Abstract
BackgroundAlthough over a hundred million dollars have been invested in offering free quadrivalent human papillomavirus (HPV) vaccination to young girls in Ontario, there continues to be very little information about its usage. In order to successfully guide future HPV vaccine programming, it is important to monitor HPV vaccine use and determine factors associated with use in this population.MethodsLinking administrative health and immunization databases, we conducted a population-based, retrospective cohort study of girls eligible for Ontario's Grade 8 HPV vaccination program in Kingston, Frontenac, Lennox, and Addington. We determined the proportion of girls who initiated (at least one dose) and completed (all three doses) the vaccination series overall and according to socio-demographics, vaccination history, health services utilization, medical history, and program year. Multivariable logistic regression was used to estimate the strength of association between individual factors and initiation and completion, adjusted for all other factors.ResultsWe identified a cohort of 2519 girls, 56.6% of whom received at least one dose of the HPV vaccine. Among vaccinated girls, 85.3% received all three doses. Vaccination history was the strongest predictor of initiation in that girls who received the measles-mumps-rubella, meningococcal C, and hepatitis B vaccines were considerably more likely to also receive the HPV vaccine (odds ratio 4.89; 95% confidence interval 4.04-5.92). Nevertheless, HPV vaccine uptake was more than 20% lower than that of these other vaccines. In addition, while series initiation was not influenced by income, series completion was. In particular, girls of low income were the least likely to receive all three indicated doses of the HPV vaccine (odds ratio 0.45; 95% confidence interval 0.28-0.72).ConclusionsThe current low level of HPV vaccine acceptance in Kingston, Frontenac, Lennox, and Addington will likely have important implications in terms of the health benefits and cost-effectiveness of its publicly funded program. We identified important factors associated with series initiation and completion that should be considered in efforts to improve HPV vaccine use in this population.
Highlights
Over a hundred million dollars have been invested in offering free quadrivalent human papillomavirus (HPV) vaccination to young girls in Ontario, there continues to be very little information about its usage
Based on birth year, we determined that 185,398 girls were eligible for Ontario’s Grade 8 HPV vaccination program in its first two years (Figure 1)
Series initiation increased significantly across campaign years (OR = 1.29; 95% CI 1.08-1.53), but the increase corresponded to an absolute difference of only 4.0% (Table 1)
Summary
Over a hundred million dollars have been invested in offering free quadrivalent human papillomavirus (HPV) vaccination to young girls in Ontario, there continues to be very little information about its usage. While the initial goal of the Ontario government was to immunize 80% of eligible girls during the program’s first two years [5], only 53% received the first dose in year 1 [3] This level of vaccine coverage is considerably lower than that of similar school-based vaccination programs in the province [6], and represents the lowest known level of HPV vaccine acceptance in Canada [7]. The reasons for such low coverage in Ontario remain unknown; surveys have consistently reported that parental concerns about the safety and long-terms effects of the HPV vaccine affect intent to vaccinate [8,9,10,11,12]. On the other hand, increased contact with healthcare providers (e.g., physicians) may lead to increased opportunities to discuss the benefits of vaccination, thereby increasing HPV vaccine acceptance and use
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