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CPHA conference, Toronto, ON May 27, 2014

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. Disclosures.

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CPHA conference, Toronto, ON May 27, 2014

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  1. 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

  2. Disclosures • I have no financial or other conflicts of interest

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

  4. 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 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

  5. 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

  6. 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 • 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.

  7. 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)

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

  9. Ontario adolescent meningococcal immunization coverage: 2007/08 to 2012/13

  10. Ontario HPV immunization coverage: 2007/08 to 2009/10 1 1 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

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

  12. 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

  13. 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

  14. 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 ProgramsSection of the Ontario Ministry of Health and Long-Term Care

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