Introduction of Gardasil HPV Vaccine in Sikkim's Routine Immunization Programme
Cervical cancer is a major health issue in Sikkim, India, prompting the introduction of the Gardasil HPV vaccine to address the high prevalence of HPV infections leading to cervical cancer. The state-wide immunization campaign targeted girls aged 9-14, aiming to incorporate the vaccine into the routine immunization programme. Challenges faced included limited cancer care facilities, low screening compliance, and costly referrals. The initiative, beginning in 2018, involved a mixed delivery strategy through schools and health facilities, procuring the vaccine through UNICEF at GAVI prices.
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Topic: Replicable Practices and Innovation in Public Health care system in India. Title: Human Papilloma Virus Vaccine, Gardasil, Introduction in the State of Sikkim and subsequent inclusion in Routine Immunization Programme of the State.
Introduction:Cervical cancer is the most common cancer in humans, the second most common cancer in women worldwide and the most common cause of death due to cancer in the developing countries. In India, cervical cancer contributes to approximately 6 29% of all cancers in women.
ETIOLOGY: Sexually transmitted human papilloma virus (HPV) infection is the most important risk factor for cervical intraepithelial neoplasia and invasive cervical cancer.[ At any given time, about 6.6% of women in the general population are estimated to harbour cervical HPV infection. HPV serotypes 16 and 18 account for nearly 76.7% of cervical cancer in India.
Rationale of HPV vaccination in Sikkim: In Sikkim, Ca Cervix is the 2nd leading cancer site among all cancer in women accounting for approximately 10% of all female cancer cases. As per PBCR, Sikkim report of 2015, total number of cancer cases in female was 217, out which 25 cases are cervical.
RATIONAL CONTD- Though the number of cases were small, major hurdles encountered were: Absence of reliable and comprehensive cancer care facilities and specialists in the state. Small number of cases in the state. Hence, creating extensive infrastructure within the state for a small population were not be cost effective. Compliance with cervical Pap smear screening was low. Patients come to treatment facilities when they are in an advanced stage Patients had to be referred to higher centres outside State causing huge economic burden to Families.
Hence, The need for a State-wide Immunization drive was felt. First to vaccinate girls of 9-14 years age group, and subsequently to incorporate HPV Vaccine in Routine Immunization (RI) programme of the State. Govt. of Sikkim introduced HPV vaccine in campaign mode from 30thJul 2018, free of cost, entirely from State Budget.
The vaccine was procured through UNICEF supply division at GAVI price. 1stdose of the vaccine was given to 9-14 years old girls of all Govt, Govt-aided and Private schools, including out-of-school girls of Sikkim. The Vaccine-Delivery Strategy was mixed one, That is, health-facility as well as school-based. The 1stround activities continued till 14thAug 2018. 2nddose was administered from 23rdApr 2019 to 4thMay 2019.
Human Resources: Existing HCWs and CHVs like ASHAs and AWWs were involved in the programme. Trainings and workshops were undertaken with the health care workers and vaccination teams involved. Principals and Nodal Teachers from each school were given sensitization training regarding HPV vaccine. Also, Parent Teacher Meetings were held to resolve any issues and allay apprehensions related to a new vaccine being introduced in the State. Media sensitization was done with Press Conferences, LED Displays at prominent places.
AWARENESS GENERATION ACTIVITIES: Media sensitization was done with Press Conferences, LED Displays at prominent places. Banners, leaflets and posters being displayed and handed out. Vaccine cards were distributed and advertisements were placed in local newspapers. Radio spots were booked on FM/AIR on HPV. Also, appeal was made by the HCM regarding the Vaccine.
A total of 1123 schools were covered during HPV vaccination drive. 97.85% of the beneficiaries were vaccinated in the 1stround and 97.81% in the 2ndround. Total number of doses administrated were 59,443. Total expenditure incurred was of Rs.3.92 Crore.
