The special nation-wide vaccination campaign against human papilloma virus (HPV), which causes cervical cancer, will be flagged off by Prime Minister Narendra Modi on February 28 from Rajasthan’s Ajmer. All 14-year-old girls and those who turn 15 during the following 90 days will be eligible to receive the shot, according to instructions provided by the union health ministry to all the states.
The decision to immunise girls is important considering persistent HPV infections lead to a majority of cervical cancer, which continues to be the second most common form of cancer in Indian women, affecting 1.25 lakh and killing 75,000 each year.
Vaccination points
The vaccines will be made available through nearly 30,000 immunisation centres across the country located in government health centres and hospitals. These are the centres that have a cold chain point, staff trained in giving the shots and facilities for managing any adverse reaction. The vaccine will be available on all days across these centres for the first 90 days of the campaign. Following this period, the vaccine will be available at the same centres on routine immunisation days, usually twice a week.
“An estimated 1% of a state’s population is considered to be in the eligible age group. Based on this calculation, all of the larger states have already been provided half of the required number of vaccine doses,” said Dr Amit Yadav, director, National Health Mission-Rajasthan, where the vaccination drive will be rolled out.
There are around 1,000 vaccination points across the state where the shots will be provided. And, the staff at these centres have already been trained in giving 0.5 ml shot on the left arm and managing any adverse events. He added that there was no additional challenge with storing the HPV vaccines as they have to be maintained at a 2-8 degree C temperature range, which is the common setting for most other vaccines under the government’s universal immunisation programme.
Awareness drive for maximum turnout
To encourage girls to come forward for vaccination, he said, awareness has been created through schools with the help of the education department.
Importantly, the health ministry has made it mandatory to seek consent from parents or guardians before giving the shot. The HPV vaccination would require an “opt-in” consent rather than “opt-out” method followed for all other childhood vaccines. For all other childhood vaccines delivered under the government’s routine immunisation programme, consent of guardians is assumed unless they say otherwise. This was the same method followed while introducing the Measles Rubella catch-up and routine immunisation in 2017.
For the HPV vaccination, however, guardians would have to provide their consent on the U-win app or on a hard copy in the absence of the internet, according to the guidelines provided by the health ministry to the state. During the 90 day intensive campaign, girls who receive the vaccine will be marked on the left index finger.
What are guidelines for eligibility, contraindications
Any 14-year-old girl — as per their date of birth — will be eligible to get the shots. Girls who turn 15 within the 90 campaign period will also be eligible for the shot, according to the health ministry guidelines.
The guidelines add that girls who have any moderate to severe illness should not be given the shot till they recover. Girls who have had an allergic reaction to a previous vaccination, or are allergic to yeast, should avoid getting vaccinated. Anyone who is outside the target age group or is pregnant should not be given the shot. And, girls who have already taken any of the HPV vaccines — Gardasil-4, Gardasil-9, Cervarix, or Cervavac — will not be eligible for a shot under the campaign. Their vaccination status will be updated on the U-win platform.
The guidelines also say that the vaccination centres should ensure that the girls are not empty stomach at the time of getting the shot, while advising parents to give them breakfast before taking them to the vaccination centre. The centres have also been advised to make arrangements for some refreshments on site so that a child who has missed a breakfast at home is also able to get the shot.
After immunisation, the children have to wait at the centre for 30 minutes to ensure they do not have any adverse reaction due to the vaccine. The guidelines urge the centre to arrange some engaging activity in the observation rooms “to distract girls from post-vaccination pain and anxiety.” The centres have also been asked to minimise crowding.
Girls can walk in or book their vaccination slots on government’s U-win vaccination management application.
The common reactions after HPV vaccination include local pain, redness, or swelling at the site of injection, fever, headache, tiredness, nausea, dizziness or fainting — with the last two being associated with the fear of getting a shot or empty stomach rather than the vaccine. These can all be managed through simple steps such as giving paracetamol, fluids, removing layers of clothing, or cold compress at the site of injection. All of this mostly resolves on its own within a couple of days.
Still, the centres are provided kits for managing anaphylaxis — a severe allergic reaction that can close the airway and even cause death if not treated immediately. The vaccination centres will also be linked to their nearest 24*7 health centre to ensure help is available whenever needed.
The decision to immunise girls is important considering persistent HPV infections lead to a majority of cervical cancer, which continues to be the second most common form of cancer in Indian women, affecting 1.25 lakh and killing 75,000 each year. (File Photo) 
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