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Vaccine. 2018 Apr 25;36(18):2411-2416. doi: 10.1016/j.vaccine.2018.03.054. Epub 2018 Mar 27.

Human papillomavirus vaccination coverage in Luxembourg - Implications of lowering and restricting target age groups.

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Epidemiology and Microbial Genomics, Laboratoire National de Santé, 1 rue Louis Rech, L-3555 Dudelange, Luxembourg. Electronic address:
Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Rue Juliette Wytsman 14, 1050 Ixelles, Belgium.
Department of Obstetrics and Gynecology, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
Epidemiology and Microbial Genomics, Laboratoire National de Santé, 1 rue Louis Rech, L-3555 Dudelange, Luxembourg.



In Luxembourg, a national Human Papillomavirus (HPV) vaccination programme was introduced in 2008, targeting 12-17 year old girls offering a choice of bivalent or quadrivalent vaccine free of charge. In 2015, the programme was changed offering the bivalent vaccine only to 11-13 year old girls. The aim of this study was to evaluate the HPV vaccination coverage, to assess the impact of age target changes and compare vaccination coverage to other European countries.


Anonymous HPV vaccination records consisting of individual vaccine doses obtained free of charge in pharmacies between 2008 and 2016 were extracted from the Luxembourgish Social Security database. Additional aggregate tables by nationality and municipality were analysed.


Of the target cohort of 39,610 girls born between 1991 and 2003 residing in Luxembourg, 24,550 (62.0%) subjects obtained at least one dose, 22,082 (55.7%) obtained at least two doses, and 17,197 (43.4%) obtained three doses of HPV vaccine. The mean age at first dose was 13.7 years during 2008-14 and 12.7 years in 2016 after the age target change. Coverage varied significantly by nationality (p < 0.0001): Portuguese (80%), former Yugoslavs (74%), Luxembourgish (54%), Belgian (52%), German (47%), French (39%) and other nationalities (51%). Coverage varied also by geographical region, with lower rates (<50%) noted in some Northern and Central areas of Luxembourg (range: 38% to 78%).


Overall HPV vaccination coverage in Luxembourg is moderate and varied by nationality and region. The policy changes in 2015 did not have a substantial impact except lowering age at initiating vaccination. Options to improve coverage deserve further investigation.


Bivalent vaccine; Cervical cancer; HPV vaccine; Human papillomavirus; Quadrivalent vaccine; Vaccination coverage

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