Achieving high coverage in Rwanda's national human papillomavirus vaccination programme
Achieving high coverage in Rwanda's national human papillomavirus vaccination programme
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DOI：
10.2471/blt.11.097253
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发表时间：
2012-08-01
期刊：
影响因子：
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通讯作者：
Ngabo, Fidele
中科院分区：
文献类型：
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作者：
Binagwaho, Agnes;Wagner, Claire M;Ngabo, Fidele
问题：几乎所有患有宫颈癌的妇女都感染了人类乳头瘤病毒(HPV)。在每年死于宫颈癌的27.5万名妇女中，88%生活在发展中国家。两种针对HPV的疫苗已经获得批准。然而，低收入国家的疫苗实施往往落后于高收入国家的实施15至20年。2011年，卢旺达卫生部与默克公司合作，向所有适龄女孩提供Gardasil HPV疫苗。该部建立了“公私社区伙伴关系”，确保有效和公平地提供服务。地方环境由于国家高度重视加强卫生系统，超过90%的卢旺达12-23个月婴儿接受了世界卫生组织推荐的所有基本免疫接种。2011年发生了重大变化，卢旺达的HPV疫苗接种方案在六年级女孩的第一个三剂疫苗接种疗程后，覆盖率达到93.23%。这是通过以学校为基础的疫苗接种和社区参与查明失学或未入学的女孩而实现的。在交付第一剂疫苗之前，在全国范围内开展了一场宣传运动。通过一系列创新的伙伴关系，卢旺达将高收入国家和低收入国家在疫苗引进方面20年的历史差距减少到仅仅5年。由于实施了建立在卢旺达强大的疫苗接种系统和人力资源框架基础上的交付战略，实现了很高的覆盖率。在全球疫苗和免疫联盟决定开始资助HPV疫苗接种后，卢旺达的榜样应该会激励其他国家探索普遍的HPV疫苗覆盖范围，尽管实施必须根据当地情况量身定做。
Problem Virtually all women who have cervical cancer are infected with the human papillomavirus (HPV). Of the 275 000 women who die from cervical cancer every year, 88% live in developing countries. Two vaccines against the HPV have been approved. However, vaccine implementation in low-income countries tends to lag behind implementation in high-income countries by 15 to 20 years.Approach In 2011, Rwanda's Ministry of Health partnered with Merck to offer the Gardasil HPV vaccine to all girls of appropriate age. The Ministry formed a "public-private community partnership" to ensure effective and equitable delivery.Local setting Thanks to a strong national focus on health systems strengthening, more than 90% of all Rwandan infants aged 12-23 months receive all basic immunizations recommended by the World Health Organization.Relevant changes In 2011, Rwanda's HPV vaccination programme achieved 93.23% coverage after the first three-dose course of vaccination among girls in grade six. This was made possible through school-based vaccination and community involvement in identifying girls absent from or not enrolled in school. A nationwide sensitization campaign preceded delivery of the first dose.Lessons learnt Through. a series of innovative partnerships, Rwanda reduced the historical two-decade gap in vaccine introduction between high- and low-income countries to just five years. High coverage rates were achieved due to a delivery strategy that built on Rwanda's strong vaccination system and human resources framework. Following the GAVI Alliance's decision to begin financing HPV vaccination, Rwanda's example should motivate other countries to explore universal HPV vaccine coverage, although implementation must be tailored to the local context.