Institute of Virology, Saarland University Medical Center, Homburg, Germany.
Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg, Germany.
PLoS One. 2022 Sep 2;17(9):e0273332. doi: 10.1371/journal.pone.0273332. eCollection 2022.
In Germany, the incidence of cervical cancer, a disease caused by human papillomaviruses (HPV), is higher than in neighboring European countries. HPV vaccination has been recommended for girls since 2007. However, it continues to be significantly less well received than other childhood vaccines, so its potential for cancer prevention is not fully realized. To find new starting points for improving vaccination rates, we analyzed pseudonymized routine billing data from statutory health insurers in the PRÄZIS study (prevention of cervical carcinoma and its precursors in women in Saarland) in the federal state Saarland serving as a model region. We show that lowering the HPV vaccination age to 9 years led to more completed HPV vaccinations already in 2015. Since then, HPV vaccination rates and the proportion of 9- to 11-year-old girls among HPV-vaccinated females have steadily increased. However, HPV vaccination rates among 15-year-old girls in Saarland remained well below 50% in 2019. Pediatricians vaccinated the most girls overall, with a particularly high proportion at the recommended vaccination age of 9-14 years, while gynecologists provided more HPV catch-up vaccinations among 15-17-year-old girls, and general practitioners compensated for HPV vaccination in Saarland communities with fewer pediatricians or gynecologists. We also provide evidence for a significant association between attendance at the children´s medical check-ups "U11" or "J1" and HPV vaccination. In particular, participation in HPV vaccination is high on the day of U11. However, obstacles are that U11 is currently not financed by all statutory health insurers and there is a lack of invitation procedures for both U11 and J1, resulting in significantly lower participation rates than for the earlier U8 or U9 screenings, which are conducted exclusively with invitations and reminders. Based on our data, we propose to restructure U11 and J1 screening in Germany, with mandatory funding for U11 and organized invitations for HPV vaccination at U11 or J1 for both boys and girls.
在德国，宫颈癌的发病率高于邻国欧洲国家，这种疾病是由人乳头瘤病毒（HPV）引起的。自 2007 年以来，已建议为女孩接种 HPV 疫苗。然而，它的接种情况明显不如其他儿童疫苗，因此其预防癌症的潜力并未得到充分发挥。为了找到提高疫苗接种率的新起点，我们分析了作为示范地区的萨尔州法定健康保险公司 PRÄZIS 研究（萨尔州女性宫颈癌及其前体的预防）中的匿名常规计费数据。我们表明，将 HPV 疫苗接种年龄降低到 9 岁已经导致 2015 年已经有更多的 HPV 疫苗接种完成。从那时起，HPV 疫苗接种率和已接种 HPV 的女性中 9 至 11 岁女孩的比例稳步增加。然而，2019 年萨尔兰州 15 岁女孩的 HPV 疫苗接种率仍远低于 50%。儿科医生总体上为最多的女孩接种了疫苗，在推荐的 9-14 岁疫苗接种年龄比例特别高，而妇科医生则为 15-17 岁的女孩提供了更多的 HPV 补种疫苗，普通科医生则在儿科医生或妇科医生较少的萨尔兰州社区中补偿 HPV 疫苗接种。我们还提供了证据表明，参加儿童医疗检查“U11”或“J1”与 HPV 疫苗接种之间存在显著关联。特别是，在 U11 当天，HPV 疫苗接种率很高。然而，障碍在于目前并非所有法定健康保险公司都为 U11 提供资金，并且 U11 和 J1 都缺乏邀请程序，导致参与率明显低于仅通过邀请和提醒进行的早期 U8 或 U9 筛查。根据我们的数据，我们建议对德国的 U11 和 J1 筛查进行重组，为 U11 提供强制性资金，并为 U11 或 J1 为男孩和女孩组织 HPV 疫苗接种邀请。
