The grades of recommendations (A-E and L) and levels of evidence (I, II-1, II-2, II-3, and III) are defined at the end of the "Major Recommendations" field.
- Government agencies should advocate for public funding to evaluate the cost-benefit analyses reported thus far for the human papillomavirus (HPV) vaccines. IIIA
- Additional sensitivity analyses of HPV vaccines should be done urgently, along with examination of the cost-effectiveness of male vaccination in alternative strategies, such as with different ages at vaccination and with catch-up vaccination. IIIA
- HPV vaccination is recommended for females aged 9 to 26 years against high-risk HPV types 16 and 18 for prevention of cervical cancer. IA
- HPV vaccination is recommended for females aged 9 to 26 against low-risk HPV types 6 and 11 for prevention of external genital warts. IA
Definitions:
Levels of Evidence*
I: Evidence obtained from at least one properly designed randomized controlled trial.
II-1: Evidence obtained from well-designed controlled trials without randomization.
II-2: Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.
II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
*The quality of evidence reported in these guidelines has been adapted from The Evaluation of Evidence criteria described in the Canadian Task Force on Preventive Health Care.
Grades of Recommendations* †
A. There is good evidence to recommend the clinical preventive action
B. There is fair evidence to recommend the clinical preventive action
C. The existing evidence is conflicting and does not allow to make a recommendation for or against use of the clinical preventive action; however, other factors may influence decision-making
D. There is fair evidence to recommend against the clinical preventive action
E. There is good evidence to recommend against the clinical preventive action
L. There is insufficient evidence (in quantity or quality) to make a recommendation; however, other factors may influence decision-making
* Woolf SH, Battista RN, Angerson GM, Logan AG, Eel W. Canadian Task Force on Preventive Health Care. New grades for recommendations from the Canadian Task Force on Preventive Health Care. Can Med Assoc J 2003;169(3):207-8.
† Recommendations included in these guidelines have been adapted from the Classification of Recommendations criteria described in the Canadian Task Force on Preventive Health Care.