Publication:

Single-dose versus multiple-dose HPV vaccination for prevention of cervical cancer: a systematic review and meta-analysis

Cervical cancer remains a major global burden, especially in low- and middle-income countries (LMICs). Although HPV vaccination is a key preventive strategy, multi-dose schedules pose cost and logistical challenges. This review assessed whether single-dose HPV vaccination offers protection comparable to multi-dose regimens. Following PRISMA guidelines, we searched PubMed, Cochrane, Scopus, and Google Scholar (2000-2025) for RCTs, cohort studies, and case-control studies comparing single-dose with two- or three-dose HPV vaccination. Outcomes included persistent HPV infection, high-grade cervical lesions (CIN2/3, HSIL), and immunogenicity. Random-effects models were used to calculate risk ratios (RRs), and heterogeneity was assessed with I². Twenty-six studies were included (10 RCTs, 16 observational), involving females aged 9-26 years from multiple countries. Sample sizes ranged from 200 to 590,083, with follow-up of 1-16 years. Single-dose vaccination showed >90% efficacy against persistent HPV16/18 infection. Compared with unvaccinated controls, the pooled estimate showed no statistically significant difference (RR 1.05, 95% CI 0.73-1.52). Compared with two-dose schedules, no statistically significant difference was observed (RR 0.72, 95% CI 0.40-1.32). Similarly, comparison with multiple-dose schedules showed no statistically significant difference (RR 0.93, 95% CI 0.60-1.44). Seropositivity remained high at 16 years (98.8-99.4%). Heterogeneity was substantial (I² 93.6-96.8%). Single-dose HPV vaccination provides substantial, durable protection comparable to multi-dose regimens in most settings. These findings support WHO’s recommendation and reinforce single-dose vaccination as a practical, cost-effective strategy to expand coverage and accelerate cervical cancer elimination in LMICs.