Venturelli Francesco, Baldacchini Flavia, Campari Cinzia, Perilli Cinzia, Pascucci Maria Grazia, Finarelli Alba Carola, Moscara Luigi, Rossi Paolo Giorgi
Interinstitutional Epidemiology Unit, Local Health Authority of Reggio Emilia, Reggio Emilia, Italy.
Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
BMJ Open. 2017 Sep 25;7(9):e016189. doi: 10.1136/bmjopen-2017-016189.
In Emilia-Romagna, the Human Papillomavirus (HPV) vaccination campaign started in 2008 offering free vaccines for 1996 and 1997 cohorts. Systematic active invitation was implemented for the 1997 cohort. Our study aimed at measuring the impact of the active invitation campaign on HPV vaccine coverage and on coverage inequalities in 11-year-old girls. Second, we evaluated the effect of the HPV vaccination campaign on participation in cervical cancer screening by mothers of target girls.
We collected information on vaccination status for girls residing in Reggio Emilia in 2008 and mothers' screening history, before and after the 2008 vaccination campaign. Log-binomial regression models were performed to estimate Relative Risk (RR) and 95% confidence intervals (CIs) of being vaccinated as regarded citizenship, siblings, mothers' education, marital status and screening history, stratified by birth cohort. We also calculated RR of receiving a Pap test after the vaccination campaign as regarded education, daughter's cohort and mothers' decision to have their daughter vaccinated. Interaction between education and cohort in mothers overdue for Pap testing was calculated.
Vaccination coverage was 46.3% for the uninvited cohort (1046/2260) and 77.9% for the invited cohort (1798/2307). In the uninvited cohort, daughters' vaccination showed association with mothers' education (8 to 11 years of education vs. graduated mothers, RR 1.61 95% CI 1.14-2.28), citizenship (foreigners vs. Italians, RR 0.45 95% CI 0.37-0.56) and screening history (regular vs. non-participant; RR 1.72 95% CI 1.26-2.36). In the invited cohort, only a slight association with screening history persisted (regular vs. non-participant; RR 1.20 95% CI 1.04-1.40). Highly educated under-screened mothers of the invited cohort showed a higher probability of receiving a Pap test after the vaccination campaign period (RR 1.27 95% CI 1.04-1.56) compared with those not invited, CONCLUSION: Active invitation could increase overall HPV immunisation coverage and reduce socio-demographic inequalities and the association with mothers' screening participation.
在艾米利亚 - 罗马涅大区，人乳头瘤病毒（HPV）疫苗接种活动于2008年启动，为1996年和1997年出生队列的人群免费提供疫苗。对1997年出生队列实施了系统性主动邀请。我们的研究旨在衡量主动邀请活动对11岁女孩HPV疫苗接种率及接种率不平等情况的影响。其次，我们评估了HPV疫苗接种活动对目标女孩母亲参与宫颈癌筛查情况的影响。
我们收集了2008年居住在雷焦艾米利亚的女孩的疫苗接种状况信息，以及2008年疫苗接种活动前后其母亲的筛查史。采用对数二项回归模型，按出生队列分层，估计在公民身份、兄弟姐妹数量、母亲教育程度、婚姻状况和筛查史方面接种疫苗的相对风险（RR）和95%置信区间（CI）。我们还计算了在疫苗接种活动后接受巴氏试验的RR，该RR与母亲的教育程度、女儿的出生队列以及母亲让女儿接种疫苗的决定有关。计算了母亲巴氏试验逾期未做情况下教育程度和出生队列之间的交互作用。
未被邀请队列的疫苗接种率为46.3%（1046/2260），被邀请队列的疫苗接种率为77.9%（1798/2307）。在未被邀请队列中，女儿的疫苗接种情况与母亲的教育程度（8至11年教育程度的母亲与毕业母亲相比，RR 1.61，95% CI 1.14 - 2.28）、公民身份（外国人与意大利人相比，RR 0.45，95% CI 0.37 - 0.56）和筛查史（定期筛查与未参与者相比；RR 1.72，95% CI 1.2
