Vaccine coverage for Ontario's three school-based vaccination programs: 2012/13 school year and recent trends

S Wilson, GH Lim, CY Seo, T Harris, MA McIntyre, J Fediurek, SL Deeks

CPHA conference, Toronto, ON May 27, 2014

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Disclosures

• I have no financial or other conflicts of interest

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Rationale for school-based immunization delivery

• Provide a platform to reach adolescents• Adolescents have low HCP attendance1, especially males2

• Improve compliance/coverage of multiple-dose vaccines

• Immunize before onset of risk behaviours• Sexual debut, injection drug use, etc.

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1. Rand et al. Pediatrics 2007;120:461e6.2. Dempsey & Freed. Pediatrics 2010;125:43e9.

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Benefits of school-based immunization delivery

• Cost-effectiveness as compared to HCP-delivered• Demonstrated for Hepatitis B1,2 and meningococcal conjugate3

• Convenience leading to increased coverage1

• Improved health equity?• Reverse gradient found for HPV vaccine uptake in BC4, not ON5

• Peer support at the time of vaccination6

• Opportunity to evaluate new schedules7

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1. Guay et al. CJPH 2003;94:64-67.2. Dueson et al. Am J Public Health 1999;89:1722-27.3. Trotter et al. BMJ 2002;324:809.4. Ogilvie et al. PLoS Med. 2010 May 4;7(5):e1000270. 5. Smith et al. BMC Public Health. 2011 Aug 13;11:645. 6. Robbins et al. Sex Health 2010;7(3):271-78.7. Eggertson L. CMAJ August 28, 2007 vol. 177 no. 5 doi: 10.1503/cmaj.071048

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Ontario’s school-based immunization programs

• Hepatitis B vaccine (1994)• 2 dose program• Delivery in grade 7, extended eligibility until end of grade 8

• Invasive meningococcal disease (2005, MCV4 since 2009)• 1 dose (Men-C program for toddlers)• Delivery in grade 7, once eligible, always eligible

• Human papillomavirus (HPV, 2007)• 3 dose program• Delivery to grade 8 girls, extended eligibility until end of grade 12

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National coverage targets

• Hepatitis B vaccine• Achieve and maintain 95% hepatitis B immunization of populations targeted in

universal programs by 1997

• Meningococcal conjugate vaccine• Coverage target of 90% for Men-C vaccine at age 17 by 2012• No coverage target specific to MCV4 vaccine

• HPV vaccine• Coverage targets of 80% within 2 years and 90% within 5 years

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1. Health Canada. Canadian National Report on Immunization, 1996. CCDR 1997;23S4.2.Public Health Agency of Canada. Final Report of Outcomes from the National Consensus Conference for Vaccine-Preventable Diseases in Canada. CCDR 2007;33S3:1-56.3. Canadian Immunization Committee. Recommendations on a human papillomavirus immunization program. Ottawa, ON: Public Health Agency of Canada; December 2007.

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Methods

• June 2013: PHUs contacted to request coverage data• Immunizations received as of June 30, 2013 entered into the Immunization

Records Information System (IRIS)

• Coverage was expressed as the proportion of enrolled students who were assessed to be “complete for age” using IRIS logic• Assessed for each antigen and birth cohort

• Data validation with PHUs for 2010/11 to 2012/13 data

• PHU-specific data compiled to derive provincial estimates

• Temporal trend data• Historical IRIS data with the exception of survey in 2011/12; • Supplementary data on HPV via survey methodology (2007/8 to 2009/10)

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Ontario Hepatitis B immunization coverage: 2007/08 to 2012/13

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Ontario adolescent meningococcal immunization coverage:

2007/08 to 2012/13

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Ontario HPV immunization coverage: 2007/08 to 2009/10

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Wilson SE, Harris T, Sethi P, Fediurek J, Macdonald L, Deeks SL. Coverage from Ontario, Canada's school-based HPV vaccine program: The first three years. Vaccine. 2013 Jan 21;31(5):757-62. doi: 10.1016/j.vaccine.2012.11.090. Epub 2012 Dec 13

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School-based immunization coverage: 2007/08 to 2012/13

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Limitations

• Coverage estimates reported here do not include extended eligibility doses, with exception of HPV vaccine coverage survey• Likely underestimates true program uptake

• Completeness of denominator data

• Mismatch between program eligibility (grade-based) and coverage calculation (age-based)

• Coverage reports not specific to vaccine products • Men-C vaccine versus MCV4

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Conclusions

• School-based immunization delivery is an effective platform to achieve high immunization coverage

• Ontario’s coverage estimates meets national coverage target for meningococcal conjugate• Direction of recent trends encouraging for HPV and Hepatitis B

• New information system (Panorama) presents opportunities for more detailed assessment of coverage and analysis of predictors of uptake

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Acknowledgements

• VPD managers and staff at Ontario’s 36 Public Health Units

• Immunization coverage team at PHO• Dr. Shelley Deeks• Jill Fediurek• Tara Harris• Gillian Lim • Margaret McIntyre• Chi Yon Seo

• Immunization Policy and Programs Section of the Ontario Ministry of Health and Long-Term Care

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