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News|Articles|July 17, 2024

Minimal recovery in HPV vaccination reported in Japan despite recommendations

HPV vaccination coverage in Japan remains critically low despite the resumption of proactive recommendations by the Ministry of Health, Labour, and Welfare, highlighting the need for stronger cervical cancer control measures.

Human papillomavirus (HPV) vaccination coverage is only minimally recovered in Japan even after the resumption of proactive recommendations from Japan’s Ministry of Health, Labour, and Welfare (MHLW), according to a recent study published in JAMA Network Open.1

Takeaways

  1. Despite the resumption of proactive recommendations by Japan's Ministry of Health, Labour, and Welfare (MHLW) in November 2021, HPV vaccination coverage has only minimally recovered.
  1. HPV vaccination coverage drastically declined after the MHLW temporarily suspended its recommendation for the vaccine in June 2013, affecting vaccine uptake for several years.
  1. Japan is significantly behind the World Health Organization’s goal of 90% HPV vaccination coverage by 2030, with current rates falling far short.
  1. Early HPV vaccination is linked to a reduced risk of cervical cancer, underscoring the importance of improving vaccination rates to prevent cervical intraepithelial neoplasia grade 3 and cervical cancer.
  1. The study suggests that stronger cervical cancer control measures are necessary in Japan to achieve better HPV vaccination coverage and meet international health goals.

HPV vaccine coverage of 90% by 2030 is part of the World Health Organization’s (WHO) goal for cervical cancer elimination. However, Japan is in a critical situation with HPV vaccine coverage, as HPV vaccination is not part of national routine vaccination. The MHLW temporarily suspended its recommendation for the HPV vaccine in June 2013, significantly reducing HPV vaccine uptake.

Early HPV vaccination has been linked to a reduced risk of cervical intraepithelial neoplasia grade 3 or cervical cancer (CIN3+).2 In one study, cumulative incidence functions for CIN3+ were 22.9%, 31.5%, and 37.6% for those vaccinated when aged under 15 years, when aged 15 to 20 years, and unvaccinated, respectively.

The HPV vaccine has been proven safe and effective, in preventing HPV-related cervical cancer lesions.1 With this in mind, the MHLW resumed its recommendations for the vaccine in November 2021, and other programs have been initiated to boost vaccine coverage.

To calculate birth fiscal year (BFY)-specific vaccination coverage in Japan, investigators conducted a cross-sectional study. Vaccination environments were assessed for BFY-specific cumulative first-dose coverage and generation-specific vaccination coverage.1

BFY coverage from 1994 to 2010 was included in the analysis, as well as fiscal year (FY) coverage from 2010 to 2022. First-dose coverage to be achieved by 2028 was also evaluated. Results were reported based on the FY, which starts in April and ends in March the following year in Japan.

Data was obtained from MHLW reports, which included the Emergency Promotion Project of HPV vaccination implementation report, regional health promotion program data, and preliminary FY 2022 monthly vaccination counts. Female patients receiving HPV vaccination were classified as HPV vaccination recipients.

There were 9,414,620 patients with relevant vaccination data included in the analysis. Vaccine coverage was 53.51% to 79.47% for the vaccination generation BFYs 1994 to 1999. For BFYs 2000 to 2010, coverage was 0.84% to 25.21%.1

Vaccination coverage was notably reduced in the vaccine-suspension generation, at 14.04% for BFY 2000, 1.53% for BFY 2001, 0.84% for BFY 2002, and 1.74% for BFY 2003. In BFY 2004 patients, information was delivered individually. Coverage was still low but rose to 10.20%, followed by 23.74% for BFY 2005 and 25.21% for BFY 2006.

The end of the routine vaccination target age was reached by FY 2022. Routine vaccination was available in FY 2022 for individuals with BFY 2010, with 2.83% receiving coverage. This rate was higher than among 12-year-olds in the vaccine-suspension generation and the generation receiving information individually.

The mean cumulative immunization coverage was 71.96% in the vaccination generation, which was the closest to the 90% goal set by the WHO. The vaccine-suspension generation had a coverage rate of 4.62% by FY 2022, the individual information generation 16.16%, and the vaccine-resumed generation 2.83%.1

Investigators also estimated vaccination coverage up to FY 2028 assuming coverages in FY 2022 are the same for each BFY after FY 2023. Estimates were 32.96% for BFY 2007, 39.18% for BFY 2008, 42.16% for BFY 2009, and 43.16% for BFYs 2010 to 2012. A plateau was reported at 43.16%.

These results indicated only minimal recovery of HPV vaccination coverage in Japan after the resumption of MHLW recommendations. Investigators recommended stronger cervical cancer control measures be implemented.1

Reference

  1. Yagi A, Ueda Y, Oka E, Nakagawa S, Kimura T. Human papillomavirus vaccination by birth fiscal year in Japan. JAMA Netw Open. 2024;7(7):e2422513. doi:10.1001/jamanetworkopen.2024.22513
  2. Krewson C. Study finds reduced CIN3+ risk from early HPV vaccination. Contemporary OB/GYN. April 16, 2024. Accessed July 17, 2024. https://www.contemporaryobgyn.net/view/study-finds-reduced-cin3-risk-from-early-hpv-vaccination

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