Department of Economics and CEBI, University of Copenhagen, Copenhagen, Denmark.
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States.
Vaccine. 2020 Jun 9;38(28):4432-4439. doi: 10.1016/j.vaccine.2020.04.055. Epub 2020 May 15.
Human papillomavirus (HPV) vaccine coverage was high in Denmark until it plunged following negative media coverage. We examined whether the decline in HPV vaccination undermined uptake of another adolescent vaccine, measles, mumps and rubella (MMR).
The Danish national health register provided data on uptake of MMR vaccine dose 2 (at age 13) for children born from 1991 to 2003 (n = 827,716). The primary exposure variable comprised three time periods: before HPV vaccine introduction, during high HPV vaccine coverage, and after the drop in HPV vaccine coverage. To examine the effect of HPV vaccination on MMR2 uptake, we estimated MMR2 uptake by age 13 using logistic regression, controlling for gender, birth month, birth year, and maternal education.
MMR2 vaccination coverage was high for both girls and boys (86% and 85%) in 2009. Following the introduction of HPV vaccine for girls in 2009, MMR2 coverage increased for girls even as it decreased for boys (gender gap 4·6 percentage points, 95% CI 4·3 to 4·8). Coverage with MMR2 for girls continued to be high over the following four years, and almost all girls (91%) who received MMR2 vaccination also received HPV1 vaccination within the same week. When negative media coverage led to a decline in HPV vaccination, MMR2 uptake for girls also declined. By 2015, MMR2 coverage for girls and boys had become similar again (80% and 79%). Families with the highest level of maternal education showed the strongest decline in MMR2 coverage for girls.
Concomitant vaccine provision can increase overall vaccine uptake. However, reduced demand for one vaccine may reduce concomitant vaccination and undermine resiliency of a country's vaccination program.
Drs. Gørtz and Ejrnæs appreciate generous funding from the Novo Nordisk Foundation (grant no. NNF17OC0026542) and from the Danish National Research Foundation through its grant (DNRF-134) to the Center for Economic Behavior and Inequality (CEBI) at the University of Copenhagen.
在丹麦，人乳头瘤病毒（HPV）疫苗的接种率很高，直到负面媒体报道后大幅下降。我们研究了 HPV 疫苗接种率的下降是否会削弱另一种青少年疫苗——麻疹、腮腺炎和风疹（MMR）的接种率。
丹麦国家健康登记处提供了 1991 年至 2003 年出生的儿童在 13 岁时接种 MMR 疫苗第二剂（剂量）的数据（n=827716）。主要的暴露变量包括三个时间段：HPV 疫苗接种前、HPV 疫苗高接种率期间和 HPV 疫苗接种率下降后。为了研究 HPV 疫苗接种对 MMR2 接种率的影响，我们使用逻辑回归估计了 13 岁时的 MMR2 接种率，控制了性别、出生月份、出生年份和母亲的教育程度。
2009 年，男孩和女孩的 MMR2 疫苗接种率均很高（分别为 86%和 85%）。2009 年为女孩接种 HPV 疫苗后，女孩的 MMR2 接种率增加，而男孩的接种率下降（性别差距为 4.6 个百分点，95%CI 为 4.3 至 4.8）。接下来的四年，女孩的 MMR2 接种率继续保持高位，而且几乎所有接受 MMR2 接种的女孩（91%）也在同一周内接种了 HPV1 疫苗。当负面媒体报道导致 HPV 疫苗接种率下降时，女孩的 MMR2 接种率也随之下降。到 2015 年，女孩和男孩的 MMR2 接种率又变得相似（分别为 80%和 79%）。母亲教育水平最高的家庭中，女孩的 MMR2 接种率下降幅度最大。
同时提供疫苗可能会增加整体疫苗接种率。然而，一种疫苗需求的减少可能会减少同时接种疫苗的数量，并破坏一个国家疫苗接种计划的弹性。
Gørtz 博士和 Ejrnæs 博士感谢诺和诺德基金会（NNF17OC0026542 号）和丹麦国家研究基金会通过其对哥本哈根大学经济行为与不平等中心（CEBI）的资助（DNRF-134）慷慨资助。
