The situation with vaccination in Shkodra region after the first year of implementation of human papillomavirus vaccine
DOI:
https://doi.org/10.26641/2307-0404.2025.2.333445Keywords:
human papillomavirus, HPV, vaccine, vaccination, immunization, public health, healthcareAbstract
Human papillomavirus (HPV) is a common sexually transmitted infection with potentially serious health consequences, including anogenital and oropharyngeal cancers and genital warts. In 2022, Albania implemented an HPV vaccination program for girls aged 13-20 years, offering a single dose of the bivalent or quadrivalent vaccine. This study aims to evaluate the status of HPV vaccination in the Shkodra region after its first year of implementation and explore reasons for non-vaccination. This retrospective study collected data from official vaccination registers at health centers in the Shkodra region for the period 2022-2023. Additionally, face-to-face interviews were conducted with nurses responsible for administering vaccinations (vaccinators) and with parents present at the centers. Quantitative data were obtained and validated by the Chief Vaccination Office in the Epidemiology Sector at the Local Health Care Unit in Shkodra. A simple descriptive and comparative method was employed. Data for this study were gathered from two main sources: official vaccination records and interviews conducted with nurses and parents. Quantitative data were processed and analyzed using Microsoft Office Excel 2010. The vaccination coverage plan aimed to vaccinate 812 girls, with 67% (n=546) from urban areas and 33% (n=266) from rural areas. Overall, vaccination coverage was 51% (n=412 girls). Coverage was higher in rural areas (72.6%, n=193 girls) than in urban areas (40%, n=219 girls). This study highlights the challenges and successes of the HPV vaccination program in the Shkodra region during its first year of implementation. Vaccination coverage was higher in rural areas (72.6%) compared to urban areas (40%). Key barriers to vaccine uptake included parental refusal, lack of information, and fear of side effects.
References
Dunne EF, Unger ER, Sternberg M, McQuillan G, Swan DC, Patel SS, et al. Prevalence of HPV Infection Among Females in the United States. JAMA. 2007 Feb 28;297(8):813. doi: https://doi.org/10.1001/jama.297.8.813
Smith JS, Gilbert PA, Melendy A, Rana RK, Pimenta JM. Age-Specific Prevalence of Human Papillo-mavirus Infection in Males: A Global Review. Journal of Adolescent Health. 2011 Jun;48(6):540-52. doi: https://doi.org/10.1016/j.jadohealth.2011.03.010
Winer RL, Feng Q, Hughes JP, O’Reilly S, Kiviat NB, Koutsky LA. Risk of Female Human Papilloma-virus Acquisition Associated with First Male Sex Partner. J Infect Dis. 2008 Jan 15;197(2):279-82. doi: https://doi.org/10.1086/524875
Baandrup L, Blomberg M, Dehlendorff C, Sand C, Andersen KK, Kjaer SK. Significant Decrease in the Incidence of Genital Warts in Young Danish Women After Implementation of a National Human Papillomavirus Vaccination Program. Sex Transm Dis. 2013 Feb;40(2):130-5. doi: https://doi.org/10.1097/OLQ.0b013e31827bd66b
Chaturvedi AK. Beyond Cervical Cancer: Burden of Other HPV-Related Cancers Among Men and Women. Journal of Adolescent Health. 2010 Apr;46(4):S20-6. doi: https://doi.org/10.1016/j.jadohealth.2010.01.016
Giuliano AR, Anic G, Nyitray AG. Epidemiology and pathology of HPV disease in males. Gynecol Oncol. 2010 May;117(2):S15-9. doi: https://doi.org/10.1016/j.ygyno.2010.01.026
Giuliano AR, Palefsky JM, Goldstone S, Morei-ra ED, Penny ME, Aranda C, et al. Efficacy of Quadri-valent HPV Vaccine against HPV Infection and Disease in Males. New England Journal of Medicine. 2011 Feb 3;364(5):401-11. doi: https://doi.org/10.1056/NEJMoa0909537
Hariri S, Markowitz LE, Dunne EF, Unger ER. Population Impact of HPV Vaccines: Summary of Early Evidence. Journal of Adolescent Health. 2013 Dec;53(6):679-82. doi: https://doi.org/10.1016/j.jadohealth.2013.09.018
Parkin DM, Bray F. Chapter 2: The burden of HPV-related cancers. Vaccine. 2006 Aug;24:S11-25. doi: https://doi.org/10.1016/j.vaccine.2006.05.111
Forhan SE, Gottlieb SL, Sternberg MR, Xu F, Datta SD, McQuillan GM, et al. Prevalence of Sexually Transmitted Infections Among Female Adolescents Aged 14 to 19 in the United States. Pediatrics. 2009 Dec 1;124(6):1505-12. doi: https://doi.org/10.1542/peds.2009-0674
Giuliano AR, Lu B, Nielson CM, Flores R, Papenfuss MR, Lee J, et al. Age‐Specific Prevalence, Incidence, and Duration of Human Papillomavirus Infections in a Cohort of 290 US Men. J Infect Dis. 2008 Sep 15;198(6):827-35. doi: https://doi.org/10.1086/591095
Etter DJ, Zimet GD, Rickert VI. Human papillomavirus vaccine in adolescent women. Curr Opin Obstet Gynecol. 2012 Oct;24(5):305-10. doi: https://doi.org/10.1097/GCO.0b013e3283567005
Fisher WA. Understanding Human Papillomavirus Vaccine Uptake. Vaccine. 2012 Nov;30:F149-56. doi: https://doi.org/10.1016/j.vaccine.2012.04.107
Stupiansky NW, Alexander AB, Zimet GD. Hu-man papillomavirus vaccine and men. Curr Opin Infect Dis. 2012 Feb;25(1):86-91. doi: https://doi.org/10.1097/QCO.0b013e32834ed5be
Markowitz LE. dvisory Committee on Immunization Practices (ACIP). Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2007;2(56):1-24. doi: https://doi.org/10.1037/e601292007-001
Dunne EF; MLE; CHCCRSMGJUER. Recom-mendations on the Use of Quadrivalent Human Papillo-mavirus Vaccine in Males – Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep. 2011 Dec 23;60(50):1705-8. PMID: 22189893
Curtis CR YDJJDCSSMJHS. National and State Vaccination Coverage Among Adolescents Aged 13-17 years – United States, 2012. MMWR Morb Mortal Wkly Rep. 2013 Aug 30;62(34):685-93. PMID: 23985496.
Nolan KM, Seaton B, Antonello J, Zhang Y, Cook L, Delfino K, et al. Development and Validation of Two Optimized Multiplexed Serologic Assays for the 9-Valent Human Papillomavirus Vaccine Types. mSphere. 2023 Apr 20;8(2):e0096221. doi: https://doi.org/10.1128/msphere.00962-21
Borah P, Kim S, Xiao X, Lee DKL. Correcting misinformation using theory-driven messages: HPV vaccine misperceptions, information seeking, and the moderating role of reflection. Atl J Commun. 2022 May 27;30(3):316-31. doi: https://doi.org/10.1080/15456870.2021.1912046
Adekanmbi V, Sokale I, Guo F, Ngo J, Hoang TN, Hsu CD, et al. Human Papillomavirus Vaccination and Human Papillomavirus–Related Cancer Rates. JAMA Netw Open. 2024 Sep 5;7(9):e2431807. doi: https://doi.org/10.1001/jamanetworkopen.2024.31807
Dorji T, Nopsopon T, Tamang ST, Pongpirul K. Human papillomavirus vaccination uptake in low-and middle-income countries: a meta-analysis. Ecli¬nicalMe-dicine. 2021 Apr;34:100836. doi: https://doi.org/10.1016/j.eclinm.2021.100836
Dykens JA, Peterson CE, Holt HK, Harper DM. Gender neutral HPV vaccination programs: Reconsidering policies to expand cancer prevention globally. Front Public Health. 2023 Feb 21;11:1067299. doi: https://doi.org/10.3389/fpubh.2023.1067299
Athanasiou A, Bowden S, Paraskevaidi M, Foto-poulou C, Martin-Hirsch P, Paraskevaidis E, et al. HPV vaccination and cancer prevention. Best Pract Res Clin Obstet Gynaecol. 2020 May;65:109-24. doi: https://doi.org/10.1016/j.bpobgyn.2020.02.009
Pojani E, Bozo S, Capparelli E, Hoxha B. Cervical Cancer and HPV vaccination: Insights into know-ledge, attitudes, and practices among Albanian women. Vaccine X. 2025 Jan;22:100594. doi: https://doi.org/10.1016/j.jvacx.2024.100594
Merkuri L, Kamberi F, Qorri E, Shapo L. Asses-sment of the Albanian University female students’ know-ledge, attitudes, and practices on cervical cancer. The Journal of Infection in Developing Countries. 2023 Apr 30;17(04):534-41. doi: https://doi.org/10.3855/jidc.18121
Bakiri F, Abazi E, Lika M. Albanian Male Students Perception and Knowledge of Human Papilloma-virus (HPV). Journal of Biological Studies. 2023 Dec 31;6(4):273-81. doi: https://doi.org/10.62400/jbs.v6i4.8727
Shin MB, Sloan KE, Martinez B, Soto C, Baez-conde-Garbanati L, Unger JB, et al. Examining multilevel influences on parental HPV vaccine hesitancy among multiethnic communities in Los Angeles: a qualitative analysis. BMC Public Health. 2023 Mar 22;23(1):545. doi: https://doi.org/10.1186/s12889-023-15318-2
Kennedy J. Vaccine Hesitancy: A Growing Concern. Pediatric Drugs. 2020 Apr 19;22(2):105-11. doi: https://doi.org/10.1007/s40272-020-00385-4
Kong WY, Oh NL, Kennedy KL, Carlson RB, Liu A, Ozawa S, et al. Identifying Healthcare Profes-sionals With Lower Human Papillomavirus (HPV) Vaccine Recommendation Quality: A Systematic Review. Journal of Adolescent Health. 2024 May;74(5):868-77. doi: https://doi.org/10.1016/j.jadohealth.2023.11.016
Vahabi M, Mishra G, Pimple S, Wong JPH, Khan M, Prakash V, et al. Effectiveness of family-centred sexual health education and HPV self-sampling in promoting cervical cancer screening among hard-to-reach indian women in rural and tribal areas: a community-based pilot study. BMC Public Health. 2023 Apr 11;23(1):671. doi: https://doi.org/10.1186/s12889-023-15602-1
ICO/IARC Information Centre on HPV and Cancer. Albania. Human Papillomavirus and Related Cancers. Fact Sheet 2023 [Internet]. 2023 Mar 10 [cited 2025 Jan 11]. Available from: https://hpvcentre.net/statistics/reports/ALB.pdf
Beavis AL, Krishnamoorthi MS, Adler S, Fles-zar LG, Moran MB, Rositch AF. Contemporary provider perspectives on how to address HPV vaccine hesitancy in the US: A qualitative study. Vaccine X. 2024 Oct;20:100533. doi: https://doi.org/10.1016/j.jvacx.2024.100533
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