No 22 - 2012

HPV vaccination, Coverage 2011

On 1 January 2009, human papillomavirus (HPV) vaccination was introduced to the Danish Childhood Vaccination Programme as an offer given to girls aged 12 years, born in 1996 or later.
Furthermore, girls born in 1993, 1994 or 1995 were offered free HPV vaccination as part of a catch-up programme which ran from October 2008 to the end of 2010, EPI-NEWS 35/08.

The 4-valent vaccine used in the Danish Childhood Vaccination Programme has been marketed in Denmark since 23 October 2006. It is therefore expected that particularly girls from the earlier birth years comprised by the catch-up programme will themselves have paid for vaccination. In connection with the establishment of The Danish Vaccination Register, information on prescription-based HPV vaccination was obtained. Such vaccines are counted as part of the report in line with vaccines settled with the National Danish Health Insurance by General Practitioners.

Vaccination coverage was calculated on the basis of person-identifiable data from the National Childhood Vaccination Database.
Coverage was calculated as per 16 April 2012. There is a 2-3-month delay from a vaccination is administered until it is registered in the Childhood Vaccination Database.

Method of calculation

Vaccination coverage was recorded using the administrative service codes indicated by GPs when settling first, second and third HPV vaccinations, respectively, EPI-NEWS 18/11. The numerator is therefore e.g. the number of girls born in 1993 who received the initial HPV vaccination, and the denominator is the number of girls from the birth year residing in Denmark when the data were analysed.

Catch-up programme coverage

A total of 86-89% of girls born in 1993, 1994 or 1995 have received the first HPV vaccination, 83-86% the second and 78-83% the third vaccination, Table 1.

Vaccination programme coverage

A total of 88-90% of girls born in 1996, 1997 or 1998 have received the first HPV vaccination, 83-86% the 2nd and 76-82% the 3rd, Table 1.
Vaccination of girls born in 1999 had not been concluded when the data were analysed and therefore expectedly shows a lower coverage than other birth years.

National coverage

HPV vaccination coverage varies geographically. When broken up by area, the coverage is lower in Copenhagen City, i.e. the municipalities of Copenhagen, Frederiksberg, Dragør and Tårnby. This trend is observed for the catch-up programme as well as for the standard vaccination programme, Table 2.

The average vaccination coverage of the third HPV vaccination in the 1993-98 period was 72% (12,165/16,801) for Copenhagen City versus 81% (153,433/189,532) in the remaining parts of Denmark. If data are broken down by municipalities, it becomes evident that the low coverage observed in Copenhagen is primarily located to Copenhagen and Frederiksberg municipalities with 71% (9,023/12,724) and 74% (1,524/2,048), respectively, whereas the coverage recorded in Dragør and Tårnby municipalities was 79% (427/538) og 80% (1,191/1,491), respectively.

If coverage is presented for all 98 municipalities, it becomes clear that it is lover in the small municipalities of Læsø and Ærø with 66% (33/50) and 69% (146/212), respectively. The highest coverage was recorded in Skive, where 90% (1,748/1,940) were vaccinated. In addition to the low coverage seen in the Municipality of Copenhagen, low figures were also observed for other municipalities, including Lolland 72% (1,128/1,570) and Vordingborg 72% (1,234/1,724).

Detailed figures on the coverage of the Childhood Vaccination Programme are available via the SSI's new application ati.dk/data, EPI-NYT 17/12. The app allows users to display data on a map of Denmark to get a quick overview of the vaccination coverage in municipalities and areas of Denmark. It is possible to filter the data provided by gender, relevant birth years, municipality and area.

Commentary

The HPV vaccination coverage of the recently concluded catch-up programme including prescription-based HPV vaccines is satisfactory. HPV1 vaccination coverage is at par with MMR2 vaccination, which is given at the age of 12 years, www.ssi.dk/data.

The coverage of the Childhood Vaccination Programme for 12-year-old girls born in 1996, 1997 and 1998 is marginally higher than the coverage recorded in the catch-up programme for HPV1, at par with that recorded for HPV2 and approx. 2 percentage points higher than that recorded for HPV3. Low HPV3 coverage is particularly evident in birth year 1998, which is presumably due to delay rather than opt-out.

The Department of Infectious Disease Epidemiology receives many requests regarding precautions in connection with delayed HPV vaccination. It is recommended that all three vaccinations be given within the course of a year. In case of delayed vaccination, the next vaccine should be given as soon as possible. The vaccination sequence should not be reinitiated.

Overall, it is assessed that the introduction of HPV vaccination of girls in the Childhood Vaccination Programme has been well received. However, it remains essential to focus attention on HPV vaccination to maintain and, if possible, improve coverage in the future.

(P. Valentiner-Branth, L.K. Knudsen, P.H. Andersen, Department of Infectious Disease Epidemiology)

30 May 2012