Summary of the National Advisory Committee on Immunization (NACI) Statement: Updated guidance on human papillomavirus (HPV) vaccines

Background: Without vaccination, approximately 75% of people in Canada will acquire a human papillomavirus (HPV) infection in their lifetime. HPV vaccine coverage rates continue to fall short of the national goal of 90% coverage for two or more doses by 17 years of age. Recent evidence and World Health Organization (WHO) guidance now support a 1- or 2-dose schedule for younger age groups, which can simplify vaccination efforts and improve coverage rates compared to a multi-dose immunization program.

Methods: The National Advisory Committee on Immunization (NACI) reviewed available evidence on the clinical benefits and risks of a 1-dose HPV vaccine schedule, as well as additional factors, including ethics, equity, feasibility and acceptability. The evidence and programmatic considerations were organized using a process informed by the Grading of Recommendations Assessment, Development and Evaluations (GRADE) framework and all of the information was used to facilitate NACI guidance development.

Results: A 1-dose schedule is highly effective against HPV infection based on available evidence in younger female populations, with current follow-up of up to 11 years following vaccination. Infectious disease modelling shows that a 1-dose strategy in males and females in Canada is expected to have similar health outcomes over the short and long term compared to two doses.

Conclusion: NACI updated recommendations for individuals 9 to 20 years of age to receive one dose of 9vHPV (Gardasil-9, Merck) vaccine. For individuals 21 years of age and older, a 2-dose schedule should be administered. Individuals considered immunocompromised and individuals infected with HIV should receive a 3-dose series. NACI also issued a discretionary recommendation for HPV vaccination for individuals 27 years and older, and updated guidance to allow HPV vaccine during pregnancy.