http://orcid.org/0000-0002-3987-1589
To the editor,
In Japan, vaccination with public aid against the human papillomavirus (HPV) became available to girls aged 13–16 in 2010. However, early in the spring of 2013, the media began repetitively reporting that adverse patient events might be linked to the vaccine,Citation1,2 even though it was not exactly known whether these effects were actually caused by the vaccine. Although, in April of 2013, HPV vaccination was included in the National Immunization Program for girls aged 12–16, the Ministry of Health, Labor and Walfare of Japan suspended its active recommendation for the HPV vaccination in June of 2013. As a result, the HPV vaccination rate in Japan has significantly dropped.Citation3,4 A large population of young women unprotected from HPV infection will be genarated due to delays in resuming the national HPV vaccination, because some girls might have sexual intercourse by resuming vaccination encouragement. If the current situation continues in Japan, disparities will occur in the incidence of HPV infections among young women, depending on an unfortunate year of birth.Citation5 In the future, this cohort gap will result in higher incidences of cervical and other HPV-related diseases.
If, in a few years, Japan resumes its encouragement for some form of HPV vaccination, the vaccination rate will be unlikely to recover immediately. We have studied this issue and found that mothers of vaccine-eligible daughters will tend to delay vaccinating their daughters until after vaccinations have spread safely among their daughters' close friends and acquaintances.Citation6 Due to this expected lag, simply restarting vaccinations for females aged 12-16 y will be inadequate to reduce the incidence of HPV-related diseases. New national strategies must be developed to address this HPV protection gap. One approach must be focused encouragement for catch-up vaccinations for females in this unprotected cohort. Another would be use of 9-valent HPV vaccines (currently, only bi- and quadrivalent HPV vaccines are licensed in Japan). Lastly, we must begin promoting the HPV vaccines for males, as is done in other countries.Citation7 Our health agencies should be actively exploring all reasonable actions to reduce the future incidence of HPV-related diseases resulting from our current gap in protecting our youth.
Disclosure of potential conflicts of interest
Dr. Tanaka declares no competing interests.
Drs. Ueda and Kimura received lecture fees from GlaxoSmithKline/Japan Vaccine.
Dr. Ueda received a lecture fee, research fund (grant number J550703673), and a consultation fee from Merck Sharp & Dohme, and research funding from Japan Agency for Medical Research and Development (grant number 15ck0106103h0102).
Acknowledgment
We would like to thank Dr. G.S. Buzard for his constructive critique and editing of our manuscript.
Funding
Dr. Tanaka has no financial relationships relevant to this article to disclose.
Drs. Ueda and Kimura received lecture fees from GlaxoSmithKline/Japan Vaccine.
Dr. Ueda received a lecture fee, research fund (grant number J550703673), and a consultation fee from Merck Sharp & Dohme, and research funding from Japan Agency for Medical Research and Development (grant number 15ck0106103h0102).
References
- Morimoto A, Ueda Y, Egawa-Takata T, Yagi A, Terai Y, Ohmichi M, Ichimura T, Sumi T, Murata H, Kanzaki H, et al. Effect on HPV vaccination in Japan resulting from news report of adverse events and suspension of governmental recommendation for HPV vaccination. Int J Clin Oncol 2015; 20(3):549-55; PMID:25001869; http://dx.doi.org/10.1007/s10147-014-0723-1
- Larson HJ, Wilson R, Hanley S, Parys A, Paterson P. Tracking the global spread of vaccine sentiments: the global response to Japan's suspension of its HPV vaccine recommendation. Hum Vaccin Immunother 2014; 10(9):2543-50; PMID:25483472; http://dx.doi.org/10.4161/21645515.2014.969618
- Ueda Y, Enomoto T, Sekine M, Egawa-Takata T, Morimoto A, Kimura T. Japan's failure to vaccinate girls against human papillomavirus. Am J Obstet Gynecol 2015; 212(3):405-6; PMID:25434842; http://dx.doi.org/10.1016/j.ajog.2014.11.037
- Hanley SJ, Yoshioka E, Ito Y, Kishi R. HPV vaccination crisis in Japan. Lancet 2015; 385(9987):2571; PMID:26122153; http://dx.doi.org/10.1016/S0140-6736(15)61152-7
- Tanaka Y, Ueda Y, Egawa-Takata T, Yagi A, Yoshino K, Kimura T. Outcomes for girls without HPV vaccination in Japan. Lancet Oncol 2016; 17(7):868-9; PMID:27396634; http://dx.doi.org/10.1016/S1470-2045(16)00147-9
- Yagi A, Ueda Y, Egawa-Takata T, Tanaka Y, Morimoto A, Terai Y, Ohmichi M, Ichimura T, Sumi T, Murata H, et al. Development of an efficient strategy to improve HPV immunization coverage in Japan. BMC Public Health 2016; 16(1):1013; PMID:27663658; http://dx.doi.org/10.1186/s12889-016-3676-7
- Van Damme P, Meijer CJ, Kieninger D, Schuyleman A, Thomas S, Luxembourg A, Baudin M. A phase III clinical study to compare the immunogenicity and safety of the 9-valent and quadrivalent HPV vaccines in men. Vaccine 2016; 34(35):4205-12; PMID:27354258; http://dx.doi.org/10.1016/j.vaccine.2016.06.056