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Crowcroft NS, Hamid JS, Deeks SL, Frank J. Human papilloma virus vaccination programs reduce health inequity in most scenarios: a simulation study. BMC Public Health 2012; 12:935. [PMID: 23113881 PMCID: PMC3529110 DOI: 10.1186/1471-2458-12-935] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 10/03/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The global and within-country epidemiology of cervical cancer exemplifies health inequity. Public health programs may reduce absolute risk but increase inequity; inequity may be further compounded by screening programs. In this context, we aimed to explore what the impact of human papillomavirus (HPV) vaccine might have on health equity allowing for uncertainty surrounding the long-term effect of HPV vaccination programs. METHODS A simple static multi-way sensitivity analysis was carried out to compare the relative risk, comparing after to before implementation of a vaccination program, of infections which would cause invasive cervical cancer if neither prevented nor detected, using plausible ranges of vaccine effectiveness, vaccination coverage, screening sensitivity, screening uptake and changes in uptake. RESULTS We considered a total number of 3,793,902 scenarios. In 63.9% of scenarios considered, vaccination would lead to a better outcome for a population or subgroup with that combination of parameters. Regardless of vaccine effectiveness and coverage, most simulations led to lower rates of disease. CONCLUSIONS If vaccination coverage and screening uptake are high, then communities are always better off with a vaccination program. The findings highlight the importance of achieving and maintaining high immunization coverage and screening uptake in high risk groups in the interest of health equity.
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Affiliation(s)
- Natasha S Crowcroft
- Infectious Diseases, Public Health Ontario, 480 University Avenue, Suite 300, Toronto, Ontario, M5G 1V2, Canada
- Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Science Building, 6th floor, Toronto, Ontario, M5T 3M7, Canada
| | - Jemila S Hamid
- Infectious Diseases, Public Health Ontario, 480 University Avenue, Suite 300, Toronto, Ontario, M5G 1V2, Canada
- Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
- Pathology and Molecular Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Shelley L Deeks
- Infectious Diseases, Public Health Ontario, 480 University Avenue, Suite 300, Toronto, Ontario, M5G 1V2, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Science Building, 6th floor, Toronto, Ontario, M5T 3M7, Canada
| | - John Frank
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Science Building, 6th floor, Toronto, Ontario, M5T 3M7, Canada
- Scottish Collaboration for Public Health Research and Policy, Edinburgh, Ontario, Canada
- University of Edinburgh, Old College, South Bridge, Edinburgh, Scotland, EH8 9YL, UK
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Ladhani S, Heath PT, Aibara RJ, Ramsay ME, Slack MPE, Hibberd ML, Pollard AJ, Moxon ER, Booy R. Long-term complications and risk of other serious infections following invasive Haemophilus influenzae serotype b disease in vaccinated children. Vaccine 2010; 28:2195-2200. [PMID: 20056189 DOI: 10.1016/j.vaccine.2009.12.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 12/10/2009] [Accepted: 12/23/2009] [Indexed: 10/20/2022]
Abstract
This study describes the long-term complications in children with Haemophilus influenzae serotype b (Hib) vaccine failure and to determine their risk of other serious infections. The families of 323 children with invasive Hib disease after appropriate vaccination (i.e. vaccine failure) were contacted to complete a questionnaire relating to their health and 260 (80.5%) completed the questionnaire. Of the 124 children with meningitis, 18.5% reported serious long-term sequelae and a further 12.1% of parents attributed other problems to Hib meningitis. Overall, 14% (32/231 cases) of otherwise healthy children and 59% (17/29 cases) of children with an underlying condition developed at least one other serious infection requiring hospital admission. In a Poisson regression model, the risk of another serious infection was independently associated with the presence of an underlying medical condition (incidence risk ratio (IRR) 7.6, 95% CI 4.8-12.1; p<0.0001), both parents having had a serious infection (IRR 4.1, 95% CI 1.6-10.3; p=0.003), requirement of more than two antibiotic courses per year (IRR 2.3, 95% CI 1.4-3.6; p=0.001) and the presence of a long-term complication after Hib infection (IRR 1.8, 95% CI 1.1-3.1; p=0.03). Thus, rates of long-term sequelae in children with vaccine failure who developed Hib meningitis are similar to those in unvaccinated children in the pre-vaccine era. One in seven otherwise healthy children (14%) with Hib vaccine failure will go on to suffer another serious infection requiring hospital admission in childhood, which is higher than would be expected for the UK paediatric population.
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Affiliation(s)
- Shamez Ladhani
- Academic Unit of Paediatrics, Barts and The London School of Medicine and Dentistry, London, United Kingdom.
| | - Paul T Heath
- Vaccine Institute and Division of Child Health, St George's, University of London, United Kingdom
| | - Rashna J Aibara
- Department of Paediatrics, Central Middlesex Hospital, London, United Kingdom
| | - Mary E Ramsay
- Centre for Infections, Health Protection Agency, London, United Kingdom
| | - Mary P E Slack
- Centre for Infections, Health Protection Agency, London, United Kingdom
| | - Martin L Hibberd
- Infectious Diseases Unit, Genome Institute of Singapore, Republic of Singapore
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - E Richard Moxon
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Robert Booy
- Academic Unit of Paediatrics, Barts and The London School of Medicine and Dentistry, London, United Kingdom; National Centre for Immunisation Research & Surveillance, University of Sydney, Australia
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