Abstract
Objective. The study aimed to assess the impact of HPV immunization campaigns organizational aspects, the characteristics of immunization program (vaccination targets and type of offer), and communicative strategies adopted by four Italian administrative regions on vaccination coverage observed. Methods. From November 2017 to March 2018, regional and Local Health Units (LHUs) representatives were invited to complete an online survey including 54 questions evaluating vaccination invite systems, access systems to vaccination centres, reminder and recall systems, and adverse events surveillance. An overall descriptive analysis was conducted. Since observed vaccine coverage (VC) obtained in females (2002-2004 birth cohorts) was lower than objectives fixed by the Italian Ministry of Health, variables were assessed using the national VC mean obtained in the 2003 girls birth cohort as outcome. Results. Twenty-six LHUs belonging to 4 Northern and Southern Italian regions participated in the study. Organizational aspects significantly related to VC lower than the national mean were access to vaccine centres without appointment and parents' reservation as appointment planning system. Recall systems for both the first and the second dose, including the appointment in the invitation letter, the availability of regional immunization registry, and education of healthcare workers on universal HPV immunization strategies, instead, were related to higher VC. As regards preadolescent immunization strategies, both VC obtained in girls and boys were far from the Ministerial goals. Only 20% of LHUs introduced multicohort female strategies while all LHUs adopted copayment targeting both men and women. Immunizations strategies targeting subjects at risk were implemented only in half of participating LHUs. Conclusions. VC observed in participating LHUs are largely lower than the national objectives in all anti-HPV vaccine targets. Both organizational and educational strategies have to be implemented to improve the VC goals.
Highlights
Human papillomavirus (HPV) is considered one of the most common sexually transmitted infections in the world, affecting people especially in developed countries
HPV vaccination has been recommended for adolescent women prior to sexual debut, and it has already been showed to be highly effective in reducing HPV-related lesions, such as genital warts as well as Cervical Intraepithelial Neoplasia (CIN) [7]
An online questionnaire was administered through Google Drive platform to 26 Local Health Units (LHUs), belonging to 4 Northern and Southern Italian regions, where the universal preadolescents HPV vaccine recommendation was introduced before the PNPV 2017-2019, covering 25.7% of the national population
Summary
Human papillomavirus (HPV) is considered one of the most common sexually transmitted infections in the world, affecting people especially in developed countries. Since HPV was discovered to cause cervical, penile, anal, vaginal, BioMed Research International oropharynx, hypopharynx, and larynx cancers, the development of effective anti-HPV vaccines was considered one of the most important public health goals to be achieved [2,3,4]. In 2006, the European Medicines Agency (EMEA) approved a quadrivalent vaccine containing antigens against four HPVtypes (6, 11, 16, and 18) and, one year later, they approved a second bivalent vaccine against oncogenic HPV-types (16 and 18). In 2015, a nonavalent vaccine extending antigens to five additional HPV-types (31, 33, 45, 52, and 58) to that contained in the quadrivalent vaccine was approved by EMA [5, 6]. Increasing evidence demonstrated the consistent burden of HPV-related diseases in men, such as anal, head, and neck cancers (4 times or more than women) and penile cancers [8, 9]
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