Introduction of single dose Gardasil® Quadrivalent Human Papillomavirus vaccine in the Routine Immunization Schedule: Recommendation of the Tanzania Immunization Technical Advisory Group

Background: The Human Papillomavirus (HPV) is linked to different types of cancer, with cervical cancer as the most common HPV-related cancer. One of the most efficient strategies for control is vaccination against HPV infection in pre-adolescent girls. Tanzania introduced a two-dose vaccination schedule for girls from 9 to 14 years of age. However, ongoing studies have shown that a single-dose schedule may be efficient to prevent HPV infection and related morbidities with a relatively low cost. Therefore, this review aimed to assess if a single-dose HPV Gardasil® (quadrivalent) vaccine can be recommended to adolescent girls aged 9-14 years old in Tanzania and its cost and programmatical implication. Methods: The Tanzania Immunization Technical Advisory Group (TITAG) held its meeting in February 2023 in Mwanza and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to evaluate available evidence regarding safety, efficacy, cost-effectiveness, and programmatic implications of introducing a single-dose HPV Gardasil® (quadrivalent) vaccine in the target group. Results and recommendations: Available evidence assessed and demonstrated that a single-dose HPV Gardasil® (quadrivalent) vaccine is safe and effective in preventing HPV infection and is cost-effective compared to multiple dose schedules. Therefore, TITAG recommended that a single-dose HPV Gardasil® (quadrivalent) vaccine schedule should be introduced in Tanzania. In addition, continuous surveillance for HPV serotypes and related cancer incidence should be closely monitored..