HPV Vaccination Recommendations in India
In India, HPV vaccination is recommended for all girls aged 9-14 years with a two-dose schedule, and for females aged 15-26 years with a three-dose schedule to prevent cervical cancer and other HPV-related diseases. 1
Target Population and Dosing Schedule
- Girls aged 9-14 years are the primary target group for HPV vaccination in India, with a two-dose schedule administered at 0 and 6 months (interval extendable to 18 months) 1
- For females aged 15-26 years, a three-dose schedule is recommended at 0,1-2, and 6 months 1, 2
- Catch-up vaccination is recommended for all females through age 26 years who have not been adequately vaccinated 2, 1
- The minimum interval between the first and second doses is 4 weeks, and between the second and third doses is 12 weeks 2, 3
Available Vaccines in India
- Both bivalent and quadrivalent HPV vaccines are available in India, with the nonavalent vaccine licensed but not yet widely available 1, 4
- A new affordable quadrivalent HPV vaccine (Cervavac) developed by the Serum Institute of India has shown non-inferior immune response compared to established vaccines, which could improve access and coverage 5
Special Populations
- Three-dose schedules are recommended for immunocompromised individuals regardless of age at initiation 2, 1
- HPV vaccine can be administered to women with abnormal Papanicolaou test results, though they should be informed that vaccination does not protect against already acquired infections 3, 1
- Vaccination is not recommended during pregnancy; if a woman becomes pregnant during the vaccination series, subsequent doses should be postponed until after delivery 3, 6
- Breastfeeding women can safely receive the HPV vaccine 3, 6
Implementation Considerations
- Family support and peer influence are the most significant factors affecting vaccine acceptance in rural India, followed by cost and perceived risk of HPV 7
- Knowledge about cervical cancer and HPV vaccination remains poor in many parts of India, highlighting the need for increased awareness campaigns 7, 8
- The primary obstacle to HPV vaccination in India is financial; the introduction of affordable vaccines is crucial for improving coverage 1, 8
- Successful implementation has been demonstrated in Punjab and Sikkim states with high coverage and safety 4
Clinical Practice Points
- No prevaccination testing (HPV DNA or antibody) is needed before vaccination at any age 2
- HPV vaccination does not replace the need for cervical cancer screening; regular screening should continue according to guidelines 3, 2
- The vaccine is most effective when administered before potential exposure to HPV through sexual activity 2, 1
- HPV vaccine can be administered at the same visit as other age-appropriate vaccines using separate syringes at different anatomic sites 2
Pitfalls and Caveats
- Vaccination does not protect against HPV types that a person is already infected with at the time of vaccination, though it will protect against other vaccine HPV types 3
- Public hesitancy may exist due to past controversies; healthcare providers should address concerns with evidence-based information 4, 8
- Single-dose vaccination results are promising but not yet part of standard recommendations in India 1, 4
- Despite vaccination, cervical cancer screening remains essential as vaccines do not protect against all oncogenic HPV types 3, 2