The European Centre for Disease Prevention and Control (ECDC) published an update to its 2008 guidance on human papillomavirus (HPV) vaccines in Europe on 5 September 2012 [1]. The update follows the introduction of vaccination programmes in 19 European countries and new evidence from research studies over the past four years.

Randomised trials and observations from the field have demonstrated good safety profiles and efficacy against cervical cancer precursors for the vaccines. Despite this, and although most of these countries are providing the vaccine for free, vaccination rates are lower than expected.
The vaccination rates for those meeting the prescribed schedule of three doses in six months range from 17% to 84% for the reporting countries. Portugal (84%), the United Kingdom (80%) and Denmark (79%) were at the top of that range. Separate reports suggest that Sweden’s vaccination coverage rate is also around 80% of their target group. The update considers among the deterring factors the high cost of the vaccines and the regime of three doses in six months.

Since the vaccine was authorised, the inclusion of HPV for boys in vaccination programmes is regularly debated. The ECDC guidance document recommends that public health initiatives should continue to focus on vaccinating girls. Routine HPV vaccination should target girls aged 10-14 years before the onset of sexual activity and should be administered in three doses within six months.

The update points to evidence that alternative vaccination schedules are not less effective than the currently recommended protocol of three doses. Further research is needed to confirm this but could have a great impact on costs and strategies for HPV vaccination programmes. The update does not recommend changing the current vaccination schedule at this point in time.