Giambi Cristina, Del Manso Martina, D'Ancona Fortunato, De Mei Barbara, Giovannelli Ilaria, Cattaneo Chiara, Possenti Valentina, Declich Silvia
Communicable Disease Epidemiology Unit, National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
Unit of Training and Communication, National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
Vaccine. 2015 May 15;33(21):2425-31. doi: 10.1016/j.vaccine.2015.04.007. Epub 2015 Apr 11.
In Italy, HPV vaccination is offered to 11-year-old girls since 2007. In 2012 coverage was 69%. Strategies for offering and promoting HPV vaccination and coverage rates (26-85%) vary among Regions and Local Health Authorities (LHAs). We conducted a national study to identify strategies to improve HPV vaccination uptake.
In 2011-2012 we invited the 178 LHAs to fill a web-questionnaire, inquiring implementation of HPV vaccination campaigns (immunization practices, logistics of vaccine delivery, training, activities to promote vaccination, barriers, local context). We described type of offer and vaccination promotion in each LHA and studied the association of these factors with vaccination coverage rates.
We analyzed 133 questionnaires. The communication tools more frequently used to promote vaccination were: brochures/leaflets (92% of LHAs), fliers/posters (72%). Television (24%) and radio (15%) were less used. Using ≥3 communication channels was associated to a coverage ≥70% (ORadj=5.9, 95%CI 2.0-17.4). The probability to reach a coverage ≥70% was higher if the invitation letter indicated a pre-assigned date for HPV vaccination (ORadj=7.0, 95%CI 1.2-39.8) and >1 recall for non-respondents was planned (ORadj=4.1, 95%CI 1.8-9.3). Immunization services and paediatricians were involved in informative and training activities in most LHAs (80-90%), instead general practitioners, women and family's healthcare services and public gynaecologists in 60-70%, cervical cancer screening services and private gynaecologists in 20-40%. The main factors that negatively affected vaccination uptake were: poor participation to training events of professional profiles different from personnel of immunization services (reported by 58% LHAs), their mistrust towards HPV vaccination (55%) and insufficient resources (56%).
The synergy of multiple interventions is necessary for a successful vaccination programme. Practices such as pre-assigning vaccination date and repeatedly recalling non-respondents could improve vaccination uptake. Efforts are required to strengthen the training of different professional profiles and services and encourage their collaboration. Economical resources are needed to promote vaccination.
在意大利，自2007年起为11岁女孩提供人乳头瘤病毒（HPV）疫苗接种服务。2012年的接种覆盖率为69%。不同地区和地方卫生当局（LHA）提供和推广HPV疫苗接种的策略以及接种覆盖率（26%-85%）各不相同。我们开展了一项全国性研究，以确定提高HPV疫苗接种率的策略。
在2011 - 2012年，我们邀请178个地方卫生当局填写一份网络调查问卷，询问HPV疫苗接种活动的实施情况（免疫接种操作、疫苗配送后勤、培训、推广接种活动、障碍、当地情况）。我们描述了每个地方卫生当局提供疫苗接种服务的类型和推广方式，并研究了这些因素与疫苗接种覆盖率之间的关联。
我们分析了133份调查问卷。最常用于推广疫苗接种的沟通工具是：宣传册/传单（92%的地方卫生当局）、传单/海报（72%）。电视（24%）和广播（15%）的使用较少。使用≥3种沟通渠道与≥70%的接种覆盖率相关（校正比值比=5.9，95%置信区间2.0 - 17.4）。如果邀请信中指明了HPV疫苗接种的预先安排日期，达到≥70%接种覆盖率的概率更高（校正比值比=7.0，95%置信区间1.2 - 39.8），并且计划对未回复者进行>1次召回时也是如此（校正比值比=4.1，95%置信区间1.8 - 9.3）。在大多数地方卫生当局（80%-90%），免疫接种服务和儿科医生参与了信息提供和培训活动，而全科医生、妇女和家庭医疗服务以及公共妇科医生的参与比例为60%-70%，宫颈癌筛查服务和私立妇科医生的参与比例为20%-40%。对疫苗接种率产生负面影响的主要因素有：与免疫接种服务人员不同专业背景的人员参与培训活动的积极性不高（58%的地方卫生当局报告）、他们对HPV疫苗接种的不信任（55%）以及资源不足（56%）。
成功的疫苗接种计划需要多种干预措施协同作用。预先安排疫苗接种日期和反复召回未回复者等做法可以提高疫苗接种率。需要努力加强对不同专业背景人员和服务的培训，并鼓励他们开展合作。推广疫苗接种需要经济资源。
