The Clinical Effectiveness of Single-Dose Human Papillomavirus Vaccination

Abstract

The human papillomavirus (HPV) vaccine was initially approved for a three-dose regimen. Due to resource limitations, budget constraints, low acceptance, and poor adherence, global vaccination coverage is only 15%. A single-dose regimen could simplify logistics, reduce costs, and improve accessibility. However, its clinical effectiveness remains debatable. This review systematically searched PubMed, Embase, and Cochrane Library, including 42 clinical studies, to assess the effectiveness of a single-dose HPV vaccination for preventing HPV infections, cervical abnormalities, and genital warts. We summarized the effectiveness of bivalent, quadrivalent, and nonavalent vaccines across different age groups and buffer periods, and analyzed the factors contributing to the inconsistency of results. The review also provides insights into designing robust future research to inform single-dose HPV vaccination policies and guidelines, highlighting the need for further research to refine vaccination strategies.

Keywords: dose; effectiveness; human papillomavirus; vaccine.

Figure 1

Flow diagram of study selection process.

Figure 2

Effectiveness of varying doses of bivalent, quadrivalent, and nonavalent HPV vaccines in protecting women against HPV 16/18 infection [13,17,21,22,27,32,33,43,49,50,51,53]. Purple square: 3 dose vs. 0 dose; blue square: 2 doses vs. 0 dose; red square: 1 dose vs. 0 dose. ^a The risk ratio encompasses various measures depending on the study, including risk ratio, hazard ratio, prevalence ratio, or odds ratio. The risk ratio for Sankaranarayanan 2018 and Safaeian 2018 was not provided in the original texts and was calculated based on sample sizes. Other risk ratios in the figure were extracted directly from the original articles. If the original articles did not include available data for all age groups, they were excluded from this figure.

Figure 3

Effectiveness of varying doses of quadrivalent HPV vaccine in protecting women against HPV 6/11/16/18 infection. Purple square: 3 dose vs. 0 dose; blue square: 2 doses vs. 0 dose; red square: 1 dose vs. 0 dose [39,44,49]. ^a The risk ratio encompasses various measures depending on the study, including risk ratio, prevalence ratio, or hazard ratio. The risk ratio for Sonawane 2019 was not provided in the original texts and was calculated based on sample sizes. Other risk ratios in the figure were extracted directly from the original articles. If the original articles did not include available data for all age groups, they were excluded from this figure.

Figure 4

Effectiveness of varying doses of bivalent, quadrivalent, and nonavalent HPV vaccines in protecting women against HPV 31/33/35 infection. Purple square: 3 dose vs. 0 dose; blue square: 2 doses vs. 0 dose; red square: 1 dose vs. 0 dose [17,21,22,27,32,33,39,40,49,51]. ^a The risk ratio encompasses various measures depending on the study, including risk ratio, prevalence ratio, hazard ratio, or odds ratio. The risk ratio for Sankaranarayanan 2018, Sonawane 2019, and Safaeian 2018 was not provided in the original texts and was calculated based on sample sizes. Other risk ratios in the figure were extracted directly from the original articles. If the original articles did not include available data for all age groups, they were excluded from this figure.

Figure 5

Effectiveness of varying doses of bivalent and quadrivalent HPV vaccines in protecting women against CIN3+ [11,14,18,34,37,38,46]. Purple square: 3 doses vs. 0 dose; blue square: 2 doses vs. 0 dose; red square: 1 dose vs. 0 dose. ^a The risk ratio encompasses various measures depending on the study, including hazard ratio, risk ratio, incidence rate ratio, or odds ratio. The risk ratio in the figure was extracted directly from the original articles. If the original articles did not include available data for all age groups, they were excluded from this figure.

Figure 6

Effectiveness of varying doses of bivalent and quadrivalent HPV vaccines in protecting women against CIN2+. Purple square: 3 doses vs. 0 dose; blue square: 2 doses vs. 0 dose; red square: 1 dose vs. 0 dose [11,14,15,18,34,37,38,42,46]. ^a The risk ratio encompasses various measures depending on the study, including hazard ratio, odds ratio, risk ratio, or incidence rate ratio. The risk ratio in the figure was extracted directly from the original articles. If the original articles did not include available data for all age groups, they were excluded from this figure.

Figure 7

Effectiveness of varying doses of bivalent and quadrivalent HPV vaccines in protecting women against cytological high-grade abnormalities [11,14,24,38]. Purple square: 3 doses vs. 0 dose; blue square: 2 doses vs. 0 dose; red square: 1 dose vs. 0 dose. ^a The risk ratio encompasses various measures depending on the study, including hazard ratio or odds ratio. The risk ratio in the figure was extracted directly from the original articles. If the original articles did not include available data for all age groups, they were excluded from this figure.

Figure 8

Effectiveness of varying doses of bivalent and quadrivalent HPV vaccines in protecting women against cytological low-grade abnormalities [11,14,24,38,47]. Purple square: 3 doses vs. 0 dose; blue square: 2 doses vs. 0 dose; red square: 1 dose vs. 0 dose. ^a The risk ratio encompasses various measures depending on the study, including hazard ratio or odds ratio. The risk ratio in the figure was extracted directly from the original articles. If the original articles did not include available data for all age groups, they were excluded from this figure.

Figure 9

Effectiveness of varying doses of bivalent and quadrivalent HPV vaccines in preventing women against genital warts [16,20,28,31,53]. Purple square: 3 doses vs. 0 dose; blue square: 2 doses vs. 0 dose; red square: 1 dose vs. 0 dose. ^a The risk ratio encompasses various measures depending on the study, including incidence rate ratio, risk ratio, hazard ratio, or prevalence ratio. The risk ratio in the figure was extracted directly from the original articles. If the original articles did not include available data for all age groups, they were excluded from this figure.