Identification of subgroups in the Danish population for targeted human papillomavirus vaccination efforts

BackgroundIn the Danish childhood vaccination program, the human papillomavirus (HPV) vaccination coverage is lower than for other vaccines. To tailor a targeted HPV vaccination effort, we aimed to identify girls in Denmark with lower first dose HPV vaccination coverage than girls in general.MethodsA population-based retrospective cohort study was performed of girls born in 2001–2004, residing in Denmark in September 2019 (N = 128,351). Data from the Danish Vaccination Register was linked to sociodemographic data from the Danish Civil Registration System and Statistics Denmark. Cox's proportional hazard regression models were used to compare vaccination uptake rates between subgroups of girls.ResultsHPV vaccination coverage at 14 years of age varied widely by municipality (53.4–80.6%). Girls living with neither of their parents had a lower chance of being vaccinated compared to girls living with both their parents (HR 0.43; 95% CI 0.41–0.46), likewise for girls attending special need education compared with girls attending public schools (HR 0.50; 95% CI 0.42–0.59). The vaccination uptake among immigrants was lower compared to Danish-born girls (HR 0.51; 95% CI 0.49–0.54), especially among immigrant girls whose parents had not passed any Danish exams. Finally, girls who were DTaP-IPV revaccinated had a 50% greater chance of being HPV vaccinated compared to girls who were not (HR 1.61; 95% CI 1.58–1.64).ConclusionTo increase the HPV vaccination uptake, we recommend vaccination efforts targeting girls living without any of their parents, girls attending special need education, immigrants, and girls who are not DTaP-IPV revaccinated. When targeting immigrants, the effort should focus on disseminating sufficient and understandable information about the Danish childhood vaccination program to the parents.     

中国适龄女性乳腺癌筛查服务的可及性——筛查率及其构成分析

目的 分析中国适龄女性乳腺癌筛查率及其不同筛查服务类型的构成。方法 基于核心文献、相关官方网站、项目或调查报告等,摘录现有全国性调查中女性乳腺筛查率数据并进行整合分析,对40~69岁及35~64岁组筛查率进行标化和比较(用2010年普查人口结构)。检索乳腺癌筛查服务类型构成(组织性筛查、体检及机会性筛查)相关期刊文献,分析3种筛查服务类型的检出文献量、单篇筛查人数中位数等,并以其为权重估算筛查服务类型的构成比。结果 共查到6次全国性的乳腺癌筛查率相关报道,其中国家卫生服务调查2次(2013、2018年),中国CDC"慢性病监测系统"4次(调查起始年份分别为2010年、2013年以及2015年2次)。2015年中国40~69岁女性1年内、2年内和3年内的乳腺癌筛查率分别为16.9%、20.2%和21.4%。乳腺癌既往筛查率有所变化,40~69岁女性分别为2013年的21.1%和2015年的23.5%,35~64岁女性分别为23.3%和25.7%。选择2015年发表的期刊文献行综述分析,共纳入130篇,其中涉及组织性筛查、体检及机会性筛查的篇数分别占71.0%、23.7%和5.3%,估算2015年对应筛查类型个体服务量分别占总体的88.0%、11.2%和0.8%。结论 2015年中国适龄女性乳腺癌筛查率高于2013年,文献综述分析初步提示中国当下乳腺癌筛查服务类型以组织性筛查服务为主。     

Methodological changes implemented over time to support accurate and timely COVID-19 vaccine coverage estimates: Ontario,Canada

AbstractThe COVID-19 vaccination program implementation in Ontario, Canada has spanned multiple years and is ongoing. To meet the challenges of the program, Ontario developed and implemented a new electronic COVID-19 immunization registry, COVaxON, which captures individual-level data on all doses administered in the province enabling comprehensive coverage assessment. However, the need for ongoing COVID-19 vaccine coverage assessments over a multi-year vaccination program posed challenges necessitating methodological changes. This paper describes Ontario’s COVID-19 immunization registry, the methods implemented over time to allow for the ongoing assessment of vaccine coverage by age, and the impact of those methodological changes.Throughout the course of the vaccination program, four different methodological approaches were used to calculate age-specific coverage estimates using vaccination data (numerator) obtained from COVaxON. Age-specific numerators were initially calculated using age at time of first dose (method A), but were updated to the age at coverage assessment (method B). Database enhancements allowed for the exclusion of deceased individuals from the numerator (method C). Population data (denominator) was updated to 2022 projections from the 2021 national census following their availability (method D). The impact was most evident in older age groups where vaccine uptake was high. For example, coverage estimates for individuals aged 70–79 years of age for at least one dose decreased from 104.9 % (method B) to 95.0 % (method D). Thus, methodological changes improved estimates such that none exceeded 100 %.Ontario’s COVID-19 immunization registry has been transformational for vaccine program surveillance. The implementation of a single registry for COVID-19 vaccines was essential for comprehensive near real-time coverage assessment, and enabled new uses of the data to support additional components of vaccine program surveillance. The province is well positioned to build on what has been achieved as a result of the COVID-19 pandemic and expand the registry to other routine vaccination programs.     

Economic impact of vaccine safety incident in Ukraine: The economic case for safety system investment

BackgroundVaccine confidence and coverage decreased following a death temporally but not causally related to measles vaccination in Ukraine in 2008. Large measles outbreaks including international exportations followed. Herein we characterize this experience including associated costs.MethodsMixed-methods were used to characterize this vaccine safety incident and quantify health and economic costs. Qualitative interviews illuminate the incident, social climate, and corruption that influenced vaccine confidence in Ukraine. A literature review explored attitudes toward vaccines in the USSR and post-independence Ukraine. Infectious disease incidence was examined before and after the vaccine safety incident. An economic analysis estimated associated healthcare costs, including prevention and outbreak control measures, additional vaccination activities due to failure of the 2008 campaign, treatment costs for new cases domestically and foreign exportation, and productivity loss from treatment time and mortality for new cases.FindingsVaccine hesitancy and distrust in government and public health programs due to corruption existed in Ukraine before the vaccine safety incident. The mishandling of the 2008 incident catalyzed the decline of vaccine confidence and prompted poor procurement decisions, leading to a drop in infant vaccination coverage, increased domestic measles cases, and exportation of measles. The estimated cost of this incident was approximately $140 million from 2008 to 2018.InterpretationAbsent a rapid and credible vaccine safety response, a coincidental death following immunization resulted in major outbreaks of measles with substantial economic costs. Adequate investments in a post-licensure safety system may help avoid similar future incidents.     

Empowering Health Workers to Build Public Trust in Vaccination: Experience from the International Pediatric Association’s Online Vaccine Trust Course, 2020–2021

BackgroundThe quality of interactions between health workers (HWs) and caregivers is key in vaccine acceptance. To optimize this, HWs need knowledge about best vaccine communication practices in person and on social media. Most pre-service curricula do not include such approaches. COVID-19 necessitated the International Pediatric Association (IPA) to shift from in-person train the trainer workshops to developing an online Vaccine Trust Course to address these gaps.MethodThe seven-module, 8-hour Vaccine Trust Course was offered online in seven languages and promoted globally. Course outcomes for participants between September 1, 2020 and September 30, 2021 were assessed using enrollment, participation, and completion data; pre-and post-training surveys of attitudes, knowledge, and practice skills; and follow-up practice surveys 3 months post course completion.ResultsOf the 4,926 participants across 137 countries who registered; 2,381 (48.3 %) started the course, with 1,217 (51.1 %) completing. The majority were 25 – 39 years (57 %), female (57 %), and in pediatrics (70 %); 31 % came from India. 62 % of completers rated course structure/design as excellent, 36 % as good. Over 80 % rated the content as the most valuable aspect. Three months post training, 61 % HWs reported increased empathy towards caregivers, confidence while counseling and increased vaccine acceptance amongst their patients. 21 % identified the course as the only factor in these positive changes.ConclusionShifting from face-to-face to online training due to the COVID-19 pandemic helped increase the global reach of HWs course engagement and uptake. Trained HWs reported increased empathy towards caregivers and confidence while counseling and increased patient vaccine acceptance.