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Bechini A, Cosma C, Di Pisa G, Fanfani A, Ionita G, Liedl D, Lunetta C, Martorella L, Mele S, Stacchini L, Vaccaro G, Zuccaro O, Valente S, Prandi GM, Bonanni P, Boccalini S. Human Papilloma Virus Vaccination and Cervical Screening in the Italian Regions: An Overview of the Current State of the Art. Vaccines (Basel) 2024; 12:504. [PMID: 38793755 PMCID: PMC11125645 DOI: 10.3390/vaccines12050504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Human Papilloma Virus (HPV) infection and HPV-related cancers can be prevented through vaccinations and mass cervical screening programmes. The Ministry of Health in Italy provides recommendations on primary and secondary prevention of HPV-related diseases, but the 19 Italian regions and 2 autonomous provinces have organisational and decision-making autonomy, with differences in the strategies for offering prevention. The aim of this study is to describe the HPV vaccination and cervical screening offered in all Italian regions. Regional official documents up until 31 December 2021 were first identified. Subsequently, primary and secondary prevention experts from each region were interviewed to validate the previously collected data. The National Immunisation Plan (NIP) 2017-2019 recommends HPV vaccination from the age of 11 for both sexes, with a coverage target of 95%. HPV vaccination is offered free of charge or co-payment. All regions have screening programmes for cervical cancer, using PAP or HPV-DNA tests every three to five years. All regions have an electronic registry for vaccination and screening status. All regions have developed awareness-raising campaigns. It is important to harmonise regional policies with the implementation of information systems integration. The collected data could enhance both regional and national public health initiatives, bolstering the resilience of vaccination programs.
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Affiliation(s)
- Angela Bechini
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (A.B.); (P.B.); (S.B.)
| | - Claudia Cosma
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Giulia Di Pisa
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Alice Fanfani
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Giulia Ionita
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Davide Liedl
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Carla Lunetta
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Linda Martorella
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Silvia Mele
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Lorenzo Stacchini
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Gabriele Vaccaro
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Ornella Zuccaro
- Department of Prevention and Public Health, Local Health Authority Asl Roma 2, 00182 Rome, Italy;
| | | | | | - Paolo Bonanni
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (A.B.); (P.B.); (S.B.)
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (A.B.); (P.B.); (S.B.)
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Setiawan D, Annisa AN, Lianawati, Hutubessy RCW, Ting Yeung KH. The Cost Analysis of Human Papillomavirus Vaccination Program in Indonesia. Value Health Reg Issues 2023; 35:102-108. [PMID: 36934486 DOI: 10.1016/j.vhri.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/05/2022] [Accepted: 01/20/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES This study aimed to analyze and describe the cost of HPV vaccination program in Indonesia. METHODS This study identified the cost-related HPV vaccination program implemented in Makassar, Manado, and Surabaya cities, Indonesia, according to the previous activities performed. Cost information was collected and analyzed in each specific activity for each cost components, using the HPV vaccination module of the World Health Organization Cervical Cancer Prevention and Control Costing tool. RESULTS According to the Cervical Cancer Prevention and Control Costing tool, the recurrent costs, both financial and economic costs, dominated the HPV vaccination program costs in Surabaya (US dollars [USD] 264 618; USD 268 724), Makassar (USD 166 852; USD 293 300), and Manado (USD 270 815; USD 270 946), with a total cost of USD 702 285 for financial cost and USD 832 970 for economic cost. Vaccine procurement drives the recurrent cost. CONCLUSIONS The implementation of demonstration program in Surabaya, Makassar, and Manado cities was considerably succeed. Any prediction related to the cost of implementation of HPV vaccination in Indonesia can be calculated and used to advocate regional or national government.
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Affiliation(s)
- Didik Setiawan
- Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Purwokerto, Central of Java, Indonesia; Center for Health Economics Studies, Universitas Muhammadiyah Purwokerto, Purwokerto, Central of Java, Indonesia.
| | - Andi Nurul Annisa
- Center for Health Economics Studies, Universitas Muhammadiyah Purwokerto, Purwokerto, Central of Java, Indonesia
| | - Lianawati
- Center for Health Economics Studies, Universitas Muhammadiyah Purwokerto, Purwokerto, Central of Java, Indonesia
| | - Raymond C W Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Switzerland
| | - Karene Hoi Ting Yeung
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Switzerland
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Calabrò GE, Riccardi MT, D'Ambrosio F, Castagna C, Sapienza M, Millevolte R, Pellacchia A, Ricciardi R, de Vincenzo RP, de Waure C. Cervical cancer elimination in Italy: Current scenario and future endeavors for a value based prevention. Front Public Health 2022; 10:1010237. [PMID: 36530690 PMCID: PMC9747937 DOI: 10.3389/fpubh.2022.1010237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022] Open
Abstract
Background Cervical Cancer (CC) is a vaccine-preventable disease, and it is treatable if diagnosed early and managed properly. However, it is the fourth most common cancer in women worldwide with about 604,127 cases and 341,831 deaths in 2020. In Italy, it represents the fifth most common cancer in women under 50 years of age with about 2,400 new cases in 2020. The CC elimination is today a global public health goal published by the World Health Organization (WHO) in 2020 and a commitment of the European Union that has included it in Europe's Beating Cancer Plan. Therefore, urgent action is needed, at international and national level, to implement value-based interventions regarding vaccination, screening and timely management of the disease. Our study aims to describe the state of the art of Human Papilloma Virus (HPV) prevention in Italy and to get a consensus on indicators for monitoring the progress toward CC elimination at national level. Methods The study envisaged the following activities: research and synthesis of the evidence on strategies and actions for CC elimination at regional Italian level; identification of indicators to monitor such strategies/actions; organization of a multi-stakeholder consensus to reach the agreement on main indicators to be used in Italy. Results As for HPV vaccination coverage, the last Italian available data (December 31st, 2020) showed that it was way below the target (95%) with full cycle vaccination coverage ranging from 6 to 61.7% in female adolescents and from 5.4 to 55.4% in male adolescents (2008 birth cohorts). The coverage rate of CC screening is variable with a range of 61.7-89.6%. Furthermore, coverage rates due to organized screening programs (excluding out-of-pocket screening) shows a range from 20.7 to 71.8%. The mapping of the Italian Regions highlighted an important regional heterogeneity in respect to organizational/operational issue of HPV vaccination and CC screening. Indicators for monitoring CC elimination strategies have been drawn from the Australian experience and distinguished by disease outcomes, vaccination coverage, screening participation and treatment uptake. The highest consensus was reached for the following indicators: CC incidence; detection of high-grade cervical disease; CC mortality; full cycle vaccination coverage; screening participation; high-grade cervical disease treatment rates; CC treatment rates. Conclusions The assessment of the current status of CC elimination as overarching goal beyond the achievement of vaccine, screening and treatment targets represents the first step for the identification of interventions to be implemented to accelerate the path toward CC elimination. Based on this and following the WHO call, a value-based approach is proposed to untangle the full benefit of HPV-related cancers elimination strategies and identify priority and best practices.
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Affiliation(s)
- Giovanna Elisa Calabrò
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- VIHTALI Value in Health Technology and Academy for Leadership and Innovation, Spin Off of Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Teresa Riccardi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Floriana D'Ambrosio
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carolina Castagna
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Sapienza
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Andrea Pellacchia
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Roberto Ricciardi
- VIHTALI Value in Health Technology and Academy for Leadership and Innovation, Spin Off of Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosa Pasqualina de Vincenzo
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
- University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Tjalma WAA, van Heerden J, Van den Wyngaert T. If prophylactic HPV vaccination is considered in a woman with CIN2+, what is the value and should it be given before or after the surgical treatment? Eur J Obstet Gynecol Reprod Biol 2021; 269:98-101. [PMID: 34979365 DOI: 10.1016/j.ejogrb.2021.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/27/2021] [Accepted: 11/05/2021] [Indexed: 11/04/2022]
Abstract
Since the introduction of human papilloma virus (HPV) vaccination, the number of precancerous lesions has decreased in countries with a high HPV vaccination coverage. Currently women who present with a precancerous cervical lesions (CIN2 + ), are often not vaccinated or not vaccinated with the latest vaccine. Although resection of the precancerous lesion is the standard approach, the guidelines regarding vaccination are not clear. Vaccination will be valuable in reducing the risk of recurrence. Therefore, it is beneficial to understand the importance of vaccination or revaccination with the nonavalent vaccine in these cases. Furthermore, the timing of vaccination, either before or after surgery, should be determined. To answer these questions, twelve studies regarding vaccination and conization were reviewed. The inconsistency of study designs and inclusion criteria between the different studies introduced a considerable risk of bias. Nevertheless, the analysis showed that 43 women needed to be vaccinated and treated for CIN2 + lesions to prevent a recurrence. The ideal timing could not be established, but theoretically vaccination before the start of treatment was most logic. Although the data is not level 1 evidence, these recommendations should be used during counseling in the clinical setting until results of ongoing randomized controlled trials become available.
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Affiliation(s)
- Wiebren A A Tjalma
- Multidisciplinary Breast Clinic, Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium.
| | - Jaques van Heerden
- Paediatric Haematology and Oncology, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium.
| | - Tim Van den Wyngaert
- Multidisciplinary Breast Clinic, Department of Nuclear Medicine, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium.
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