Доктор ахборотномаси № 4 (101)—2021
23
N. N. Zakhirova, M. N. Tillyashaykhov,...
DOI: 10.38095/2181-466X-20211014-23-28 УДК 618.146-006.52-053.6:615.37(575.1)
EXPERIENCE OF THE NATIONAL VACCINATION PROGRAM IMPLEMENTATION
AGAINST HUMAN PAPILLOMA VIRUS IN THE REPUBLIC OF UZBEKISTAN
N. N. Zakhirova, M. N. Tillyashaykhov, A. A. Adylkhodjaev, D. A. Nishanov,
O. M. Akhmedov, E. Z. Osmanova, V. A. Saydakhmedova
Republican specialized scientific and practical medical center of oncology and radiology,
Tashkent, Uzbekistan
Key words:
vaccination, cervical cancer, primary prevention, human papillomavirus.
Таянч сўзлар:
эмлаш, бачадон бўйни саратони, бирламчи профилактика, инсон папиллома вируси.
Ключевые слова:
вакцинация, рак шейки матки, первичная профилактика, вирус папилломы человека.
Introduction.
Cervical cancer is one of the most serious threats to women's health. This is the fourth most
common cancer in women around the world. According to the forecasts of international experts (taking into account
population growth and an increase of life span expectancy), the increase in the incidence and prevalence of cervical
cancer will have made up 40% in developing countries and in economically developed countries - 11% by 2020. In the
case of non-conducting timely measures for the prevention and treatment of cervical cancer, malignant neoplasms of
the cervix will affect up to 1 million women annually after 2050 in the world.
Aim of the study
is primary prevention
of cervical cancer by introducing vaccination to 9 years old girls of the Republic of Uzbekistan.
Material and meth-
ods.
The Gardasil MK vaccine was imported to the Republic of Uzbekistan in 2019. From October 21 to November
30, 2019, the first dose was vaccinated to 9 years old girls in the republic; the introduction of the 2nd dose is planned
in 6 months.
Results and discussion.
Vaccination rates significantly increased after the measures taken on November
30: in the city of Tashkent - 97%, in the Tashkent region - 90.8%, in Bukhara - 90.2%. Refusers made up 66.9% of
unvaccinated girls. Temporary left who also did not receive vaccination made up 360 (4%). 1935 girls were not vac-
cinated by other reasons and they made up 21.4% of the total unvaccinated population.
Conclusion.
As a result of
joint efforts by the Government of the Republic of Uzbekistan, the Ministry of Health with the support of international
organizations from WHO and UNICEF, the first dose of the tetravalent HPV vaccine - Gardasil MK- was successfully
administered to 9 years old girls all over the country. According to the data of Health Ministry of the Republic of Uz-
bekistan no adverse reactions were observed in 292,867 girls after vaccination.
ЎЗБЕКИСТОН РЕСПУБЛИКAСИДA ОДAМ ПAПИЛЛОМA ВИРУСИГA ҚAРШИ ЭМЛAШ МИЛЛИЙ
ДAСТУРИ ТAЖРИБAСИ
Н. Н. Заҳирова, М. Н. Тиллашайхов, A. A. Aдилхўжаев, О. М. Aҳмедов, Д. А. Нишанов,
Э. З. Османова, В. A. Сайдахмедова
Республика ихтисослаштирилган онкология ва радиология илмий амалий тиббиѐт маркази,
Тошкент, Ўзбекистон
Кириш.
Бачадон бўйни саратони аѐллар саломатлиги учун энг жиддий таҳдидлардан биридир. Бу дунѐ
бўйлаб аѐлларда тўртинчи энг кенг тарқалган саратон ҳисобланади. Ҳалқаро экспертларнинг 2020-йилги про-
гнозларига кўра (аҳоли сонининг ўсиши ва умр кўриш давомийлигининг ошиши ҳисобга олинган ҳолда) риво-
жланаѐтган мамлакатларда бачадон бўйни саратони билан касалланиш ва тарқалишининг ўсиши 40 фоизни,
иқтисодий ривожланган мамлакатларда эса 11 фоизни ташкил қилади. Бачадон бўйни саратонининг олдини
олиш ва даволаш бўйича ўз вақтида чоралар кўрилмаса, бачадон бўйни саратони 2050 йилдан кейин дунѐ бўй-
лаб ҳар йили 1 миллион аѐлда касаллик келтириб чикаради.
Тадқиқот мақсади.
Ўзбекистон Республикаси-
нинг 9 ѐшли қизларини эмлаш орқали бачадон бўйни саратонининг бирламчи профилактикаси ҳисобланади.
Материаллар ва усуллар.
Гардасил МК ваксинаси Ўзбекистон Республикасига 2019-йилда олиб келинган.
2019-йилнинг 21-октабрдан 30-ноябрига қадар Республикада 9 ѐшли қизларга биринчи доза эмланди; 2-доза 6
ой ичида режалаштирилган.
Натижалар ва муҳокама.
30 ноябрь куни амалга оширилган чора-тадбирлардан
сўнг эмлаш кўрсаткичлари сезиларли даражада ошди: Тошкент шаҳрида – 97%, Тошкент вилоятида – 90,8%,
Бухорода – 90,2%. Эмлашдан бош тортганлар эмланмаган қизларнинг 66,9%ни ташкил қилади. Вақтинчалик
ташлаб кетилганлар, шунингдек, эмланмаганлар 360 (4%) ни ташкил қилади. 1935 нафар қиз бошқа сабабларга
кўра эмланмаган ва умумий эмланмаган аҳолининг 21,4%ни ташкил қилади.
Хулоса.
Ўзбекистон Республика-
си Ҳукумати, Соғлиқни сақлаш вазирлиги, ЖССТ ва ЮНИСЕФ ҳалқаро ташкилотлари кўмагида биргаликдаги
саъй-ҳаракатлари натижасида ИПВ га қарши тўрт валентли вакцина – Гардасил МКнинг биринчи дозаси
мамлакат буйлаб 9 ѐшли қизларда муваффақиятли эмланди. Ўзбекистон Республикаси Соғлиқни Сақлаш ва-
зирлиги маълумотларига кўра, 292 867 нафар қиз болада эмлашдан сўнг ножўя реакциялар кузатилмаган.
Доктор ахборотномаси № 4 (101)—2021
24
Introduction.
Cervical cancer is one of the most serious threats to women's health. This is
the fourth most common cancer in women around the world. According to WHO data, around
600,000 newly diagnosed cases and more than 300,000 death cases from cervical cancer in the
world were recorded in 2019 (WHO guidelines). According to the forecasts of international ex-
perts (taking into account population growth and an increase of life span expectancy), the increase
in the incidence and prevalence of cervical cancer will have made up 40% in developing countries
and in economically developed countries - 11% by 2020. In the case of non-conducting timely
measures for the prevention and treatment of cervical cancer, malignant neoplasms of the cervix
will affect up to 1 million women annually after 2050 in the world [1,5,8].
Indicators of morbidity and mortality from cervical cancer are also unpromising in the Re-
public of Uzbekistan. The frequency of cervical cancer advanced forms (stage III-IV) remains
high, making up 45.3%. 5-year survival at stage III is 30-35%, at stage IV - only 5-7%. In 2018,
the number of initially diagnosed cases of cervical cancer was 1,600 cases, and more than 800 pa-
tients died from this disease. Below are the intensive indicators of the morbidity rate per 100 thou-
sand population in Uzbekistan.
Recent epidemiological studies have shown that cervical cancer is caused by oncogenic
types of human papillomavirus (HPV). Two oncogenic types of HPV that most often cause cervi-
cal cancer are types 16 and 18. They together cause approximately 70% of cervical cancer cases in
all countries of the world, in other cases the etiological role of the cervical cancer development
belongs to other serotypes of viruses [7]. HPV 16 in 41-54% of cases causes the t cervical cancer
development [10]. Cervical cancer does not occur in the absence of the virus. The development of
the disease is slow, so it is detected after decades [9]. In 2008 the Nobel Committee awarded a
prize in physiology and medicine for the discovery of viruses that annually take millions of human
lives. Half of the prize was awarded to Harald zur Hausen "for the discovery of human papilloma-
viruses that cause cervical cancer", the other half – to Francoise Barre-Sinoussi and Luc Monta-
gnier "for the discovery of the human immunodeficiency virus" [4]. Currently, two vaccines are
approved for the prevention of oncogenic types of HPV infection in most countries. Vaccines con-
tain virus-like particles - the papilloma virus (PV), similar in shape with the human papilloma vi-
rus. As far as vaccines consisting of PV do not contain the virus, they cannot cause infection. Vac-
Оригинальная статья
ОПЫТ РЕАЛИЗАЦИИ НАЦИОНАЛЬНОЙ ПРОГРАММЫ ВАКЦИНАЦИИ ПРОТИВ ВИРУСА
ПАПИЛЛОМЫ ЧЕЛОВЕКА В РЕСПУБЛИКЕ УЗБЕКИСТАН
Н. Н. Захирова, М. Н. Тиллашайхов, A. A. Aдилхужаев, О. М. Aхмедов, Д. А. Нишанов,
Э. З. Османова, В. A. Сайдахмедова
Республиканский специализированный научно-практический
медицинский центр онкологии и радиологии, Ташкент, Узбекистан
Введение.
Рак шейки матки представляет одну из серьезнейших угроз здоровью женщин. Это четвер-
тый по распространенности вид рака у женщин всего мира. Согласно оценкам ВОЗ, в мире в 2019 году было
зарегистрировано около 600 000 вновь выявленных случаев и более 300 000 случаев смерти от рака шейки
матки (руководство ВОЗ). По прогнозам международных экспертов (с учетом роста населения и увеличения
ожидаемой продолжительности жизни), к 2020 году в развивающихся странах рост заболеваемости и распро-
страненности РШМ составит 40%, а в экономически развитых странах – 11%. В случае не проведения своевре-
менных мероприятий по профилактике и лечению РШМ, после 2050 года ежегодно в мире злокачественными
новообразованиями шейки матки будут заболевать до 1 млн. женщин.
Цель исследования
- Первичная про-
филактика рака шейки матки, путем внедрения вакцинации 9 летним девочкам Республики Узбекистан.
Мате-
риал и методы.
Вакцина Гардасил МК была ввезена в Республику Узбекистан в 2019 году. С 21 октября по 30
ноября 2019 года в Республике проведена вакцинация 1 дозы 9-летним девочкам; введение 2-й дозы заплани-
ровано через 6 месяцев.
Результаты и обсуждение.
После проведенных мероприятий 30 ноября показатели
вакцинации заметно увеличились: в городе Ташкенте - 97%, в Ташкентской области - 90,8%, в Бухаре - 90,2%.
Отказавшиеся от вакцинации составили 66,9% непривитых девушек. Временно выбывшим, которым также не
произведена вакцинация составили 360 (4%). По другим разным причинам не вакцинированы 1935 девочек,
что составило 21,4% из числа всего невакцинированного контингента.
Заключение.
В результате совместных
усилий со стороны Правительства Республики Узбекистан, Министерства здравоохранения при поддержке
международных организаций ВОЗ и ЮНИСЕФ успешно осуществлено введение первой дозы четырехвалент-
ной вакцины против ВПЧ - Гардасил МК- была 9 летним девочкам по всей Республике. По данным Минздрава
Республики Узбекистан, после вакцинации у 292 867 девочек никаких побочных реакций не наблюдалось.
Доктор ахборотномаси № 4 (101)—2021
25
cines stimulate the production of antibodies to PV, which, due to their similarity with HPV, will
prevent the infection caused by HPV in contact with it in the future [2,3]. Vaccines are highly safe
and can be prescribed along with other vaccines that do not contain live pathogens [6].
There are proven and effective strategies for cervical cancer at all stages of the continuum of
medical care in world practice. The first step in this strategy is vaccination against human papillo-
mavirus (HPV) which in 95-98% of cases is the cause of cervical cancer. The WHO Director-
General has called for action to eliminate cervical cancer in May, 2018. Partners and countries
should work over an increase of access to three main measures for cervical cancer prevention -
HPV vaccination, screening and treatment of precancerous conditions and increase of their cover-
age rates. Uzbekistan is one of six pilot countries in the framework of the United Nations Joint
Global Program for the Prevention and Control of Cervical Cancer. The goal of this program is to
join the efforts of all seven participating UN organizations to work with the government and other
partners in order to promote the development and implementation of a sustainable, comprehensive
and high-quality national cervical cancer program that provides women with equal access to ser-
vices and information. The joint program aims to eliminate cervical cancer at a global level. A na-
tional action plan for 2020-2025 was developed for accelerating the implementation of this pro-
gram and ensure its effectiveness in the country.
Aim of the study
is primary prevention of cervical cancer by introducing vaccination to 9
years old girls of the Republic of Uzbekistan.
Material and methods.
In 2015, by the Order of the Government of the Republic of Uzbek-
istan, with the support of GAVI, WHO, UNICEF and the Ministry of Health, the national vaccina-
tion schedule included the HPV vaccination for girls aged 9–13 years produced by MerckSharp &
Dohme (sometimes called MSD or Merck, USA), which received a license for use in 2006. This
vaccine is tetravalent and protects against 4 types of HPV– 6,11,16,18. The Gardasil MK vaccine
was imported to the Republic of Uzbekistan in 2019. From October 21 to November 30, 2019, the
first dose was vaccinated to 9 years old girls in the republic; the introduction of the 2nd dose is
planned in 6 months. A total number of 9 years old girls in the republic is 292617 (100%). Results
and discussion
The vaccination process was carried out from October 21 to November 30, 2019. Preparation
for vaccination was started in March 2019 by the Ministry of Health with the assistance of interna-
tional organizations WHO, UNICEF, leaders of the working group (obstetrician-gynecologists,
epidemiologists, general practitioners, oncologists). Preparatory activities included the following:
creating videos, information brochures, flyers, manuals for doctors, parents and carers in Russian
and Uzbek; organization of conferences and seminars with the participation of European experts in
the field of vaccination; performances in the media and in social networks. Also, by the UNICEF
initiative, a video was created in Uzbek and Russian about cervical cancer, with the participation
of leading oncologists of the republic. The video began to be shown a week before vaccination be-
gan on several TV channels, in public transport (metro, buses) for a month. Vaccination was car-
ried out in family polyclinics and medical centers of secondary schools, in the presence of the par-
ents of the vaccinated girls, a general practitioner and an epidemiologist. The vaccination was per-
formed by a specially trained, licensed vaccine nurse.
Vaccination coverage by regions (absolute number /%): Autonomous Republic of Kara-
kalpakstan - 15616 (93.4%); Kharezm region - 16507 (99%); Ferghana region - 30829 (95.4%);
Tashkent region - 20582 (90.2%); Syrdarya region - 6499 (92.4%); Surkhandarya region - 23501
(97.6%); Samarkand region - 35065 (98.1%); Namangan region - 22332 (95.8%); Navoi region -
7629 (92.4%); Kashkadarya region - 28235 (96%); Jizzakh region - 12345 (98%); Bukhara region
- 14175 (90.8%); Andijan region - 26549 (96.2%) and Tashkent city - 19772 (97%) (Tab.1). The
analysis of the table showed that the largest number of 9 years old girls in the Samarkand region
was 35748, the smallest one was in the Syrdarya (7008), and vaccination coverage in these regions
was 98.1% and 95%, respectively. The highest vaccination coverage was observed in the Kharezm
region - 99%, the smaller - 93.9% in the Tashkent region and the Autonomous Republic of Kara-
N. N. Zakhirova, M. N. Tillyashaykhov,...
Доктор ахборотномаси № 4 (101)—2021
26
Table 1.
Vaccination coverage in Uzbekistan
kalpakstan. Despite the fact that the Autonomous Republic of Karakalpakia and the Kharezm re-
gion are geographically distant, vaccination activity was quite high, as the specialists involved in
vaccination were trained and certified by the Ministry of Health and WHO experts.
When studying the dynamics of vaccination coverage, the smallest number of vaccinated
girls was observed in the capital of the Uzbekistan, the city of Tashkent, where coverage was 28%,
in Bukhara and Tashkent regions coverage was lower than in other regions - 71.9% and 74.5%,
respectively. The main reason for this situation in the capital was the spread by social networks
unreasonable audio and video messages about the side effects of HPV vaccination which lead to
infertility, allergic reactions, up to the death, that this event is aimed at the destruction or genocide
of the nation and etc. a week before the vaccination began. In connection with the above situation,
working groups consisting of epidemiologists, gynecologists, oncologists were created, who, ac-
cording to the approved schedule, visited all schools in Tashkent, gave lectures, made presenta-
tions refuting false Internet messages. The Ministry of Health of the Republic of Uzbekistan,
UNICEF and WHO actively participated in the coordination of the working groups.
When analyzing the dynamics of the vaccination process, there was a tendency to an in-
crease in the number of vaccinated girls (Fig. 1).
Vaccination rates significantly increased after the measures taken on November 30: in the
city of Tashkent - 97%, in the Tashkent region - 90.8%, in Bukhara - 90.2%. It should be noted
that adverse reactions were not observed after vaccination. Despite the carried out organizational,
sanitary and educational measures, 9043 (3.1%) girls were not vaccinated for several reasons. The
main reason was the refusal of parents to vaccinate, despite repeated explanatory discussions about
the need for vaccination. The refusal was reasoned by the disagreement of father, grandmother,
grandfather and other relatives, religious affiliation, etc. The largest number of refusing was ob-
served in Kashkadarya region - 1166, in Tashkent region - 1114 and the Republic of Karakalpak-
stan - 914. In the Namangan region 868 girls also refused vaccination. Refusers made up 66.9% of
unvaccinated girls. The next reason was medical challenge for one reason or another; the total
number of medical challenges in the republic was 702 (7.7%): girls with acute inflammatory and
respiratory diseases, exacerbation of chronic diseases, the presence of an allergic reaction at the
time of vaccination, etc. However, after the condition improves, the girls will be vaccinated (Fig.
2).
Temporary left who also did not receive vaccination made up 360 (4%). 1935 girls were not
vaccinated by other reasons and they made up 21.4% of the total unvaccinated population.
Оригинальная статья
Administrative
territories
Contingent to be vaccinated
n=292617
Vaccinated
n=283574
%
Tashkent city
20775
20367
98.0
Andijan region
27359
26782
97.9
Bukhara region
15619
15288
97.8
Djizzak rigion
12592
12350
98.1
Kashkadarya region
29401
28235
96.0
Navoi region
8253
8024
97.2
Namangan region
23305
22332
95.8
Samarkand region
35748
35069
98.1
Surkhandarya region
24075
23599
98.0
Syrdarya region
7008
6660
95.0
Tashkent region
22815
21423
93.9
Fergana region
32329
31281
96.8
Kharezm region
16669
16507
99.0
Republic of Karakalpakstan
16761
15657
93.4
Total
96.9
Доктор ахборотномаси № 4 (101)—2021
27
Conclusion.
Our experience with HPV vaccination has shown that more attention should be
paid to educational work (social videos, audio messages, meetings in the media, in magazines,
newspapers, etc.), on TV and in social networks a few months earlier than planned vaccination,
organize lectures, presentations in schools, polyclinics 2-3 months before the planned vaccination,
with the mandatory participation of leading experts in the field of epidemiology, virology, gyne-
cology and oncology. Also, a comprehensive action plan should be drawn up before, during and
after vaccination with the involvement of experts from international organizations with sufficient
experience in conducting such large-scale events.
As a result of joint efforts by the Government of the Republic of Uzbekistan, the Ministry of
Health with the support of international organizations from WHO and UNICEF, the first dose of
the tetravalent HPV vaccine - Gardasil MK- was successfully administered to 9 years old girls all
Fig. 3. The reasons of non-vaccination.
Fig. 1. The dynamics of the vaccination process in Uzbekistan.
N. N. Zakhirova, M. N. Tillyashaykhov,...
Доктор ахборотномаси № 4 (101)—2021
28
over the country. According to the data of Health Ministry of the Republic of Uzbekistan no ad-
verse reactions were observed in 292,867 girls after vaccination.
References:
1. A comprehensive fight against cervical cancer. WHO practice guidelines. Second Edition. Chapter 4., 2017.- P.
119-141.
2. Baseman and Koutsky, 2005; Cohen, 2005.
3. Garcia M. Global cancer Facts and Figures 2007. – Atlanta, GA: American Cancer Society, 2007.
4. Kaprin A.D., Novikova E.G., Trushina O.I., Gretsova O.P. Cervical Cancer Screening - Unresolved Issues // Re-
search and Practice in Medicine. - 2015. - Vol.2, No. 1. - P. 36-41.
5. Kartoglu U, Ozguler NK, Wolfson LJ, Kurzatkowski W. Validation of the shake test for detecting freeze damage
to adsorbed vaccines. Bull World Health Organ. 2010;88:624–31.
6. Method for evaluating new vaccines after implementation. Geneva; WHO; 2010 WHO Information Note: Integrat-
ed Cervical Cancer Prevention and Control - A Healthy Future for Girls and Women. Geneva: WHO; 2013.
7. Noel et al., 2001; Baseman and Koutsky, 2005.
8. Novikova EG, Kaprin A.D., Trushina O.I. Oncogynecologist's view oncervical cancer screening // Russian Bulle-
tin of the Obstetrician-Gynecologist. - 2014. - No. 5. - P. 39-43.
9. Science and life, No. 11, 2008
10. WHO-UNICEF Integrated Multi-Year Planning Guide for Immunization. Geneva: WHO; 2014.
Оригинальная статья
