A decade of Latin-American experience with HPV prevention Dr. Pablo Elmassian

Trends in ICC incidence: LATAM and Caribbean countries New cases per year Deaths per year

Trends in ICC deaths: LATAM and Caribbean countries 2010-2100

HPV Vaccines WHO Position Paper HPV vaccines should be introduced as a part of a coordinated strategy to prevent cervical and other HPV-related diseases: Education, Information, Screening programmes

INTEGRAL PROGRAM Primary prevention VACCINE Secondary Prevention SURVEILLANCE Secondary Prevention SCREENING

Countries with HPV vaccine in the national immunization programme 2017 Introduced* to date 86 countries (40%) (74 countries or 38.1%) Not Available, Not Introduced/No Plans (120 countries or 61.9%) 114 countries (60%) * Includes partial introduction Not applicable Data source: WHO/IVB Database, as of 09 August 2017 Map production Immunization Vaccines and Biologicals (IVB), World Health Organization

12 LAC have National Vaccination Programmes

LAC: Vaccination Policies I All LAC prioritize vaccination among adolescents girls cohorts aged 9-14 years with one-year and several years birth cohorts Three countries have included adolescent boys as a secondary target group Delivery strategy is focused in health centers, school-based strategy or a combination of both

Vaccination Policies II Most countries are using tetravalent vaccine Most countries switched to a two-dose schedule All countries have implemented VAERS

Vaccination Coverage Coverage for the first dose started high and decreased with subsequent cohorts A decline in coverage between the first and second dose in most countries Coverage with 3 doses: 75% Panama (2010-2014) and 73,5% Peru (2011-2014)

Men and Women, from 11 to 26 years with HPV Immunization Strategy in Argentina 2011 Introduction to NIP for 11 years girls born after 2000 2014 Switch to quadrivalent vaccine 2015 Switch to 2 doses 2017 Introduction to NIP for 11 years boys born after2006 Men and Women, from 11 to 26 years with HIV and transplanted

Vaccination strategies Immunization in schools Immunization in Health Centers

HPV Vaccination Coverage: Argentina 2011-2016

VAERS HPV: Argentina 2011-2016 Number of dosis administered: 3.883.178 Serious: 11 8 seizures secondary to vasovagal syncope 1 generalized rash 2 bronchospasm 100% full recovery

Colombia: “Carmen de Bolivar Episode” 2012: 1st 97,5%, 2nd 96,7%, 3rd 87,1% 2013: 91,4% of 2.4 millions After the “Carmen de Bolivar episode”the coverage decreased to a mere 20.4% by the end of 2014. 2012: 1st 97,5%, 2nd 96,7%, 3rd 87,1% 2013: 91,4% of 2.4 millions

Safety of HPV Vaccine: GACVS (WHO) Since licensure in 2006 > 270 million doses No association between HPV vaccine and GBS  risk of anaphylaxis: 1,7 cases per million doses  syncope: a common anxiety or stress-related reaction to the injection No evidence for a causal association between HPV vaccine and: CRPS-POTS- premature ovarian insufficiency- primary ovarian failure, and venous thromboembolism, autoimmune issues

Vaccination and Laboratory Centers in BA City

“PATIENTS ASSISTED IN A PRIVATE INSTITUTION AFTER BEING VACCINATED OR HAVING A LABORATORY STUDY” Objectives:Describe the characteristics of assisted patients and relate de requirement for medical assistance with vaccination or having a laboratory study Population: 1142 assisted patients over a total of 1.190.428 at Stamboulian Medical Centers from 3/2010 to 12/2012 Age of assisted patients: Mean: 21,8 years Median: 16 years

Results I 1142 assisted patients: Most women: 71,5% 56,65% vaccinated 43,34% laboratory practice Most women: 71,5% Main reasons for medical assistance: 84% lipothymia, 8% dizziness, 3,3% syncope,

Results II More applied vaccines in assisted patients post vaccination DTPa 212 HPV 289 Meningococcal cuadrivalent 136 Conclusions: Adolescent and female patients required assistance more frequently There was a statistically significant difference in favor of the patients who attended the laboratory on those who attended for vaccines.

A call to Action: Overcoming Barriers Limited knowledge of HPV, HPV related diseases, and features of the HPV vaccine Misguided safety concerns by parents and targeted population for HPV vaccine Cultural barriers

A call to Action: Overcoming Barriers The key to reach high HPV vaccination coverage is to promote the integrated alliance of 3 areas: Health Education Communication

Thank you pelmassian@fidec-online.com