Level 3, Level 4 resources (highest and higher level of resourcing)
–Recommended population for vaccination?
A1a: Public health authorities, ministries of health, and primary care providers should routinely vaccinate girls aged 9-14 years against HPV, preferring early to late vaccination (Type of recommendation: Evidence supports. Quality of evidence: high. Strength of recommendation: strong).
A1b: Public health authorities may set the upper age limit for the target population at 14 years or older, depending on local policies and resource availability (Recommendation type: Evidence supported. Quality of evidence: low. Strength of recommendation: moderate).
–Frequency of vaccination and interval between vaccinations?
A2a: 2 doses of vaccination are recommended for immunocompetent girls aged 9-14 years (Type of recommendation: Evidence support. Quality of Evidence: Moderate. Strength of recommendation: Moderate).
A2b: At least 6 months between vaccinations, but may be extended to 12-15 months (①6 months-Type of Recommendation.
Evidence supports. Quality of evidence: high. Strength of recommendation: strong. ②12 to 15 months-Type of recommendation: Evidence supports. Quality of evidence: low. Strength of Recommendation: Weak).
A2c: Girls ≥15 years of age at first vaccination should receive three doses of vaccine (Recommendation type: Based on informal consensus. Quality of evidence: moderate. Strength of recommendation: moderate).
– Do people not at the optimal age for vaccination need additional HPV vaccine?
A3: For women who have received one dose of the vaccine and are >14 years of age, public health authorities need to provide additional HPV vaccine.
14 years, public health authorities may offer additional doses or complete vaccination before age 26 years (Type of recommendation: Based on informal consensus. Quality of evidence: moderate. Strength of recommendation: moderate).
– To prevent HPV infection, should men also receive HPV vaccine?
A4: ①Males may be vaccinated if the vaccine is used to prevent cervical cancer and the rate of vaccine use appropriate for women is <50% (Type of recommendation: Based on informal consensus. Quality of evidence: moderate. Strength of recommendation: moderate). (ii) Vaccination for men is not well documented when the use of vaccines for the prevention of cervical cancer and appropriate for women is ≥50% (Recommendation type: Based on informal consensus. Quality of evidence: Insufficient. Strength of recommendation: weak).
Level 2 resources (limited resourcing)
–Recommended population for vaccination?
B1a: Public health authorities, ministries of health, and primary care providers should routinely vaccinate girls aged 9-14 years against HPV, preferring early to late vaccination (Type of recommendation: Evidence supported. Quality of evidence: high. Strength of recommendation: strong).
–Frequency of vaccination and interval between vaccinations?
B2a: 2 doses of vaccination are recommended for immunocompetent girls who have their first vaccination at age 9 years (Type of recommendation: Evidence supported. Quality of evidence: moderate. Strength of recommendation: moderate).
B2b: At least 6 months between vaccinations, also extendable to 12-15 months (6 months – Type of recommendation.
Evidence support. Quality of evidence: high. Strength of recommendation: strong. 12 to 15 months-Type of recommendation: Evidence supports. Quality of Evidence: low. Strength of recommendation: moderate).
–Does the non-vaccine optimal age group need additional HPV vaccine?
B3: For women who have received one dose of vaccine and are >
14 years, public health authorities may offer additional doses or complete vaccination by age 26 years if resources are available (Type of recommendation: Supported by evidence. Quality of evidence: moderate. Strength of recommendation: moderate).
– To prevent HPV infection, should men also receive the HPV vaccine?
B4: Vaccination of men is not recommended when the rate of vaccine use for the prevention of cervical cancer and appropriate for women is ≥50%; vaccination of men may be considered when the rate of vaccine use for the prevention of cervical cancer and appropriate for women is <50% (Type of recommendation: Evidence supported. Quality of evidence: moderate. Strength of recommendation: moderate).
Level 1 resources (indispensable resources only)
–Recommended population for vaccination?
C1: Public health authorities, ministries of health, and primary care providers should vaccinate priority populations <14 years of age, starting as early as possible (Recommendation type: Evidence supported. Quality of evidence: high. Strength of recommendation: strong).
–Frequency of vaccination and interval between vaccinations?
C2a: 2 doses of vaccine are recommended for immunocompetent girls who have their first vaccination at age 9 years (Type of recommendation: Evidence support. Quality of evidence: moderate. Strength of recommendation: moderate).
C2b: At least 6 months between vaccinations, also extendable to 12-15 months (6 months – Type of recommendation.
Evidence support. Quality of evidence: high. Strength of recommendation: strong. 12 to 15 months-Type of recommendation: evidence supporting. Quality of Evidence: low. Strength of recommendation: moderate).
–Does the non-vaccine optimal age group need additional HPV vaccine?
C3: Vaccine supply must first be ensured for appropriate vaccinated populations, and vaccination of over-age populations may be considered when vaccine coverage of the target population is high (≥50%) and resources are abundant (Recommendation type: Evidence supports. Quality of evidence: high. Strength of recommendation: strong).
– To prevent HPV infection, should men also receive HPV vaccine?
C4: Vaccination of men is not recommended when the rate of vaccine use for the prevention of cervical cancer and appropriate for women is ≥50%; vaccination of men may be considered when the rate of vaccine use for the prevention of cervical cancer and appropriate for women is <50% (Type of recommendation: Evidence supported. Quality of evidence: moderate. Strength of recommendation: moderate).
Special Populations
– Without regard to resource stratification, what vaccination regimen should be used for women who are HIV-positive or immunosuppressed for other reasons?
D: The recommended age for HPV vaccination in this population is the same as above, but 3 doses are recommended (Type of recommendation: Evidence supportive. Quality of evidence: Insufficient. Strength of recommendation: weak).
– What vaccination regimen should be used for pregnant women, regardless of resource stratification?
E: HPV vaccination is not recommended for this population (Type of recommendation: Evidence supported. Quality of evidence: Insufficient. Strength of recommendation: weak).
– Without considering resource stratification, what vaccination regimen should be used for women treated for precancerous cervical lesions?
F: HPV vaccination is not recommended for this population (strong evidence).