Journal
BMC PUBLIC HEALTH
Volume 11, Issue -, Pages -Publisher
BMC
DOI: 10.1186/1471-2458-11-645
Keywords
human papillomavirus vaccine; cohort studies; vaccine acceptability; vaccination; immunization
Categories
Funding
- Ontario Graduate Student Award
- KFL&A Public Health Research, Education, and Development Studentship Award
- Canadian Foundation for Innovation (CFI)
- Ontario Ministry of Research and Innovation's (MRI)
- Allergy, Genes and the Environment Network of Centers of Excellence (AllerGen NCF)
- Physicians Services Incorporation Foundation
- Fonds de la recherche en Sante du Quebec (FRSQ)
- Ontario Ministry of Health and Long-Term Care (MOHLTC)
- University of Toronto Department of Family and Community Medicine
- Canadian Institutes of Health Research [106553]
- Institute for Clinical Evaluative Sciences (ICES)
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Background: Although 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. Methods: Linking 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. Results: We 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 vaccineswere 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). Conclusions: The 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.
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