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

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

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

4. 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

5. INTEGRAL PROGRAM Primary prevention VACCINE Secondary Prevention
SURVEILLANCE
Secondary
Prevention
SCREENING

6. 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

7. 12 LAC have National Vaccination Programmes

8. 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

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

10. 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 ( ) and 73,5% Peru ( )

11. 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

12. Vaccination strategies
Immunization in schools
Immunization in Health Centers

13. HPV Vaccination Coverage: Argentina 2011-2016

14. 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

15. 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

16. 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

17. Vaccination and Laboratory Centers in BA City

18. “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 at Stamboulian Medical Centers from 3/2010 to 12/2012
Age of assisted patients: Mean: 21,8 years Median: 16 years

19. 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,

20. 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.

21. 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

22. 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

23. Thank you