Herpes zoster vaccine (HZV): utilization and coverage 2009 - 2013, Alberta, Canada

Hospitalizations of patients with herpes zoster in Poland during 2012-2021: A population-based study

INTRODUCTION

The varicella-zoster virus (VZV) is an infectious agent that causes both chickenpox and herpes zoster/shingles (HZ). This infection can take various clinical forms, result in permanent complications, and be a marker of immunosuppression, e.g. in the course of a neoplastic disease. The aim of this study is to analyze epidemiological trends in hospitalization and hospital mortality rate among HZ patients in Poland (2012-2021).

METHODS

Our study is a population-based, retrospective analysis of hospital discharge records of patients with HZ. Data were obtained from the National Institute of Public Health in Poland, and they covered the period from 2012 to 2021. All hospitalization records with primary or secondary ICD-10 B02 code diagnosis were included in the study.

RESULTS

We analyzed the total number of 23,432 hospital discharge records of HZ patients in 2012-2021. The study group consisted of 22,169 (94.6 %) hospitalization records of first-time diagnosis of HZ in hospitalized patients: 9,309 males (42 %) and 12,860 females (58 %). In this group, 70.3 % were patients over 60 years old. The mean and median age was 64 and 69 years, respectively. The mean annual first-time hospitalization rate for HZ was estimated to be 5.8 per 100,000 person-years (95 % CI: 4.8-6.7 per 100,000 person-years). The hospitalization rate for HZ was similar during 2012-2019. There was a significant decrease in hospitalizations in 2020-2021 in comparison with the previous years (R2 = 0.42, p < 0.05). Women showed a higher hospitalization rate than men (p < 0.001). Urban residents had a higher hospitalization rate than rural residents (p < 0.001). In the analyzed period, 246 deaths were recorded (1.1 % of all hospitalized HZ patients) -119 males and 127 females.

CONCLUSIONS

The HZ-related number of hospitalizations and mortality in Poland are relatively low, but HZ is still a significant health problem. Risk factors include female gender, older age and residence in urban areas.

Willingness to vaccinate against herpes zoster in Chinese urban population: a mixed-methods study

OBJECTIVE

Although the herpes zoster vaccine has been available in mainland China since June 2020, residents' knowledge of herpes zoster and the herpes zoster vaccine is poor, and vaccination rates are low, especially among the elderly, who are at high risk for herpes zoster. This study assessed willingness to be vaccinated against herpes zoster and factors associated with vaccination among urban residents in China.

METHODS

A mixed-methods study was conducted in community health centres from August 2022 to September 2022. We used convenience sampling to select 2864 residents from 9 Chinese cities for the quantitative study and 67 adults for the qualitative study. A structured questionnaire was used for the quantitative study, and data were collected through face-to-face interviews. Multinomial logistic regression was used to analyse factors associated with willingness to vaccinate. Qualitative data were analysed using thematic analysis of barriers to herpes zoster vaccination.

RESULTS

A total of 2864 eligible respondents were included in the study. Of these, 42.67% intended to receive the herpes zoster vaccine, 21.44% refused and 35.89% were hesitant. The results of the quantitative and qualitative analyses showed that the factors associated with respondents' willingness to be vaccinated against herpes zoster included: personal characteristics such as gender, age and income; knowledge and attitudes about herpes zoster and the vaccine; vaccine characteristics such as efficacy, safety and price; and other factors such as pain tolerance and accessibility to vaccination.

CONCLUSION

The low willingness to vaccinate, especially among the elderly, is mainly related to their poor knowledge and negative attitude towards the infection and vaccination. Therefore, health education about herpes zoster, immunisation promotion, and improvement of accessibility and affordability would be valuable in China.

Vaccine promotion strategies in community pharmacy addressing vulnerable populations: a scoping review

CONTEXT

Social determinants of health are drivers of vaccine inequity and lead to higher risks of complications from infectious diseases in under vaccinated communities. In many countries, pharmacists have gained the rights to prescribe and administer vaccines, which contributes to improving vaccination rates. However, little is known on how they define and target vulnerable communities.

OBJECTIVE

The purpose of this study is to describe how vulnerable communities are targeted in community pharmacies.

METHODS

We performed a systematic search of the Embase and MEDLINE database in August 2021 inspired by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols (PRISMA ScR). Articles in English, French or Spanish addressing any vaccine in a community pharmacy context and that target a population defined as vulnerable were screened for inclusion.

RESULTS

A total of 1039 articles were identified through the initial search, and 63 articles met the inclusion criteria. Most of the literature originated from North America (n = 54, 86%) and addressed influenza (n = 29, 46%), pneumococcal (n = 14, 22%), herpes zoster (n = 14, 22%) or human papilloma virus vaccination (n = 14, 22%). Lifecycle vulnerabilities (n = 48, 76%) such as age and pregnancy were most often used to target vulnerable patients followed by clinical factors (n = 18, 29%), socio-economical determinants (n = 16, 25%) and geographical vulnerabilities (n = 7, 11%). The most frequently listed strategy was providing a strong recommendation for vaccination, promotional posters in pharmacy, distributing leaflet/bag stuffers and providing staff training. A total of 24 barriers and 25 facilitators were identified. The main barriers associated to each vulnerable category were associated to effective promotional strategies to overcome them.

CONCLUSION

Pharmacists prioritize lifecycle and clinical vulnerability at the expense of narrowing down the definition of vulnerability. Some vulnerable groups are also under targeted in pharmacies. A wide variety of promotional strategies are available to pharmacies to overcome the specific barriers experienced by various groups.

Willingness to Vaccinate Against Herpes Zoster and Its Associated Factors Across WHO Regions: Global Systematic Review and Meta-Analysis

BACKGROUND

A life-course immunization approach would enhance the quality of life across all age groups and improve societal well-being. The herpes zoster (HZ) vaccine is highly recommended for older adults to prevent HZ infection and related complications. The proportions of willingness to receive the HZ vaccine varies across countries, and various kinds of factors, including sociodemographics and individual perceptions, influence the willingness to vaccinate.

OBJECTIVE

We aim to estimate the HZ vaccination willingness rate and identify factors associated with vaccine uptake willingness across all World Health Organization (WHO) regions.

METHODS

A global systematic search was performed on PubMed, Web of Science, and the Cochrane Library for all papers related to the HZ vaccine published until June 20, 2022. Study characteristics were extracted for each included study. Using double arcsine transformation, vaccination willingness rates with 95% CIs were pooled and reported. The willingness rate and associated factors were analyzed by geographical context. Associated factors were also summarized based on Health Belief Model (HBM) constructs.

RESULTS

Of the 26,942 identified records, 13 (0.05%) papers were included, covering 14,066 individuals from 8 countries in 4 WHO regions (Eastern Mediterranean Region, European Region, Region of the Americas, and Western Pacific Region). The pooled vaccination willingness rate was 55.74% (95% CI 40.85%-70.13%). Of adults aged ≥50 years, 56.06% were willing to receive the HZ vaccine. After receiving health care workers' (HCWs) recommendations, 75.19% of individuals were willing to get the HZ vaccine; without HCWs' recommendations, the willingness rate was only 49.39%. The willingness rate was more than 70% in the Eastern Mediterranean Region and approximately 55% in the Western Pacific Region. The willingness rate was the highest in the United Arab Emirates and the lowest in China and the United Kingdom. The perception of HZ severity and susceptibility was positively associated with vaccination willingness. The perceived barriers to vaccination willingness (main reasons for unwillingness) included low trust in the effectiveness of the HZ vaccine, concerns about safety, financial concerns, and being unaware of the HZ vaccine's availability. Older individuals, those having lower education, or those having lower income levels were less likely to willing to be vaccinated.

CONCLUSIONS

Only 1 in 2 individuals showed a willingness to be vaccinated against HZ. The willingness rate was the highest in the Eastern Mediterranean Region. Our findings show the critical role HCWs play in promoting HZ vaccination. Monitoring HZ vaccination willingness is necessary to inform public health decision-making. These findings provide critical insights for designing future life-course immunization programs.

Vaccinations Status against Vaccine-Preventable Diseases and Willingness to Be Vaccinated in an Italian Sample of Frail Subjects

BACKGROUND

Study aim was to investigate the vaccination status against vaccine-preventable diseases (VPD) of frail adults during the SARS-CoV-2 pandemic and, for those subjects eligible for at least one vaccine, with respect to the recommended vaccination in line with the Italian National Vaccination Prevention Plane (NPVP), to explore the willingness to be vaccinated.

METHODS

A cross-sectional study was carried out among adults aged ≥ 60, immunocompromised or subjects affected by chronic conditions.

RESULTS

Among the 427 participants, a vaccination coverage rate lower than the targets for all the vaccines considered was found. Of those, 72.6% of subjects stated their willingness to receive recommended vaccinations, and 75.2% of the respondents stated that the advice to undergo vaccinations was received by the General Practitioner (GP). In a multivariable logistic regression model, higher odds of recommended VPD vaccination uptake (defined as having two or more of the recommended vaccinations) were associated with the willingness towards recommended VPD vaccination (Odds Ratio = 3.55, 95% Confidence Interval: 1.39 to 9.07), university education (OR = 2.03, 95% CI: 1.03 to 3.97), but having another person in the household (OR = 0.52, 95% CI: 0.28 to 0.97), and history of oncological disease (OR = 0.39, 95% CI: 0.18 to 0.87) were predictive of lower odds of vaccination uptake. In another multivariable model, higher odds of willingness to receive vaccines were associated with kidney disease (OR = 3.3, 95% CI: 1.01 to 10.5), perceived risk of VPD (OR = 1.9, 95% CI: 1.02 to 3.3), previous influenza vaccination (OR = 3.4, 95% CI: 1.8 to 6.5), and previous pneumococcal vaccination (OR = 3.1, 95% CI: 1.3 to 7.7), but increasing age (OR = 0.93 per year, 95% CI: 0.91 to 0.97), working (OR = 0.40, 95% CI: 0.20 to 0.78), and fear of vaccine side effects (OR = 0.38, 95% CI: 0.21 to 0.68) were predictive of lower odds of willingness to receive vaccines.

CONCLUSIONS

Despite specific recommendations, vaccination coverage rates are far below international targets for frail subjects. Reducing missed opportunities for vaccination could be a useful strategy to increase vaccination coverage in frail patients during the routine checks performed by GPs and specialists.

Low willingness to vaccinate against herpes zoster in a Chinese metropolis

BACKGROUND

Herpes zoster vaccine (HZV) has been available in China's mainland since June 2020. This study estimated willingness to receive HZV to characterize factors that may influence vaccination willingness.

METHODS

We conducted a face-to-face questionnaire survey in adults aged 50-69 years in 13 communities in Shanghai in late 2020. We explored the relationship between vaccination willingness and independent factors including demographic factors, medical history, knowledge of herpes zoster and HZV, and vaccine hesitancy. Outcomes included participants' willingness to vaccinate themselves, their partners, and their parents, under both the current payment scenario (self-payment) and a hypothetical scenario (payment by basic medical insurance).

RESULTS

A total of 1672 respondents aged 50-69 years were included in this study. The proportion of respondents willing to get vaccinated was 16.57% for themselves, 13.88% for their partners, and 8.49% for their parents. If the vaccine was covered under insurance, these numbers increased to 72.25%, 62.50%, and 29.96%, respectively. Younger age, female gender, higher income, higher educational level, local residents, and lower vaccine hesitancy were associated with increased willingness to vaccinate. Knowledge of herpes zoster and HZV positively influenced the willingness in the hypothetical payment scenario.

CONCLUSION

We determined a very low willingness to vaccinate HZV in adults aged 50-69 years in a Chinese metropolis. Decreasing costs is important to increase coverage. Additionally, strengthening advocacy and health promotion for the vaccine will be particularly important, especially for groups with certain underlying diseases.

Herpes zoster in older adults in Ontario, 2002-2016: Investigating incidence and exploring equity

Older adults are at increased risk of herpes zoster (HZ) and post-herpetic neuralgia (PHN) and HZ vaccines are available to help prevent infection. The objective of our study was to provide updated data on incidence of HZ and PHN related to clinical and demographic factors in older adults to inform immunization practices. We conducted a population-based, retrospective cohort study and included all cases of HZ seen in outpatient, emergency department, and hospital settings for adults aged 65 years and over between April 1, 2002 to August 31, 2016 in Ontario, Canada. We calculated the incidence of HZ and PHN, and estimated the proportion within each subgroup that developed PHN. We also assessed incidence by neighbourhood-level income quintile before and after the availability of vaccine for private purchase. The average annual incidence of HZ in any setting was 59.0 per 10,000 older adults, with higher incidence in outpatient as opposed to hospital settings. Incidence was higher in the oldest age groups, females, and those classified as immunocompromised or frail. Relative to the pre-vaccine era, the disparities in incidence of HZ by neighbourhood-level income increased, with higher rates of HZ and PHN seen in those residing in lower income quintiles. Additional prevention efforts should be targeted toward adults who are immunocompromised, frail, and those living in lower socioeconomic quintiles. Future work should assess the impact of the zoster vaccine program with a particular focus on equity in the publicly-funded era.

Influenza, pneumococcal and herpes zoster vaccination rates among patients over 65 years of age, related factors, and their knowledge and attitudes

BACKGROUND

In this study, we aimed to determine influenza, pneumococcal, and herpes zoster (HZ) vaccination status, among patients aged 65 or above, and to determine their level of knowledge about these vaccines and the factors affecting the vaccination rates.

METHODS

This was a cross-sectional descriptive study conducted through face-to-face interviews with patients who were admitted to Gemerek State Hospital Family Medicine Clinics. The questionnaire prepared by the researchers following the literature review was applied by researchers.

RESULTS

The study included a total of 326 participants with a mean age of 71.59 ± 6.96 (min: 65, max: 96). Influenza, pneumococcal, and HZ vaccination rates were 21.8% (n = 71), 4.3% (n = 14), and 1.8% (n = 6), respectively. The odds ratio (OR) in the patients for whom influenza vaccination was recommended was calculated to be 15.25 compared to those for whom influenza vaccination was not recommended (95% CI 8.73-26.64, p < 0.001), OR in the patients for whom pneumococcal vaccination was recommended was calculated to be 257.5 compared to those for whom pneumococcal vaccination was not recommended (95% CI 50.75-1306.44, p < 0.001), and OR in the patients for whom HZ vaccination was recommended was calculated to be 126.0 compared to those for whom HZ vaccination was not recommended (95% CI 18.59-853.92, p < 0.001).

CONCLUSIONS

The main findings of the present study are that the vaccination rate for all three vaccines is low, vaccination recommendation by a physician significantly increases vaccination rates, and the vaccination rate of patients, who have been informed by the physician about the vaccine, is higher.

Herpes Zoster Infection and Herpes Zoster Vaccination in a Population-Based Sample of Persons With IBD: Is There Still an Unmet Need?

BACKGROUND

We aimed to report the rates of herpes zoster infection (HZI) before and after the introduction of herpes zoster vaccine (HZVac) and to determine the rates of HZVac after it became available in Manitoba in 2009.

METHODS

We used the population-based University of Manitoba IBD Epidemiology Database to identify cases of inflammatory bowel disease (IBD) and controls (1984-2016) who were diagnosed with HZI before and after 2009 and to determine the rate of HZVac in those older than age 50 years. Further, we explored predictors of receipt of HZVac among persons with IBD.

RESULTS

Persons with IBD vs matched controls have higher rates of HZI before diagnosis and postdiagnosis. HZI rates before 2009 per 1000 person-years were increased in persons with IBD (9.2) vs controls (7.2, P < 0.0001). Persons with IBD compared with controls were more likely to get HZVac (15.5 vs 12 per 1000 person-years). Persons newly diagnosed with IBD after 2009 and of higher socioeconomic status were more likely to get HZVac. Despite the introduction of HZVac, there was a steady rise in HZI throughout the study period (annual percent change in infection rates of +0.54, P < 0.0001).

CONCLUSIONS

The increased risk of HZI in IBD may reflect an inherent risk associated with the disease or, in those already diagnosed, an increased risk secondary to the use of immunomodulating drugs. HZVac rates are very low, which may reflect physician and patient knowledge of the vaccine's availability and utility and the fact that it is not covered by the provincially provided health care plan.

Zoster vaccination inequalities: A population based cohort study using linked data from the UK Clinical Practice Research Datalink

OBJECTIVE

To quantify inequalities in zoster vaccine uptake by determining its association with socio-demographic factors: age, gender, ethnicity, immigration status, deprivation (at Lower-layer Super Output Area-level), care home residence and living arrangements.

METHOD

This population-based cohort study utilised anonymised primary care electronic health records from England (Clinical Practice Research Datalink) linked to deprivation and hospitalisation data. Data from 35,333 individuals from 277 general practices in England and eligible for zoster vaccination during the two-year period (2013-2015) after vaccine introduction were analysed. Logistic regression was used to obtain adjusted odds ratios (aOR) for the association of socio-demographic factors with zoster vaccine uptake for adults aged 70 years (main target group) and adults aged 79 years (catch-up group).

RESULTS

Amongst those eligible for vaccination, 52.4% (n = 18,499) received the vaccine. Socio-demographic factors independently associated with lower zoster vaccine uptake in multivariable analyses were: being older (catch-up group: aged 79 years) aOR = 0.89 (95% confidence interval (CI):0.85-0.93), care home residence (aOR = 0.64 (95%CI: 0.57-0.73)) and living alone (aOR = 0.85 (95%CI: 0.81-0.90)). Uptake decreased with increasing levels of deprivation (p-value for trend<0.0001; aOR most deprived versus least deprived areas = 0.69 (95%CI: 0.64-0.75)). Uptake was also lower amongst those of non-White ethnicities (for example, Black versus White ethnicity: aOR = 0.61 (95%CI: 0.49-0.75)) but was not lower among immigrants after adjusting for ethnicity. Lower uptake was also seen amongst females compared to men in the catch-up group.

CONCLUSIONS

Inequalities in zoster vaccine uptake exist in England; with lower uptake among those of non-White ethnicities, and among those living alone, in a care home and in more deprived areas. Tailored interventions to increase uptake in these social groups should assist in realising the aim of mitigating vaccination inequalities. As care home residents are also at higher risk of zoster, improving the uptake of zoster vaccination in this group will also mitigate inequalities in zoster burden.

Herpes Zoster Burden in Canadian Provinces: A Narrative Review and Comparison with Quebec Provincial Data

Background

The main aim of this review was to assess incidence rates and trends of medically attended and death cases of herpes zoster in Canada.

Methods

The search was conducted in five databases (PubMed, Cochrane, Embase, PsycNET, and Web of Science). Data on herpes zoster-related consultations and hospitalisations and deaths were also extracted from three Quebec provincial administrative databases (RAMQ, MED-ECHO, and ISQ).

Results

The electronic search yielded 587 publications. Seventeen publications satisfied inclusion criteria. These publications reported data from eleven studies. Ten studies used provincial databases, and one study used the Canadian Primary Care Sentinel Surveillance Network electronic database. Seven studies evaluated overall rates of medically attended cases (consultations and hospitalisations). Four of these studies reported an increase in rates of medically attended cases during the study period; one study reported stable rates, and two studies reported only an average rate. The rates varied from 316 to 450/100,000 p.y. The Quebec analysis shows similar rates with a slight decreasing trend (from 369 to 350/100,000 p.y.). Incidence rates of consultations were reported separately in three studies. Two studies reported an increase in rates (from 258 to 348/100,000 p.y. and from 324 to 366/100,000 p.y.), and the third study reported a decrease (from 525 to 479/100,000 p.y.). Hospitalization rates were reported separately in two studies, both reporting a decrease (from 12 to 8 cases/100,000 p.y. and from 9 to 4 cases/100,000 p.y.). Quebec data also showed a decrease, from 9 to 6 cases/100,000 p.y. One study reported herpes zoster-related deaths. In this study, the reported death rate was 0.7/1,000,000 p.y. in the overall population and 5.5/1,000,000 p.y. in those aged ≥65 years. Quebec analysis showed a death rate of 1.2/1,000,000 p.y. in the overall population and 8.6/1,000,000 p.y. in those aged ≥65 years.

Conclusions

The results of the reviewed studies and our analysis of Quebec provincial data indicate important variations in the reported overall incidence rates of medically attended herpes zoster cases in Canada. The trends in time are heterogeneous in studies in which hospitalisations and medical consultations were pooled together. We observed a decrease in hospitalization rates and a slight increase in consultation rates in studies reporting hospitalisations and consultations separately. These results consolidate the understanding of the herpes zoster burden in Canada and might be used as a tool in decision-making regarding future preventive interventions.

Varicella and herpes zoster vaccine development: lessons learned

INTRODUCTION

Before vaccination, varicella zoster virus (VZV), which is endemic worldwide, led to almost universal infection. This neurotropic virus persists lifelong by establishing latency in sensory ganglia, where its reactivation is controlled by VZV-specific T-cell immunity. Lifetime risk of VZV reactivation (zoster) is around 30%. Vaccine development was galvanised by the economic and societal burden of VZV, including debilitating zoster complications that largely affect older individuals. Areas covered: We describe the story of development, licensing and implementation of live attenuated vaccines against varicella and zoster. We consider the complex backdrop of VZV virology, pathogenesis and immune responses in the absence of suitable animal models and examine the changing epidemiology of VZV disease. We review the vaccines' efficacy, safety, effectiveness and coverage using evidence from trials, observational studies from large routine health datasets and clinical post-marketing surveillance studies and outline newer developments in subunit and inactivated vaccines. Expert commentary: Safe and effective, varicella and zoster vaccines have already made major inroads into reducing the burden of VZV disease globally. As these live vaccines have the potential to reactivate and cause clinical disease, developing alternatives that do not establish latency is an attractive prospect but will require better understanding of latency mechanisms.

Sociodemographic predictors of variation in coverage of the national shingles vaccination programme in England, 2014/15

INTRODUCTION

In September 2013, England introduced a shingles vaccination programme to reduce incidence and severity of shingles in the elderly. This study aims to assess variation in vaccine coverage with regards to selected sociodemographic factors to inform activities for improving equity of the programme.

METHODS

Eligible 70year-olds were identified from a national vaccine coverage dataset in 2014/15 that includes 95% of GPs in England. NHS England Local Team (LT) and index of multiple deprivation (IMD) scores were assigned to patients based on GP-postcode. Vaccine coverage (%) with 95% confidence intervals (CIs), were calculated overall and by LT, ethnicity and IMD, using binomial regression.

RESULTS

Of 502,058 eligible adults, 178,808 (35.6%) had ethnicity recorded. Crude vaccine coverage was 59.5% (95%CI: 59.3-59.7). Coverage was lowest in London (49.6% coverage, 95%CI: 49.0-50.2), and compared to this coverage was significantly higher in all other LTs (+6.3 to +10.4, p<0.001) after adjusting for ethnicity and IMD. Coverage decreased with increasing deprivation and was 8.2% lower in the most deprived (95%CI: 7.3-9.1) compared with the least deprived IMD quintile (64.1% coverage, 95%CI: 63.6-64.6), after adjustment for ethnicity and LT. Compared with White-British (60.7% coverage, 95%CI: 60.5-61.0), other ethnic groups had between 4.0% (Indian) and 21.8% (Mixed: White and Black African) lower coverage. After adjusting for IMD and LT, significantly lower coverage by ethnicity persisted in all groups, except in Mixed: Other, Indian and Bangladeshi compared with White-British.

CONCLUSIONS

After taking geography and deprivation into account, shingles vaccine coverage varied by ethnicity. White-British, Indian and Bangladeshi groups had highest coverage; Mixed: White and Black African, and Black-other ethnicities had the lowest. Patients' ethnicity and IMD are predictors of coverage which contribute to, but do not wholly account for, geographical variation coverage. Interventions to address service-related, sociodemographic and ethnic inequalities in shingles vaccine coverage are required.

Adverse events following HPV vaccination, Alberta 2006-2014

BACKGROUND

In Canada, private purchase of human papilloma virus (HPV) vaccines has been possible since 2006. In Alberta, Canada, a publicly funded quadrivalent HPV vaccine program began in the 2008/2009 school year. There have been concerns about adverse events, including venous thromboembolism (VTE) associated with HPV vaccines. We describe the frequencies of adverse events following HPV vaccination among Alberta females aged 9 years or older and look at VTE following HPV vaccination.

METHODS

We used the Alberta Immunization and Adverse Reaction to Immunization (Imm/ARI) repository (publicly funded vaccine), the population-based Pharmaceutical Information Network (PIN) information system (dispensing of a vaccine), and the Alberta Morbidity and Ambulatory Care Abstract reporting system (MACAR) for June 1, 2006-November 19, 2014. Deterministic data linkage used unique personal identifiers. We identified all reported adverse events following immunization (AEFI) and all emergency department (ED) utilization or hospitalizations within 42 days of immunization. We calculated the frequency of AEFI by type, rates per 100,000 doses of HPV vaccine administered and the frequencies of ICD-10-CA codes for hospitalizations and emergency department visits.

RESULTS

Over the period 195,270 females received 528,913 doses of HPV vaccine. Of those receiving at least one dose, 192 reported one or more AEFI events (198 AEFI events), i.e., 37.4/100,000 doses administered (95% CI 32.5-43.0). None were consistent with VTE. Of the women who received HPV vaccine 958 were hospitalized and 19,351 had an ED visit within 42 days of immunization. Four women who had an ED visit and hospitalization event were diagnosed with VTE. Three of these had other diagnoses known to be associated with VTE; the fourth woman had VTE among ED diagnoses but not among those for the hospitalization.

CONCLUSIONS

Rates of AEFI after HPV immunization in Alberta are low and consistent with types of events seen elsewhere.

HPV Vaccine utilization, Alberta 2008/09-2013/14 School year

BACKGROUND

In Canada both bivalent (bHPV) vaccine and quadrivalent HPV vaccine (qHPV) are authorized for use. In Alberta, while both vaccines are available for private purchase, only qHPV is publicly funded for school girls in grades 5 and 9 as of 2013. We describe HPV vaccine uptake in Alberta, by school year, from the start of the publicly funded program in the Fall of 2008 through to August 31(st) 2014 and estimate the cumulative proportion of the female population who were vaccinated by the end of the 2013/14 school year.

METHODS

We used data from the Alberta Ministry of Health Immunization and Adverse Reaction to Immunization repository (publicly funded vaccine), the population-based Pharmaceutical Information Network information systems (privately purchased vaccine) for the period September 1, 2008 to August 31, 2014 and demographic data from the Alberta Health Care Insurance Plan Registry. We estimate vaccine uptake rates and explore them by attributes of person, time, place, vaccine funding, and number of doses received. We estimated the cumulative proportions of the female population (by age group and number of doses received) who had received HPV vaccine by the end of the 2013/14 school year.

RESULTS

Of the 169,259 unique individuals who received one or more doses of HPV vaccine over the period, 98.3% were females, and 83.8% received publicly funded vaccines. Vaccine uptake increased over the period. The cumulative proportion of females aged 9-26 years as of 2013/14 who had received two or more doses of vaccine was 34.3%; for those aged 10-11 years 59.6% and for those aged 14-15 years, 76.0%. For those aged 9-26 years, 31.3% had received three doses of vaccine.

CONCLUSION

HPV vaccine uptake rates have increased in Alberta over the study period, most prominently among the age groups targeted by the publicly funded school-girl vaccine program.