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Vaccine. 2020 Feb 5;38(6):1315-1331. doi: 10.1016/j.vaccine.2019.11.081. Epub 2019 Dec 10.

Human papillomavirus vaccination coverage, policies, and practical implementation across Europe.

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Université de Lorraine, Apemac, F-54000 Nancy, France.
Université de Lorraine, Apemac, F-54000 Nancy, France; CHRU Nancy, Université de Lorraine, Plateforme d'Aide à la Recherche Clinique, F-54000 Nancy, France.
European Centre for Disease Prevention and Control, Sweden.
Université de Lorraine, Apemac, F-54000 Nancy, France; Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France.
Université de Lorraine, Apemac, F-54000 Nancy, France; CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, F-54000 Nancy, France. Electronic address:



Our objectives were to describe Human Papillomavirus vaccination coverage rates (HPV-VCR), policies, and practical steps for programme implementation that may be linked to high uptake in the population targeted by routine programmes across 30 European Union/European Economic Area Member States and Switzerland.


Information from institutional websites and from articles indexed in Medline between 01/2006 and 01/2017 was reviewed and extracted using a standardised form. In 12/2017, a cross-sectional survey was administered to national experts, in order to update the compiled information.


Data were available in 31 countries, and validated by national experts in 28 of them. National vaccination programmes targeted girls 9-15 years of age in 30 countries and boys in 11 countries. HPV-VCR in girls was monitored in 25 countries: VCR was reported ≥71%(high) in ten countries, 51-70% in seven, 31-50% in four, and ≤30%(very low) in four. In high VCR countries, HPV vaccination was mainly delivered through school health services, and invitation and reminders to attend for vaccination were used. In areas with very low VCR, vaccination tended to be opportunistic and no reminders were used.


According to our findings, school delivery within structured vaccination programmes and the use of reminders tended to be associated with highest HPV-VCR.


European Union; Human papillomavirus vaccination; Systematic review; Vaccination coverage rate; Vaccination strategies

Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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