdf&objectid=rivmp:55465&versionid=&subobjectname=

New Zealand Ministry of Health. HPV immunisation programme.HPV Immunisation Coverage by Ethnicity,

Vaccination and Eligible Birth cohort to 28 February 2014. Available from:

http://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/hpv-immunisation-programme

Norway Public Health Institute - Folkehelseinstituttet. Vaksinasjonsstatistikk for HPV-vaksinasjon [Internet].

Available from: http://www.fhi.no/artikler/?id=94510

Panama Centers for Disease Control and Prevention (CDC). Progress toward implementation of human

papillomavirus vaccination--the Americas, 2006-2010. MMWR Morb Mortal Wkly Rep. 2011 Oct 14;60(40):1382–4.

Portugal Leça A, Calé E, Castelão I, Valente P, Fernandes T. A vacinação contra o vírus do papiloma humano

(HPV) em Portugal. Boletim Vacinação Ediçao Especial. [Internet]. Direção-Geral da Saúde; 2014 Apr. Report No.: 8. Available from: http://www.dgs.pt/documentos-e-publicacoes/boletim-vacinacao-edicao-

especial-abril-2014-pdf

Leça A, Calé E, Freitas G, Castelão I, Valente P, Fernandes T. PNV - Avaliação 2012 [Internet]. Direção-Geral da Saúde; 2013 Apr. Report No.: 6. Available from: http://www.dgs.pt/documentos-e-

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Romania Poljak M, Seme K, Maver PJ, Kocjan BJ, Cuschieri KS, Rogovskaya SI, et al. Human papillomavirus prevalence and type-distribution, cervical cancer screening practices and current status of vaccination

implementation in Central and Eastern Europe. Vaccine. 2013 Dec 31;31 Suppl 7:H59–70.

Rwanda Binagwaho A, Ngabo F, Wagner CM, Mugeni C, Gatera M, Nutt CT, et al. Integration of comprehensive women’s health programmes into health systems: cervical cancer prevention, care and

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Government of Rwanda. Rwanda focuses on preventing cervical cancer through pushing early HPV

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Slovenia Nacionalni Inštitut za javno zdravje. Precepljenost (delež cepljenih) šestošolk proti okužbam s HPV (s 3

odmerki cepiva) po zdravstvenih regijah, Slovenija, šolska leta 2009/10, 2010/11, 2011/12 in 2012/13 [Internet]. 2014. Available from:

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South Africa Kamupira M, WHO Regional Office for Africa. 87% coverage in first round of introduction of Human Papilloma Virus (HPV) Vaccination - [Internet]. Available from: http://www.afro.who.int/en/south-

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vacunación (Datos definitivos 2009-2013) [Internet]. Available from: http://www.saludcastillayleon.es/profesionales/es/vacunaciones/campana-vacunacion-frente-virus-

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36

Table S4. Description of the methods, assumptions and outcomes Methods sorted by sequential order

Description Assumptions Variables and outcomes Related tables/figures

I. Data extraction

1. Identification of HPV vaccination programmes (HPV-NIP)

1.1. HPV-NIP were identified through October 2014 via several sources

These sources combined identify all HPV-NIPs Countries with PVP Table S1

1.2. Retrieval of online information from health ministries and a systematic review of the literature supplemented by web-based searches of identified HPV-NIPs

Programmatic information corresponds with actual implementation

Year of introduction, target ages, schedule, vaccine delivery and targeted birth cohorts by country/subnational entity and implementation strategy (primary vs catch-up). Dataset with birth cohorts targeted by country/subnational entity

Figure S1

2. Retrieval of HPV vaccination coverages

2.1. Systematic review of the literature and official websites

Coverage information is available online Coverage (%) for 1, 2- and 3-doses by birth cohort or age and year of the estimation

Figure S1

2.2. Conversion of all retrieved information into birth cohort-specific coverages derived from the population age and the year of the estimation.

Coverages have remained stable since the year of the estimation and the closing date of the present analysis

Dataset with birth cohorts with HPV vaccination coverage by country/subnational region

Tables S2-S3

3. Denominators 3.1. Female population data by birth cohort and country were obtained annually for the year 2012 from the United Nations Population Division and the U.S. Census Bureau

Targeted populations coincide with estimated national/subnational populations and projections

Number of females by birth cohort and country Figure S9

II. Statistical analysis

4. Treatment of missing data

4.1. Estimation of dose-specific coverage from the available data using a regression model

All targeted birth cohorts were assigned with a one-dose coverage and a full-course coverage

Figure S3

4.2. Stepwise imputation algorithm for birth cohorts with missing coverage data

Missing coverages between two distant birth cohorts with data can be approximated through linear interpolation

Tables S5-S7, Figures S4-S8

Coverages are similar in adjacent birth cohorts with the same delivery strategy

Missing subnational coverages approximate the national estimate or the average of the rest of subnational regions within the country

Missing coverages can be approximated from large previous demonstrations projects or partial implementations

When no coverage data are available for a given country, the use of the weighted average from countries with the same implementation strategy and age at vaccination imputes an non-evidence based value, but less biased than unrealistic extreme coverages of 0% or 100%

5. Estimation of the number of vaccinated females

5.1. For each birth cohort, the number of females (see 3.1) was multiplied by the coverage assigned (see 2.2, 4.1 and 4.2)

All previous related assumptions Number of vaccinated females by birth cohort and country

Table of the article, Figures 3-4

6. Estimation of the 95% confidence intervals of the number of vaccinated females

6.1. 95% confidence intervals were computed using the percentile method in a bootstrap process with 3000 replications

Each bootstrap subsample is drawn independently from other samples

Subsamples come from the same distribution of the population

Upper and lower bounds of the 95% confidence interval

Table of the article

7. Estimation of HPV 7.1. Sum of the number of vaccinated females divided All previous assumptions (1 to 6) One dose and full-course coverages by country Table of the

37

vaccination coverages by country/region

by the total/targeted population and region article, Figures 3-5, tables S9-S12

8.Estimation of the expected reduction in cervical cancer cases and deaths

8.1 Female population projections by birth cohort and country were obtained annually for the years 2012-2100 from the United Nations Population Division and the U.S. Census Bureau

Population projections will correct cancer burden estimations for overall mortality. Population projections are valid approximations of future population numbers.

Number of females by birth cohort and country for the years 2012-2100

Methods S2, Figure 5

8.2. Estimates of cervical cancer incidence and mortality rates by 5-year age groups and country were obtained from IARC’s GLOBOCAN 2012

Estimates from IARC’s GLOBOCAN 2012 are valid measures of actual contemporary cervical cancer incidence and mortality for all countries

Cervical cancer incidence and mortality rates by 5-year age groups and country

8.3. Estimation of expected cervical cancer cases in targeted birth cohorts by multiplying the contemporary age-specific incidence and mortality rates (see 8.2) by the corresponding expected annual population for 2013, 2014, etc (see 8.1), until the year of the 75th birthday by birth cohort, age and country

Birth cohorts included in the analysis would maintain the same lifetime risk of cervical cancer as estimated by current estimations (2012) in the absence of vaccination.

Number of expected cases of cervical cancer by birth cohort and country

8.4. Estimation of the number of cases prevented was computed by multiplying individual HPV vaccination coverages by the number of expected cancer cases for each birth cohort (see 8.3)

All previous assumptions and sustained vaccine effectiveness of 70% over time and across regions

Number of averted cases of cervical cancer by birth cohort and country

38

Table S5. Stepwise algorithm to impute missing specific birth-cohort data coverage

Colo

r co

de

in

figu

re S

4

Order Criteria Example N data

points

N

countries

Step 0 Original data - 645a 39b

Step 1 Linear interpolation

45 8

Step 2 Some countries had coverages split by

subnational regions. Missing data for regional

birth cohorts were imputed with national

estimates for the same birth cohort when available

106 2

Step 3 Imputation from the first previous birth cohort

available in the same country/ subnational

region.

342 35

Step 4 Imputation from the first subsequent birth

cohort available in the same country/subnational

region.

329 15

Step 5 Imputation from the first subsequent birth

cohort available in the same country/subnational

region, but with 60% reduction in coverage for

opportunistic strategies when imputation from organized/catch-up coverages

250 8

Step 6 Imputation from the weighted average of other

subnational regions of the same country (same

birth cohort or first available

previous/subsequent birth cohort –see steps 2, 3

& 4 - ). Weight corresponds to the contribution of the subnational region to the overall

population.

5 1

Step 7 Imputation from demonstration projects or

partial implementations previous to the introduction of the nation-wide program

21 5

Step 8 Imputation from the weighted average of other

countries of the same geographical region

and/or income level with the same year and age at vaccination

199 32c

TOTAL 1922 75b,c, d

*60% reduction in coverage for opportunistic strategies when imputation from organized/catch-up coverages

a 20 point estimates were from national data to be applied to regional estimates (see step 2)

bCountries with missing data imputed from estimations within the country (Steps 1 to 7): Argentina, Australia, Belgium, Bhutan, Brazil,

Canada, Colombia, Denmark, Fiji, Finland, France, Germany, Greece, Guam, Iceland, Ireland, Italy, Latvia, Lesotho, Luxembourg,

Macedonia, Malaysia, Mexico, Netherlands, New Zealand, Norway, Panama, Peru, Portugal, Romania, Rwanda, Slovenia, Spain, Sweden, Switzerland, UAE, UK, US Virgin Islands, USA, Uganda, Uruguay

cCountries with missing data imputed from estimations from other countries (Step 8): American Samoa, Austria, Barbados, Bermuda,

Brunei, Bulgaria, Cayman Islands, Chile, Cook Is., Czech Rep., Dominican Rep., Gibraltar, Greenland, Guyana, Israel, Kazakhstan,

Kiribati, Libya, Malta, Marshall Is., Micronesia, FS, Monaco, N Mariana Islands, New Caledonia, Palau, Paraguay, Russia, San Marino, Seychelles, Singapore, Suriname, Trinidad & Tob.

d Even having initiated a national HPV vaccination program, Bahamas, Belize, French Polynesia, Liechtenstein, Niue were excluded from

the analysis as targeted birth cohorts couldn’t be identified.

84

72

51

85

85

7

68

67

64

39

Table S6. Impact of the imputation algorithm in the estimations

Num-

ber Original data

Imputation

From adjacent birth cohorts*

From Pilots*

From other countries*

Theoretical level of bias

Low Moderate High Very high

World

Targeted women 118M 54% 35% 8% 2%

Full-course vaccinated females 47M 52% 30% 15% 3%

Birth cohorts 1922 33% 56% 1% 10%

High income



Birth cohorts 1737 34% 59% 0% 7%

Upper middle income



Birth cohorts 118 20% 45% 8% 26%

Lower middle income

Targeted women 0.5M 10% 6% 29% 54%

Full-course vaccinated females 0.3M 14% 7% 36% 43%

Birth cohorts 42 17% 10% 14% 60%

Low income

Targeted women 1.1M 58% 29% 13% 0%

Full-course vaccinated females 1.0M 58% 29% 13% 0%

Birth cohorts 11 36% 18% 45% 0%

M: million * “From adjacent birth cohorts” corresponds to steps 1-5 of Table S5. “From pilots” corresponds to steps 6-7 of Table S5. “From other countries” corresponds to step 8 of Table S5.

40

Table S7. Sensitivity analysis of the global estimate of number of vaccinated girls (full-course) by income and development level and geographical

region

Scenario 1 N (95% CI)







Assumptions Coverages imputed from demonstration projects (step 7, Table S5)

All coverages as 0% Imputed coverages reduced a 50%

Imputed coverages reduced a 50%

Same as scenario 5

Reference.

Same as scenario 5 All coverages as 100%

Coverages imputed from the weighted

average of other countries with same implementation strategy, age at vaccination,

and income level and/or geographical

region (step 8 Table S5)

All coverages as 0% All coverages as 0% Imputed coverages

reduced a 50%

Imputed coverages

reduced a 50%

All coverages as

100%

All coverages as

100%

World 38.7 (31.8-45.9) 42.1 (35.2-49.5) 42.8 (35.7-50.0) 46.2 (38.0-54.8) 46.9 (38.8-55.4) 48.4 (40.1-56.9) 51.4 (42.1-61.3) Less developed regions 7.5 (5.1-10.3) 10.9 (7.9-14.5) 11.3 (8.3-14.8) 14.7 (10.1-20.1) 15.0 (10.4-20.5) 15.9 (11.5-21.4) 19.0 (12.6-27.0) More developed regions 31.2 (25.0-37.9) 31.2 (25.0-37.8) 31.5 (25.5-38.1) 31.5 (25.5-38.1) 31.9 (26.0-38.5) 32.4 (26.5-39.2) 32.4 (26.4-38.9)

By income

High income 31.2 (25.3-37.5) 31.2 (24.9-37.9) 31.7 (25.7-38.1) 31.7 (25.6-38.4) 32.2 (26.1-38.8) 33.4 (27.4-39.9) 33.4 (27.0-40.0) Upper middle income 6.5 (4.2-9.0) 9.8 (6.8-12.9) 9.9 (7.0-13.0) 13.2 (8.7-18.2) 13.3 (8.8-18.3) 13.5 (9.0-18.6) 16.5 (10.3-23.8) Lower middle income 0.1 (0.0-0.1) 0.1 (0.1-0.2) 0.2 (0.1-0.3) 0.3 (0.2-0.4) 0.3 (0.2-0.5) 0.5 (0.3-0.7) 0.5 (0.3-0.7) Low income 0.9 (0.4-1.4) 1.0 (0.5-1.4) 1.0 (0.6-1.4) 1.0 (0.7-1.4) 1.0 (0.7-1.4) 1.0 (0.7-1.4) 1.0 (0.7-1.4)

By geographical region

Africa 1.3 (0.5-2.4) 1.4 (0.6-2.5) 1.5 (0.7-2.5) 1.6 (0.8-2.6) 1.6 (0.9-2.6) 1.7 (0.9-2.7) 1.7 (1.0-2.7) Northern Africa - - - - 0.0 (0.0-0.0) 0.0 (0.0-0.0) 0.1 (0.0-0.1) 0.1 (0.1-0.1) 0.1 (0.1-0.1) Sub-Saharan Africa 1.3 (0.5-2.3) 1.4 (0.6-2.4) 1.4 (0.6-2.4) 1.6 (0.8-2.5) 1.6 (0.8-2.5) 1.6 (0.8-2.5) 1.6 (0.9-2.5)

Eastern Africa 0.9 (0.4-1.5) 1.0 (0.5-1.5) 1.0 (0.5-1.5) 1.0 (0.6-1.5) 1.0 (0.6-1.5) 1.0 (0.6-1.5) 1.0 (0.6-1.5) Middle Africa - - - - - - - - - - - - - - Southern Africa 0.4 (0.0-1.2) 0.5 (0.1-1.3) 0.5 (0.1-1.3) 0.5 (0.1-1.3) 0.5 (0.1-1.3) 0.5 (0.1-1.3) 0.6 (0.2-1.3) Western Africa - - - - - - - - - - - - - -

Americas 17.8 (12.5-24.0) 21.1 (15.3-27.5) 21.2 (15.5-27.4) 24.5 (17.8-32.1) 24.7 (17.6-32.2) 24.9 (18.3-32.4) 27.9 (19.4-37.2) Latin America & Caribbean 4.7 (2.7-6.9) 8.0 (5.3-10.9) 8.2 (5.5-11.1) 11.5 (7.1-16.4) 11.6 (7.3-16.6) 11.8 (7.5-16.7) 14.8 (8.5-22.1)

Caribbean 0.0 (0.0-0.0) 0.0 (0.0-0.0) 0.0 (0.0-0.1) 0.0 (0.0-0.1) 0.1 (0.0-0.2) 0.1 (0.0-0.3) 0.1 (0.0-0.3) Central America 0.7 (0.5-0.8) 1.8 (0.8-2.9) 1.8 (0.8-2.9) 2.9 (0.8-5.7) 2.9 (0.8-5.6) 2.9 (0.8-5.1) 4.0 (0.8-7.2) South America 4.0 (2.2-6.0) 6.2 (4.0-8.5) 6.3 (4.2-8.6) 8.5 (5.2-12.4) 8.6 (5.3-12.5) 8.8 (5.5-12.7) 10.7 (5.9-16.6)

Northern America 13.1 (8.1-18.9) 13.1 (8.1-18.9) 13.1 (8.2-18.6) 13.1 (8.2-18.8) 13.1 (8.1-18.8) 13.1 (7.9-18.9) 13.1 (8.0-19.0) Asia 4.0 (2.2-6.1) 4.0 (2.1-6.1) 4.1 (2.3-6.2) 4.1 (2.3-6.2) 4.2 (2.4-6.3) 4.9 (3.1-6.9) 4.9 (3.2-6.9)

Central Asia - - - - 0.0 (0.0-0.0) 0.0 (0.0-0.0) 0.0 (0.0-0.0) 0.0 (0.0-0.0) 0.0 (0.0-0.0) Eastern Asia 2.5 (1.8-3.1) 2.5 (1.7-3.1) 2.5 (1.8-3.1) 2.5 (1.7-3.1) 2.5 (1.7-3.1) 2.5 (1.7-3.1) 2.5 (1.7-3.1) Southern Asia 0.1 (0.1-0.1) 0.1 (0.1-0.1) 0.1 (0.1-0.1) 0.1 (0.1-0.1) 0.1 (0.1-0.1) 0.1 (0.1-0.1) 0.1 (0.1-0.1) South-Eastern Asia 1.2 (0.2-2.2) 1.2 (0.2-2.2) 1.3 (0.3-2.3) 1.3 (0.3-2.3) 1.4 (0.4-2.4) 2.0 (1.2-2.9) 2.0 (1.2-2.9) Western Asia 0.1 (0.1-0.2) 0.1 (0.1-0.2) 0.2 (0.1-0.2) 0.2 (0.1-0.2) 0.2 (0.1-0.3) 0.3 (0.1-0.4) 0.3 (0.1-0.4)

Europe 13.2 (11.3-15.4) 13.2 (11.2-15.3) 13.6 (11.5-15.8) 13.6 (11.6-15.7) 14.0 (11.9-16.1) 14.5 (12.4-16.7) 14.5 (12.5-16.8) Eastern Europe 0.1 (0.0-0.1) 0.1 (0.0-0.1) 0.4 (0.3-0.4) 0.4 (0.3-0.4) 0.6 (0.5-0.8) 1.1 (0.8-1.3) 1.1 (0.8-1.3) Northern Europe 4.3 (3.1-5.7) 4.3 (3.1-5.7) 4.3 (3.0-5.7) 4.3 (3.1-5.7) 4.3 (3.0-5.7) 4.3 (3.0-5.7) 4.3 (3.1-5.7) Southern Europe 3.6 (3.3-4.1) 3.6 (3.3-4.1) 3.6 (3.3-4.1) 3.6 (3.3-4.1) 3.6 (3.3-4.1) 3.6 (3.3-4.1) 3.6 (3.3-4.1) Western Europe 5.2 (3.8-6.7) 5.2 (3.8-6.7) 5.3 (3.9-6.8) 5.3 (3.9-6.8) 5.4 (4.0-6.9) 5.5 (4.1-7.0) 5.5 (4.1-7.0)

Oceania 2.4 (1.6-3.2) 2.4 (1.6-3.2) 2.4 (1.6-3.3) 2.4 (1.6-3.3) 2.4 (1.6-3.3) 2.4 (1.6-3.3) 2.4 (1.7-3.3) Australia & New Zealand 2.4 (1.9-2.8) 2.4 (1.8-2.8) 2.4 (1.9-2.8) 2.4 (1.9-2.8) 2.4 (1.9-2.8) 2.4 (1.9-2.8) 2.4 (1.9-2.8) Melanesia 0.0 (0.0-0.0) 0.0 (0.0-0.0) 0.0 (0.0-0.0) 0.0 (0.0-0.0) 0.0 (0.0-0.0) 0.0 (0.0-0.0) 0.0 (0.0-0.0) Micronesia 0.0 (0.0-0.0) 0.0 (0.0-0.0) 0.0 (0.0-0.0) 0.0 (0.0-0.0) 0.0 (0.0-0.0) 0.0 (0.0-0.0) 0.0 (0.0-0.0) Polynesia - - - - 0.0 (0.0-0.0) 0.0 (0.0-0.0) 0.0 (0.0-0.0) 0.0 (0.0-0.0) 0.0 (0.0-0.0)

41

Table S8. Calculation of expected number of cervical cancer cases and deaths up to the

age of 74 years for Denmark’s cohort born in 2000 Birth

cohort

Year

y

Age

i

Female

populationa

pyi

Age

group

j

Age-specific

incidence rate

(per 100,000)b

rj

N expected

cases

pyi rj / 105

Age-specific

mortality rate

(per 100,000)b

mj

N expected

deaths

pyi mj / 105

2000 2012 12 33,130 10-14 0.00 0.0 0.00 0.0

2013 13 33,268 0.0 0.0

2014 14 33,398 0.0 0.0

2015 15 33,521 15-19 0.00 0.0 0.00 0.0

2016 16 33,810 0.0 0.0

2017 17 34,080 0.0 0.0

2018 18 34,340 0.0 0.0

2019 19 34,595 0.0 0.0

2020 20 34,850 20-24 8.23 2.9 0.00 0.0

2021 21 35,181 2.9 0.0

2022 22 35,508 2.9 0.0

2023 23 35,831 2.9 0.0

2024 24 36,145 3.0 0.0

2025 25 36,448 25-29 16.03 5.8 0.64 0.2

2026 26 36,720 5.9 0.2

2027 27 36,982 5.9 0.2

2028 28 37,233 6.0 0.2

2029 29 37,475 6.0 0.2

2030 30 37,707 30-34 21.08 8.0 1.81 0.7

2031 31 37,876 8.0 0.7

2032 32 38,032 8.0 0.7

2033 33 38,177 8.0 0.7

2034 34 38,311 8.1 0.7

2035 35 38,436 35-39 23.10 8.9 2.15 0.8

2036 36 38,548 8.9 0.8

2037 37 38,644 8.9 0.8

2038 38 38,725 8.9 0.8

2039 39 38,798 9.0 0.8

2040 40 38,867 40-44 22.85 8.9 2.98 1.2

2041 41 38,922 8.9 1.2

2042 42 38,962 8.9 1.2

2043 43 38,992 8.9 1.2

2044 44 39,016 8.9 1.2

2045 45 39,034 45-49 19.22 7.5 3.94 1.5

2046 46 39,030 7.5 1.5

2047 47 39,014 7.5 1.5

2048 48 38,987 7.5 1.5

2049 49 38,946 7.5 1.5

2050 50 38,893 50-54 15.48 6.0 4.27 1.7

2051 51 38,859 6.0 1.7

2052 52 38,808 6.0 1.7

2053 53 38,743 6.0 1.7

2054 54 38,665 6.0 1.7

2055 55 38,578 55-59 14.54 5.6 4.07 1.6

2056 56 38,537 5.6 1.6

2057 57 38,478 5.6 1.6

2058 58 38,405 5.6 1.6

2059 59 38,321 5.6 1.6

2060 60 38,230 60-64 13.62 5.2 4.36 1.7

2061 61 38,135 5.2 1.7

2062 62 38,027 5.2 1.7

2063 63 37,904 5.2 1.7

2064 64 37,768 5.1 1.6

2065 65 37,622 65-69 14.19 5.3 5.32 2.0

2066 66 37,437 5.3 2.0

2067 67 37,234 5.3 2.0

42

2068 68 37,017 5.3 2.0

2069 69 36,788 5.2 2.0

2070 70 36,551 70-74 15.15 5.5 7.18 2.6

2071 71 36,231 5.5 2.6

2072 72 35,897 5.4 2.6

2073 73 35,549 5.4 2.6

2074 74 35,189 5.3 2.5

Total

348 69 a United Nations Population Division3, or U.S. Census Bureau4. Female population may increase by age due to projection methods

assumptions that include migration. b Age-specific incidence or mortality rates for 5-year age intervals estimated for 2012

12

Table S9. Estimated full-course HPV vaccine coverage and number of vaccinated women as of October 2014 by region

N (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI)

World 46.91 (38.97-55.33) 1.4 (1.1-1.6) 39.7 (33.0-46.8) 54.9 (45.1-65.4) 13.3 (6.8-21.0)

Less developed regions 15.00 (10.44-20.32) 0.5 (0.4-0.7) 71.3 (49.6-96.6) 73.7 (50.9-100.0) 21.2 (12.9-29.6)

More developed regions 31.91 (25.73-38.66) 5.4 (4.4-6.5) 32.9 (26.5-39.8) 48.0 (38.2-58.5) 13.1 (6.7-21.5)

By income

High income 32.22 (26.16-38.92) 5.4 (4.4-6.5) 33.6 (27.3-40.6) 48.5 (38.6-59.3) 13.8 (7.3-22.4)

Upper middle income 13.30 (8.85-18.57) 1.1 (0.7-1.6) 64.6 (43.0-90.1) 70.8 (47.0-98.9) 3.5 (2.2-4.7)

Lower middle income 0.35 (0.21-0.51) 0.0 (0.0-0.0) 69.6 (42.1-100.0) 69.6 (42.1-100.0) - -

Low income 1.03 (0.65-1.41) 0.3 (0.2-0.4) 95.2 (60.3-100.0) 95.2 (60.3-100.0) - -

Africa 1.62 (0.86-2.65) 0.3 (0.2-0.5) 88.0 (46.5-100.0) 88.0 (46.5-100.0) - -

Northern Africa 0.05 (0.04-0.06) 0.1 (0.0-0.1) 50.5 (40.6-60.4) 50.5 (40.6-60.4) - -

Sub-Saharan Africa 1.57 (0.82-2.49) 0.4 (0.2-0.6) 90.2 (46.9-100.0) 90.2 (46.9-100.0) - -

Eastern Africa 1.03 (0.61-1.50) 0.6 (0.4-0.9) 95.1 (56.6-100.0) 95.1 (56.6-100.0) - -

Middle Africa - - - - - - - - - -

Southern Africa 0.54 (0.14-1.32) 1.7 (0.5-4.3) 82.1 (21.9-100.0) 82.1 (21.9-100.0) - -

Western Africa - - - - - - - - - -

Americas 24.69 (17.83-32.21) 5.1 (3.6-6.6) 35.5 (25.7-46.4) 52.6 (36.2-71.2) 13.7 (5.2-24.9)

Latin America & Caribbean 11.62 (7.14-16.64) 3.8 (2.3-5.4) 71.0 (43.6-100.0) 71.0 (43.6-100.0) 3.8 (2.1-5.8)

Caribbean 0.08 (0.00-0.22) 0.4 (0.0-1.0) 55.4 (2.2-100.0) 58.9 (2.0-100.0) 3.8 (2.2-5.4)

Central America 2.90 (0.81-5.06) 3.4 (1.0-6.0) 67.6 (18.8-100.0) 67.6 (18.8-100.0) - -

South America 8.64 (5.33-12.50) 4.2 (2.6-6.1) 72.4 (44.6-100.0) 72.4 (44.6-100.0) - -

Northern America 13.07 (8.04-18.86) 7.3 (4.5-10.5) 24.6 (15.1-35.5) 39.3 (20.5-62.5) 13.7 (5.3-25.1)

Asia 4.22 (2.40-6.31) 0.2 (0.1-0.3) 57.2 (32.6-85.5) 62.5 (34.0-95.4) 21.4 (14.3-28.9)

Central Asia 0.03 (0.03-0.03) 0.1 (0.1-0.1) 62.2 (56.8-67.6) 62.2 (56.8-67.6) - -

Eastern Asia 2.51 (1.75-3.08) 0.3 (0.2-0.4) 54.2 (37.8-66.5) 54.2 (37.8-66.5) - -

Southern Asia 0.07 (0.07-0.08) 0.0 (0.0-0.0) 92.0 (90.4-93.5) 92.0 (90.4-93.5) - -

South-Eastern Asia 1.38 (0.45-2.35) 0.4 (0.1-0.8) 63.7 (20.7-100.0) 86.8 (18.7-100.0) 18.6 (11.7-25.7)

Western Asia 0.23 (0.15-0.34) 0.2 (0.1-0.3) 49.8 (32.6-74.0) 67.2 (27.7-100.0) 30.8 (14.9-47.7)

Europe 13.97 (11.99-16.11) 4.3 (3.7-5.0) 39.2 (33.7-45.2) 52.8 (44.5-61.7) 11.7 (8.5-15.3)

Eastern Europe 0.65 (0.50-0.81) 0.7 (0.5-0.9) 20.1 (15.5-25.1) 40.8 (29.7-53.4) 3.8 (1.9-6.2)

Northern Europe 4.30 (3.05-5.71) 8.4 (6.0-11.2) 68.4 (48.6-90.9) 71.2 (49.8-95.7) 28.1 (12.4-46.2)

Southern Europe 3.65 (3.25-4.06) 4.6 (4.1-5.1) 36.1 (32.1-40.2) 65.2 (57.5-73.4) 6.8 (5.0-8.9)

Western Europe 5.38 (3.97-6.91) 5.5 (4.1-7.1) 33.6 (24.8-43.2) 39.4 (27.7-52.5) 18.9 (11.2-27.6)

Oceania 2.40 (1.63-3.27) 12.7 (8.6-17.3) 62.2 (42.1-84.6) 62.2 (42.1-84.6) - -

Australia & New Zealand 2.36 (1.86-2.84) 17.0 (13.4-20.5) 62.2 (49.0-74.8) 62.2 (49.0-74.8) - -

Melanesia 0.02 (0.01-0.03) 0.4 (0.2-0.7) 80.8 (33.5-100.0) 80.8 (33.5-100.0) - -

Micronesia 0.03 (0.02-0.03) 10.0 (8.1-11.9) 52.4 (42.7-62.6) 52.4 (42.7-62.6) - -

Polynesia 0.00 (0.00-0.00) 0.5 (0.2-0.7) 60.1 (31.9-90.3) 60.1 (31.9-90.3) - -Countries included in the analysis are geographically classified as follows: Northern Africa (Libya); Eastern Africa (Rwanda, Seychelles, Uganda); Southern Africa (Lesotho,

South Africa); Caribbean (Barbados, Cayman Islands, Dominican Republic, Trinidad & Tobago, US Virgin Islands); Central America (Mexico, Panama); South America

(Argentina, Brazil, Chile, Colombia, Guyana, Paraguay, Peru, Suriname, Uruguay); Northern America (Bermuda, Canada, Greenland, United States of America); Central Asia

(Kazakhstan); Eastern Asia (Japan); Southern Asia (Bhutan); South-Eastern Asia (Brunei, Malaysia, Singapore); Western Asia (Israel, United Arab Emirates); Eastern

Europe (Bulgaria, Czech Republic, Romania, Russian Federation); Northern Europe (Denmark, Finland, Iceland, Ireland, Latvia, Norway, Sweden, United Kingdom);

Southern Europe (Gibraltar, Greece, Italy, Malta, Portugal, San Marino, Slovenia, Spain, Macedonia, TFYR); Western Europe (Austria, Belgium, France, Germany,

Luxembourg, Monaco, Netherlands, Switzerland); Australia & New Zealand (Australia, New Zealand); Melanesia (Fiji, New Caledonia); Micronesia (Guam, Kiribati, Marshall

Islands, Micronesia, FS, N Mariana Islands, Palau); Polynesia (American Samoa, Cook Islands)

Area or group

Number of vaccinated girls

in millions AllPrimary target and

organized catch-up

Opportunistic

catch-up

Coverage among the targeted populationCoverage among

the total

population of

women

43

Table S10. Estimated full-course HPV vaccine coverage and number of vaccinated women as of October 2014 by age group and region

N (95% CI) % (95% CI) % (95% CI) N (95% CI) % (95% CI) % (95% CI) N (95% CI) % (95% CI) % (95% CI) N (95% CI) % (95% CI) % (95% CI)

World 18.97 (13.57-25.00) 6.7 (4.8-8.8) 56.0 (40.0-73.7) 16.38 (12.32-21.18) 5.8 (4.4-7.5) 53.6 (40.3-69.4) 8.79 (5.30-12.91) 3.0 (1.8-4.5) 38.5 (23.2-56.6) 1.83 (1.04-2.74) 0.6 (0.4-0.9) 10.9 (6.1-16.3)

Less developed regions 11.53 (6.91-16.85) 4.5 (2.7-6.6) 70.8 (42.4-100.0) 3.16 (1.58-5.05) 1.3 (0.6-2.0) 82.0 (41.0-100.0) 0.24 (0.10-0.42) 0.1 (0.0-0.2) 51.0 (21.6-88.4) 0.05 (0.02-0.09) - (0.0-0.0) 15.2 (4.8-27.6)

More developed regions 7.44 (4.88-10.62) 24.3 (15.9-34.7) 42.3 (27.7-60.3) 13.22 (9.30-17.69) 41.2 (29.0-55.1) 49.5 (34.8-66.3) 8.55 (5.08-12.81) 24.3 (14.4-36.5) 38.3 (22.7-57.4) 1.78 (1.00-2.76) 4.7 (2.6-7.3) 10.8 (6.0-16.7)

By income

High income 7.63 (5.13-10.60) 23.5 (15.8-32.7) 42.4 (28.5-58.9) 13.27 (9.33-17.81) 39.2 (27.6-52.6) 50.4 (35.4-67.6) 8.60 (5.03-12.85) 23.6 (13.8-35.3) 39.3 (23.0-58.7) 1.80 (1.01-2.75) 4.7 (2.6-7.1) 11.3 (6.4-17.3)

Upper middle income 10.51 (6.18-15.67) 13.2 (7.7-19.6) 70.5 (41.5-100.0) 2.59 (1.06-4.41) 3.1 (1.3-5.2) 71.0 (29.1-100.0) 0.16 (0.03-0.34) 0.2 (0.0-0.3) 18.0 (3.0-37.8) 0.03 (0.01-0.05) - (0.0-0.0) 3.1 (1.4-5.1)

Lower middle income 0.26 (0.12-0.44) 0.2 (0.1-0.4) 65.1 (30.5-100.0) 0.06 (0.02-0.11) 0.1 (0.0-0.1) 87.2 (30.3-100.0) 0.02 (0.00-0.05) - (0.0-0.0) 90.2 (16.4-100.0) - - - - - -

Low income 0.57 (0.21-0.99) 1.2 (0.4-2.1) 95.4 (34.5-100.0) 0.46 (0.00-0.92) 1.0 (0.0-2.1) 94.9 (0.0-100.0) - - - - - - - - - - - -

Africa 1.09 (0.39-2.12) 1.7 (0.6-3.3) 88.5 (32.0-100.0) 0.53 (0.10-1.04) 0.9 (0.2-1.8) 86.9 (15.6-100.0) - - - - - - - - - - - -

Northern Africa - - - - - - 0.05 (0.04-0.06) 0.6 (0.4-0.7) 50.5 (40.6-60.4) - - - - - - - - - - - -

Sub-Saharan Africa 1.09 (0.40-2.01) 2.0 (0.7-3.7) 88.5 (32.8-100.0) 0.48 (0.04-1.00) 1.0 (0.1-2.1) 94.3 (8.4-100.0) - - - - - - - - - - - -

Eastern Africa 0.58 (0.22-1.01) 2.6 (1.0-4.6) 95.4 (37.0-100.0) 0.46 (0.00-0.92) 2.4 (0.0-4.8) 94.9 (0.0-100.0) - - - - - - - - - - - -

Middle Africa - - - - - - - - - - - - - - - - - - - - - - - -

Southern Africa 0.52 (0.08-1.32) 17.9 (2.9-45.8) 82.0 (13.1-100.0) 0.02 (0.00-0.06) 0.8 (0.0-2.3) 84.3 (0.0-100.0) - - - - - - - - - - - -

Western Africa - - - - - - - - - - - - - - - - - - - - - - - -

Americas 12.82 (7.64-18.73) 33.0 (19.7-48.2) 55.9 (33.3-81.7) 6.49 (3.04-10.64) 16.6 (7.8-27.3) 47.9 (22.4-78.6) 4.23 (1.21-8.06) 10.9 (3.1-20.7) 36.8 (10.5-70.0) 0.75 (0.14-1.54) 2.0 (0.4-4.0) 7.0 (1.3-14.2)

Latin America & Caribbean 9.74 (5.49-14.75) 35.1 (19.8-53.2) 69.0 (38.9-100.0) 1.75 (0.52-3.27) 6.3 (1.9-11.9) 83.5 (24.7-100.0) 0.14 (0.00-0.32) 0.5 (0.0-1.2) 79.4 (0.2-100.0) 0.00 (0.00-0.00) - (0.0-0.0) 3.8 (0.8-7.6)

Caribbean 0.08 (0.00-0.22) 4.3 (0.1-12.3) 61.1 (1.3-100.0) 0.00 (0.00-0.00) - (0.0-0.1) 13.2 (5.0-24.0) 0.00 (0.00-0.00) - (0.0-0.1) 10.4 (1.4-23.8) 0.00 (0.00-0.00) - (0.0-0.0) 3.8 (0.8-6.9)

Central America 2.52 (0.41-4.75) 30.6 (4.9-57.7) 67.0 (10.8-100.0) 0.24 (0.09-0.41) 3.0 (1.1-5.1) 67.5 (26.1-100.0) 0.14 (0.00-0.28) 1.8 (0.0-3.5) 81.0 (0.0-100.0) - - - - - -

South America 7.14 (3.79-11.24) 40.4 (21.4-63.6) 69.9 (37.1-100.0) 1.50 (0.38-3.01) 8.6 (2.1-17.2) 87.1 (21.8-100.0) - - - - - - - - - - - -

Northern America 3.09 (1.00-5.76) 27.8 (9.0-51.8) 35.0 (11.3-65.3) 4.74 (1.47-8.75) 41.3 (12.8-76.2) 41.4 (12.9-76.3) 4.09 (1.08-7.93) 33.9 (8.9-65.6) 36.1 (9.5-70.0) 0.75 (0.13-1.56) 6.3 (1.0-13.0) 7.0 (1.2-14.5)

Asia 0.89 (0.24-1.75) 0.5 (0.1-1.1) 43.7 (11.5-85.9) 2.77 (1.16-4.71) 1.6 (0.7-2.8) 68.5 (28.7-100.0) 0.49 (0.06-1.31) 0.3 (0.0-0.7) 55.9 (7.0-100.0) 0.05 (0.02-0.09) - (0.0-0.0) 15.2 (4.9-26.8)

Central Asia 0.03 (0.03-0.03) 1.3 (1.2-1.4) 62.2 (56.8-67.6) - - - - - - - - - - - - - - - - - -

Eastern Asia 0.22 (0.00-0.59) 0.5 (0.0-1.4) 19.2 (0.0-52.6) 1.90 (0.78-2.74) 4.1 (1.7-5.9) 65.2 (26.8-94.0) 0.39 (0.00-1.17) 0.6 (0.0-1.9) 67.0 (0.0-100.0) - - - - - -

Southern Asia 0.02 (0.00-0.04) - (0.0-0.0) 92.0 (0.0-100.0) 0.03 (0.01-0.05) - (0.0-0.1) 92.0 (36.6-100.0) 0.02 (0.00-0.04) - (0.0-0.1) 92.0 (0.0-100.0) - - - - - -

South-Eastern Asia 0.54 (0.04-1.28) 2.0 (0.1-4.7) 74.9 (5.3-100.0) 0.80 (0.08-1.58) 3.0 (0.3-5.9) 77.5 (7.7-100.0) 0.03 (0.01-0.06) 0.1 (0.0-0.2) 16.4 (3.5-33.7) 0.01 (0.00-0.02) - (0.0-0.1) 3.7 (0.2-9.0)

Western Asia 0.09 (0.00-0.22) 0.8 (0.0-2.0) 70.4 (0.0-100.0) 0.03 (0.01-0.06) 0.3 (0.1-0.5) 59.0 (13.3-100.0) 0.05 (0.01-0.09) 0.5 (0.1-0.9) 58.2 (15.4-100.0) 0.04 (0.01-0.07) 0.4 (0.1-0.7) 30.8 (11.0-55.2)

Europe 3.79 (2.85-4.95) 24.8 (18.7-32.4) 53.0 (39.8-69.1) 5.98 (4.62-7.50) 37.1 (28.7-46.5) 52.3 (40.4-65.5) 3.46 (2.29-4.82) 18.8 (12.5-26.2) 36.5 (24.2-50.8) 0.55 (0.30-0.85) 2.7 (1.4-4.1) 11.2 (6.1-17.5)

Eastern Europe 0.29 (0.15-0.44) 7.5 (3.9-11.3) 56.7 (29.9-86.0) 0.32 (0.19-0.48) 7.5 (4.4-11.0) 31.3 (18.6-46.1) 0.01 (0.00-0.02) 0.2 (0.0-0.4) 2.0 (0.4-3.8) 0.02 (0.00-0.03) 0.2 (0.0-0.5) 2.0 (0.4-3.7)

Northern Europe 1.25 (0.56-2.14) 46.2 (20.9-79.4) 79.6 (36.0-100.0) 1.98 (1.04-3.10) 69.7 (36.6-100.0) 77.8 (40.9-100.0) 1.02 (0.44-1.73) 32.4 (14.1-54.9) 50.9 (22.1-86.2) 0.05 (0.01-0.10) 1.5 (0.3-2.9) 29.6 (6.0-58.7)

Southern Europe 1.13 (0.88-1.40) 29.9 (23.3-37.0) 63.2 (49.2-78.2) 1.80 (1.49-2.15) 47.2 (39.2-56.5) 61.5 (51.0-73.6) 0.51 (0.33-0.73) 12.5 (8.1-17.8) 26.4 (17.2-37.7) 0.12 (0.06-0.19) 2.6 (1.3-4.2) 7.4 (3.7-11.9)

Western Europe 1.13 (0.59-1.77) 23.0 (12.0-36.0) 34.2 (17.8-53.6) 1.87 (1.05-2.80) 36.6 (20.6-54.7) 38.0 (21.4-56.7) 1.92 (0.95-3.10) 35.1 (17.4-56.7) 39.1 (19.4-63.2) 0.37 (0.12-0.67) 6.2 (2.1-11.3) 16.1 (5.3-29.2)

Oceania 0.37 (0.07-0.75) 26.4 (5.2-53.6) 68.5 (13.4-100.0) 0.61 (0.21-1.10) 43.6 (15.1-78.9) 68.7 (23.7-100.0) 0.61 (0.18-1.11) 43.8 (13.2-79.4) 65.3 (19.6-100.0) 0.48 (0.10-0.94) 34.5 (7.1-67.0) 58.0 (11.9-100.0)

Australia & New Zealand 0.34 (0.05-0.71) 41.5 (5.5-85.8) 68.9 (9.2-100.0) 0.60 (0.20-1.02) 69.1 (23.4-100.0) 69.1 (23.4-100.0) 0.61 (0.24-1.07) 65.3 (26.4-100.0) 65.3 (26.4-100.0) 0.48 (0.10-0.90) 48.9 (10.2-91.2) 58.0 (12.1-100.0)

Melanesia 0.02 (0.01-0.03) 3.3 (1.0-5.6) 81.8 (24.1-100.0) 0.00 (0.00-0.00) 0.3 (0.0-0.8) 69.6 (0.0-100.0) - - - - - - - - - - - -

Micronesia 0.01 (0.01-0.01) 37.6 (23.7-52.4) 46.5 (29.3-64.8) 0.01 (0.01-0.02) 39.8 (22.6-59.8) 51.8 (29.5-77.8) 0.01 (0.00-0.01) 23.3 (8.6-41.2) 68.5 (25.4-100.0) 0.00 (0.00-0.00) 1.0 (0.0-2.9) 58.8 (0.0-100.0)

Polynesia 0.00 (0.00-0.00) 4.3 (1.9-6.7) 60.7 (27.5-95.4) 0.00 (0.00-0.00) 0.3 (0.0-0.8) 53.2 (0.0-100.0) - - - - - - - - - - - -

Number of

vaccinated girls in

millions

Age 10-14 Age 15-19 Age 20-24

Countries included in the analysis are geographically classified as follows: Northern Africa (Libya); Eastern Africa (Rwanda, Seychelles, Uganda); Southern Africa (Lesotho, South Africa); Caribbean (Barbados, Cayman Islands, Dominican Republic, Trinidad & Tobago, US Virgin Islands); Central America (Mexico,

Panama); South America (Argentina, Brazil, Chile, Colombia, Guyana, Paraguay, Peru, Suriname, Uruguay); Northern America (Bermuda, Canada, Greenland, United States of America); Central Asia (Kazakhstan); Eastern Asia (Japan); Southern Asia (Bhutan); South-Eastern Asia (Brunei, Malaysia, Singapore);

Western Asia (Israel, United Arab Emirates); Eastern Europe (Bulgaria, Czech Republic, Romania, Russian Federation); Northern Europe (Denmark, Finland, Iceland, Ireland, Latvia, Norway, Sweden, United Kingdom); Southern Europe (Gibraltar, Greece, Italy, Malta, Portugal, San Marino, Slovenia, Spain,

Macedonia, TFYR); Western Europe (Austria, Belgium, France, Germany, Luxembourg, Monaco, Netherlands, Switzerland); Australia & New Zealand (Australia, New Zealand); Melanesia (Fiji, New Caledonia); Micronesia (Guam, Kiribati, Marshall Islands, Micronesia, FS, N Mariana Islands, Palau); Polynesia

(American Samoa, Cook Islands)

Age 25-29

Number of vaccinated

girls in millions

Coverage among

the total

population of

women

Coverage among the

targeted population


girls in millions

Coverage among

the total

population of

women

Coverage among

the targeted

population

Coverage among

the total

population of

women

Coverage among

the targeted

population

Number of

vaccinated girls in

millions

Coverage among

the total

population of

women

Coverage among

the targeted

populationArea or group

44

Table S11. Estimated one-dose HPV vaccine coverage and number of vaccinated women as of October 2014 by region

N (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI)

World 59.21 (48.08-70.92) 1.7 (1.4-2.1) 50.1 (40.7-60.0) 67.3 (53.9-81.7) 20.2 (10.5-31.6)

Less developed regions 16.96 (11.18-23.83) 0.6 (0.4-0.8) 80.6 (53.1-100.0) 83.2 (54.4-100.0) 25.5 (15.6-35.6)

More developed regions 42.25 (33.16-52.19) 7.1 (5.6-8.8) 43.5 (34.1-53.7) 61.5 (47.0-76.8) 20.1 (10.4-32.8)

By income

High income 42.58 (33.60-52.29) 7.1 (5.6-8.8) 44.4 (35.0-54.5) 62.1 (47.8-77.5) 20.9 (11.2-33.8)

Upper middle income 15.31 (9.67-21.98) 1.3 (0.8-1.9) 74.4 (46.9-100.0) 81.4 (51.1-100.0) 5.2 (3.2-7.1)

Lower middle income 0.38 (0.23-0.56) 0.0 (0.0-0.0) 76.5 (46.5-100.0) 76.5 (46.5-100.0) - -

Low income 0.93 (0.48-1.39) 0.2 (0.1-0.3) 86.1 (43.9-100.0) 86.1 (43.9-100.0) - -

Africa 1.57 (0.76-2.67) 0.3 (0.1-0.5) 85.2 (40.9-100.0) 85.2 (40.9-100.0) - -

Northern Africa 0.06 (0.05-0.07) 0.1 (0.1-0.1) 59.2 (50.1-68.3) 59.2 (50.1-68.3) - -

Sub-Saharan Africa 1.51 (0.68-2.53) 0.4 (0.2-0.6) 86.7 (39.3-100.0) 86.7 (39.3-100.0) - -

Eastern Africa 0.94 (0.48-1.51) 0.6 (0.3-0.9) 86.1 (43.8-100.0) 86.1 (43.8-100.0) - -

Middle Africa - - - - - - - - - -

Southern Africa 0.57 (0.15-1.41) 1.9 (0.5-4.6) 87.7 (23.5-100.0) 87.7 (23.5-100.0) - -

Western Africa - - - - - - - - - -

Americas 33.46 (23.92-44.32) 6.8 (4.9-9.1) 48.2 (34.4-63.8) 68.8 (45.5-95.1) 21.7 (8.8-38.5)

Latin America & Caribbean 13.50 (7.82-19.90) 4.4 (2.5-6.4) 82.4 (47.8-100.0) 82.5 (47.8-100.0) 13.3 (7.2-20.1)

Caribbean 0.10 (0.01-0.27) 0.5 (0.0-1.3) 68.9 (5.0-100.0) 72.6 (4.4-100.0) 13.3 (7.8-19.0)

Central America 3.67 (1.00-6.40) 4.3 (1.2-7.5) 85.5 (23.4-100.0) 85.5 (23.4-100.0) - -

South America 9.73 (5.38-15.11) 4.8 (2.6-7.4) 81.5 (45.0-100.0) 81.5 (45.0-100.0) - -

Northern America 19.97 (12.29-28.98) 11.2 (6.9-16.2) 37.6 (23.2-54.6) 59.0 (29.9-94.5) 21.7 (8.9-38.7)

Asia 4.63 (2.67-6.91) 0.2 (0.1-0.3) 62.8 (36.1-93.7) 68.3 (37.3-100.0) 25.6 (17.3-34.4)

Central Asia 0.04 (0.04-0.04) 0.2 (0.2-0.2) 86.3 (85.2-87.5) 86.3 (85.2-87.5) - -

Eastern Asia 2.80 (2.02-3.40) 0.4 (0.3-0.4) 60.5 (43.6-73.4) 60.5 (43.6-73.4) - -

Southern Asia 0.08 (0.07-0.08) 0.0 (0.0-0.0) 94.5 (92.8-96.0) 94.5 (92.8-96.0) - -

South-Eastern Asia 1.47 (0.51-2.48) 0.5 (0.2-0.8) 67.7 (23.4-100.0) 90.5 (19.6-100.0) 23.4 (15.1-32.2)

Western Asia 0.25 (0.16-0.37) 0.2 (0.1-0.3) 54.4 (35.7-80.7) 74.0 (30.9-100.0) 33.0 (16.0-51.2)

Europe 16.71 (14.28-19.32) 5.2 (4.4-6.0) 46.9 (40.1-54.3) 62.3 (52.1-73.0) 15.8 (11.5-20.7)

Eastern Europe 0.78 (0.62-0.95) 0.8 (0.7-1.0) 24.1 (19.3-29.5) 47.6 (35.0-61.4) 5.6 (3.0-8.8)

Northern Europe 4.74 (3.39-6.29) 9.3 (6.7-12.4) 75.6 (54.0-100.0) 78.5 (55.2-100.0) 32.0 (13.7-53.3)

Southern Europe 4.16 (3.73-4.61) 5.2 (4.7-5.8) 41.2 (36.9-45.6) 72.1 (63.6-81.0) 10.1 (7.7-12.9)

Western Europe 7.02 (5.14-9.04) 7.2 (5.2-9.2) 43.9 (32.1-56.5) 51.4 (35.9-68.6) 24.8 (14.2-36.8)

Oceania 2.83 (1.91-3.85) 15.0 (10.1-20.4) 73.2 (49.4-99.6) 73.2 (49.4-99.6) - -

Australia & New Zealand 2.77 (2.18-3.34) 20.0 (15.7-24.2) 73.1 (57.5-88.2) 73.1 (57.5-88.2) - -

Melanesia 0.02 (0.01-0.03) 0.4 (0.2-0.7) 86.5 (37.3-100.0) 86.5 (37.3-100.0) - -

Micronesia 0.04 (0.03-0.04) 14.1 (11.9-16.4) 74.3 (62.5-86.0) 74.3 (62.5-86.0) - -

Polynesia 0.00 (0.00-0.00) 0.6 (0.3-0.9) 76.9 (41.8-100.0) 76.9 (41.8-100.0) - -Countries included in the analysis are geographically classified as follows: Northern Africa (Libya); Eastern Africa (Rwanda, Seychelles, Uganda); Southern Africa

(Lesotho, South Africa); Caribbean (Barbados, Cayman Islands, Dominican Republic, Trinidad & Tobago, US Virgin Islands); Central America (Mexico, Panama); South

America (Argentina, Brazil, Chile, Colombia, Guyana, Paraguay, Peru, Suriname, Uruguay); Northern America (Bermuda, Canada, Greenland, United States of America);

Central Asia (Kazakhstan); Eastern Asia (Japan); Southern Asia (Bhutan); South-Eastern Asia (Brunei, Malaysia, Singapore); Western Asia (Israel, United Arab Emirates);

Eastern Europe (Bulgaria, Czech Republic, Romania, Russian Federation); Northern Europe (Denmark, Finland, Iceland, Ireland, Latvia, Norway, Sweden, United

Kingdom); Southern Europe (Gibraltar, Greece, Italy, Malta, Portugal, San Marino, Slovenia, Spain, Macedonia, TFYR); Western Europe (Austria, Belgium, France, Germany,

Luxembourg, Monaco, Netherlands, Switzerland); Australia & New Zealand (Australia, New Zealand); Melanesia (Fiji, New Caledonia); Micronesia (Guam, Kiribati,

Marshall Islands, Micronesia, FS, N Mariana Islands, Palau); Polynesia (American Samoa, Cook Islands)

Area or group

Number of vaccinated girls

in millions

Coverage among

the total

population of

women

Coverage among the targeted population

AllPrimary target and

catch-upOpportunistic

45

Table S12. Estimated one-dose HPV vaccine coverage and number of vaccinated women as of October 2014 by age group and region

N (95% CI) % (95% CI) % (95% CI) N (95% CI) % (95% CI) % (95% CI) N (95% CI) % (95% CI) % (95% CI) N (95% CI) % (95% CI) % (95% CI)

World 23.28 (16.09-31.49) 8.2 (5.7-11.1) 68.7 (47.5-92.9) 20.01 (14.56-26.36) 7.1 (5.2-9.4) 65.5 (47.7-86.3) 11.70 (6.79-17.61) 4.0 (2.3-6.1) 51.3 (29.8-77.2) 2.79 (1.46-4.34) 1.0 (0.5-1.5) 16.6 (8.6-25.8)

Less developed regions 13.11 (7.41-19.97) 5.2 (2.9-7.9) 80.4 (45.5-100.0) 3.49 (1.75-5.56) 1.4 (0.7-2.2) 90.7 (45.6-100.0) 0.29 (0.12-0.50) 0.1 (0.0-0.2) 60.2 (25.2-100.0) 0.05 (0.02-0.10) - (0.0-0.0) 17.1 (5.8-30.8)

More developed regions 10.17 (6.06-15.51) 33.3 (19.8-50.7) 57.8 (34.4-88.1) 16.52 (11.05-22.94) 51.5 (34.4-71.5) 61.9 (41.4-86.0) 11.41 (6.44-17.50) 32.5 (18.3-49.8) 51.1 (28.9-78.4) 2.74 (1.42-4.42) 7.2 (3.7-11.7) 16.5 (8.6-26.7)

By income

High income 10.38 (6.38-15.23) 32.0 (19.7-47.0) 57.7 (35.4-84.6) 16.56 (11.04-22.98) 48.9 (32.6-67.9) 62.9 (41.9-87.3) 11.47 (6.42-17.51) 31.5 (17.6-48.1) 52.4 (29.3-80.0) 2.75 (1.42-4.34) 7.1 (3.7-11.3) 17.3 (8.9-27.3)

Upper middle income 12.14 (6.61-18.76) 15.2 (8.3-23.5) 81.5 (44.4-100.0) 2.92 (1.23-4.93) 3.5 (1.5-5.9) 79.8 (33.6-100.0) 0.20 (0.04-0.42) 0.2 (0.0-0.4) 22.5 (4.5-46.5) 0.04 (0.02-0.07) - (0.0-0.1) 4.7 (1.9-7.9)

Lower middle income 0.29 (0.14-0.49) 0.2 (0.1-0.4) 72.7 (34.1-100.0) 0.06 (0.02-0.12) 0.1 (0.0-0.1) 92.0 (32.3-100.0) 0.03 (0.00-0.05) - (0.0-0.0) 93.0 (17.5-100.0) - - - - - -

Low income 0.47 (0.02-0.92) 1.0 (0.0-1.9) 77.6 (3.7-100.0) 0.47 (0.00-0.94) 1.1 (0.0-2.1) 96.9 (0.0-100.0) - - - - - - - - - - - -

Africa 1.02 (0.28-2.16) 1.6 (0.4-3.4) 82.7 (22.6-100.0) 0.55 (0.11-1.08) 1.0 (0.2-1.9) 90.2 (18.6-100.0) - - - - - - - - - - - -

Northern Africa - - - - - - 0.06 (0.05-0.07) 0.6 (0.5-0.7) 59.2 (50.1-68.3) - - - - - - - - - - - -

Sub-Saharan Africa 1.02 (0.28-2.02) 1.9 (0.5-3.7) 82.7 (22.9-100.0) 0.49 (0.05-1.02) 1.0 (0.1-2.2) 96.5 (8.9-100.0) - - - - - - - - - - - -

Eastern Africa 0.47 (0.03-0.92) 2.1 (0.1-4.2) 77.6 (4.7-100.0) 0.47 (0.00-0.94) 2.5 (0.0-4.9) 96.9 (0.0-100.0) - - - - - - - - - - - -

Middle Africa - - - - - - - - - - - - - - - - - - - - - - - -

Southern Africa 0.55 (0.09-1.41) 19.1 (3.1-48.9) 87.6 (14.0-100.0) 0.02 (0.00-0.07) 0.8 (0.0-2.4) 90.2 (0.0-100.0) - - - - - - - - - - - -

Western Africa - - - - - - - - - - - - - - - - - - - - - - - -

Americas 16.33 (9.22-24.43) 42.1 (23.7-62.9) 71.2 (40.2-100.0) 8.83 (3.91-14.78) 22.6 (10.0-37.9) 65.2 (28.9-100.0) 6.17 (1.72-11.85) 15.9 (4.4-30.5) 53.6 (14.9-100.0) 1.40 (0.26-2.86) 3.7 (0.7-7.5) 12.9 (2.4-26.5)

Latin America & Caribbean 11.32 (5.89-17.58) 40.9 (21.3-63.4) 80.3 (41.8-100.0) 2.01 (0.61-3.72) 7.3 (2.2-13.5) 96.0 (29.3-100.0) 0.17 (0.00-0.39) 0.6 (0.0-1.4) 96.3 (0.5-100.0) 0.00 (0.00-0.00) - (0.0-0.0) 13.3 (2.7-26.4)

Caribbean 0.09 (0.00-0.26) 5.2 (0.2-14.7) 74.4 (2.5-100.0) 0.00 (0.00-0.00) 0.1 (0.0-0.2) 35.7 (16.1-56.6) 0.00 (0.00-0.00) - (0.0-0.1) 22.3 (4.9-42.2) 0.00 (0.00-0.00) - (0.0-0.0) 13.3 (2.8-24.2)

Central America 3.18 (0.50-6.01) 38.6 (6.0-72.9) 84.5 (13.2-100.0) 0.32 (0.13-0.54) 3.9 (1.6-6.6) 89.9 (36.1-100.0) 0.17 (0.00-0.33) 2.1 (0.0-4.3) 98.0 (0.0-100.0) - - - - - -

South America 8.05 (3.67-13.58) 45.5 (20.8-76.9) 78.8 (35.9-100.0) 1.68 (0.42-3.37) 9.6 (2.4-19.2) 97.5 (24.4-100.0) - - - - - - - - - - - -

Northern America 5.01 (1.50-9.57) 45.1 (13.5-86.1) 56.8 (17.0-100.0) 6.82 (1.96-12.78) 59.4 (17.1-100.0) 59.5 (17.1-100.0) 6.01 (1.51-11.60) 49.7 (12.5-96.0) 53.0 (13.3-100.0) 1.40 (0.23-2.91) 11.7 (1.9-24.2) 12.9 (2.1-26.9)

Asia 1.00 (0.28-1.93) 0.6 (0.2-1.2) 49.0 (13.9-94.5) 3.01 (1.27-5.14) 1.8 (0.8-3.1) 74.6 (31.5-100.0) 0.54 (0.07-1.45) 0.3 (0.0-0.8) 61.9 (7.9-100.0) 0.05 (0.02-0.09) - (0.0-0.1) 17.1 (5.8-29.8)

Central Asia 0.04 (0.04-0.04) 1.8 (1.8-1.8) 86.3 (85.2-87.5) - - - - - - - - - - - - - - - - - -

Eastern Asia 0.27 (0.00-0.73) 0.7 (0.0-1.7) 24.1 (0.0-64.2) 2.10 (0.86-3.02) 4.5 (1.8-6.4) 72.0 (29.5-100.0) 0.43 (0.00-1.29) 0.7 (0.0-2.1) 73.7 (0.0-100.0) - - - - - -

Southern Asia 0.02 (0.00-0.04) - (0.0-0.0) 94.5 (0.0-100.0) 0.03 (0.01-0.06) - (0.0-0.1) 94.5 (37.6-100.0) 0.02 (0.00-0.04) - (0.0-0.1) 94.5 (0.0-100.0) - - - - - -

South-Eastern Asia 0.57 (0.05-1.34) 2.1 (0.2-4.9) 79.3 (6.6-100.0) 0.85 (0.10-1.67) 3.2 (0.4-6.2) 81.8 (9.4-100.0) 0.04 (0.01-0.08) 0.1 (0.0-0.3) 20.9 (4.5-42.3) 0.01 (0.00-0.02) - (0.0-0.1) 5.3 (0.4-12.6)

Western Asia 0.10 (0.00-0.24) 0.9 (0.0-2.1) 76.9 (0.0-100.0) 0.03 (0.01-0.06) 0.3 (0.1-0.6) 66.7 (15.0-100.0) 0.05 (0.01-0.10) 0.5 (0.1-0.9) 63.6 (17.2-100.0) 0.04 (0.02-0.08) 0.4 (0.2-0.8) 33.0 (11.8-59.2)

Europe 4.50 (3.35-5.85) 29.5 (21.9-38.3) 62.9 (46.8-81.7) 6.92 (5.32-8.68) 42.9 (33.0-53.9) 60.5 (46.5-75.9) 4.27 (2.81-5.95) 23.2 (15.3-32.4) 45.0 (29.6-62.8) 0.75 (0.41-1.18) 3.6 (2.0-5.7) 15.4 (8.3-24.0)

Eastern Europe 0.34 (0.18-0.51) 8.7 (4.6-13.1) 66.0 (34.6-99.6) 0.38 (0.23-0.56) 8.8 (5.4-12.8) 36.8 (22.6-53.6) 0.02 (0.00-0.04) 0.4 (0.1-0.8) 3.5 (0.8-6.7) 0.03 (0.01-0.06) 0.4 (0.1-0.8) 3.5 (0.7-6.4)

Northern Europe 1.33 (0.61-2.28) 49.5 (22.5-84.8) 85.3 (38.8-100.0) 2.11 (1.11-3.30) 74.2 (39.2-100.0) 82.8 (43.7-100.0) 1.25 (0.53-2.14) 39.7 (16.9-68.2) 62.3 (26.6-100.0) 0.05 (0.01-0.10) 1.6 (0.3-3.2) 32.4 (6.6-64.3)

Southern Europe 1.28 (1.01-1.58) 34.1 (26.7-42.0) 72.0 (56.3-88.7) 1.96 (1.64-2.34) 51.5 (42.9-61.4) 67.0 (55.9-79.9) 0.60 (0.40-0.84) 14.8 (9.8-20.5) 31.3 (20.8-43.5) 0.17 (0.10-0.27) 3.8 (2.1-5.9) 11.0 (6.1-16.9)

Western Europe 1.54 (0.77-2.46) 31.4 (15.8-50.2) 46.8 (23.5-74.7) 2.46 (1.36-3.74) 48.2 (26.6-73.0) 50.0 (27.6-75.8) 2.40 (1.19-3.88) 43.9 (21.8-71.0) 48.9 (24.3-79.1) 0.50 (0.16-0.92) 8.4 (2.6-15.5) 21.8 (6.8-40.0)

Oceania 0.43 (0.08-0.87) 30.5 (6.0-61.9) 79.2 (15.5-100.0) 0.70 (0.24-1.26) 49.8 (17.0-90.3) 78.5 (26.8-100.0) 0.72 (0.22-1.30) 51.4 (15.6-93.4) 76.5 (23.2-100.0) 0.58 (0.12-1.15) 41.6 (8.5-82.0) 70.0 (14.3-100.0)

Australia & New Zealand 0.39 (0.05-0.82) 47.6 (6.2-98.8) 79.1 (10.2-100.0) 0.68 (0.22-1.16) 78.6 (25.9-100.0) 78.6 (25.9-100.0) 0.71 (0.28-1.26) 76.5 (30.5-100.0) 76.5 (30.5-100.0) 0.58 (0.12-1.07) 59.0 (12.1-100.0) 70.0 (14.3-100.0)

Melanesia 0.02 (0.01-0.03) 3.5 (1.1-5.9) 87.4 (26.9-100.0) 0.00 (0.00-0.00) 0.3 (0.0-0.9) 76.4 (0.0-100.0) - - - - - - - - - - - -

Micronesia 0.02 (0.01-0.02) 59.3 (38.0-81.8) 73.3 (46.9-100.0) 0.01 (0.01-0.02) 56.5 (34.6-80.8) 73.6 (45.1-100.0) 0.01 (0.00-0.01) 26.9 (10.6-46.2) 79.1 (31.3-100.0) 0.00 (0.00-0.00) 1.2 (0.0-3.5) 69.6 (0.0-100.0)

Polynesia 0.00 (0.00-0.00) 5.5 (2.4-8.7) 77.5 (34.2-100.0) 0.00 (0.00-0.00) 0.4 (0.0-1.0) 69.9 (0.0-100.0) - - - - - - - - - - - -

Coverage among

the total

population of

women

Coverage among

the targeted

population

Number of

vaccinated girls in

millions

Coverage among

the total

population of

women

Coverage among

the targeted

population

Number of

vaccinated girls in

millions

Countries included in the analysis are geographically classified as follows: Northern Africa (Libya); Eastern Africa (Rwanda, Seychelles, Uganda); Southern Africa (Lesotho, South Africa); Caribbean (Barbados, Cayman Islands, Dominican Republic, Trinidad & Tobago, US Virgin Islands); Central America (Mexico,

Panama); South America (Argentina, Brazil, Chile, Colombia, Guyana, Paraguay, Peru, Suriname, Uruguay); Northern America (Bermuda, Canada, Greenland, United States of America); Central Asia (Kazakhstan); Eastern Asia (Japan); Southern Asia (Bhutan); South-Eastern Asia (Brunei, Malaysia, Singapore); Western

Asia (Israel, United Arab Emirates); Eastern Europe (Bulgaria, Czech Republic, Romania, Russian Federation); Northern Europe (Denmark, Finland, Iceland, Ireland, Latvia, Norway, Sweden, United Kingdom); Southern Europe (Gibraltar, Greece, Italy, Malta, Portugal, San Marino, Slovenia, Spain, Macedonia, TFYR);

Western Europe (Austria, Belgium, France, Germany, Luxembourg, Monaco, Netherlands, Switzerland); Australia & New Zealand (Australia, New Zealand); Melanesia (Fiji, New Caledonia); Micronesia (Guam, Kiribati, Marshall Islands, Micronesia, FS, N Mariana Islands, Palau); Polynesia (American Samoa, Cook

Islands)

Coverage among

the total

population of

women

Coverage among

the targeted

populationArea or group

Age 10-14 Age 15-19 Age 20-24 Age 25-29


girls in millions

Coverage among

the total

population of

women

Coverage among the

targeted population


girls in millions

46

47

References

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