Singer Regina, Hübotter Imke, Hölzner Franziska, Genedl Christine, Jasker Lutz, Michalski Niels, Piepel Christiane, Rieck Thorsten, Tempel Günter, Wichmann Ole, Takla Anja
Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany; Postgraduate Training for Applied Epidemiology, Robert Koch Institute, Berlin, Germany; ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
Public Health Department, City of Bremen, Germany.
Vaccine. 2025 Jan 25;45:126636. doi: 10.1016/j.vaccine.2024.126636. Epub 2024 Dec 18.
Germany primarily relies on a practice-based, opportunistic immunisation system. Despite the introduction of the Human papillomavirus (HPV) vaccine into the German vaccination schedule in 2007, coverage remains low. International experience suggests that school-based vaccination can increase HPV coverage. Therefore, in 2013/14 Bremen's public health department offered HPV vaccinations within a school programme, targeting all 8th-graders. We aimed to evaluate the programme, with a focus on vulnerable groups. In a retrospective cohort design, we analysed vaccination status and uptake among all 8th-graders from 2015/16 to 2018/19 (girls) and 2022/23 (girls and boys). Sub-analyses were based on the School Social Index (SSI), which ranges from 1 (higher socio-economic position, SEP) to 5 (lower SEP), considering factors like poverty, migration, and living environment. The study included 13,550 students from 1,440 classes in 56 schools. Among previously unvaccinated students, 26-35 % of girls and 39 % of boys annually accepted and received the school-based HPV vaccination. Uptake was higher among students from lower as compared to higher SEP schools (SSI 5: 37 % vs. SSI 1: 30 %, p = 0.022). Vaccine uptake among unvaccinated students remained stable over time, with one-third receiving at least one HPV vaccination at school. The remaining two-thirds of unvaccinated did not make use of the vaccination offer at school. It needs to be investigated if this is possibly due to vaccine hesitancy or a preference for practice-based vaccinations. While school vaccination programmes can improve uptake, implementing a nationwide programme in Germany will be challenging and may not address all existing major uptake barriers.
德国主要依赖基于实践的机会性免疫接种系统。尽管2007年人乳头瘤病毒（HPV）疫苗被纳入德国疫苗接种计划，但覆盖率仍然很低。国际经验表明，以学校为基础的疫苗接种可以提高HPV疫苗覆盖率。因此，在2013/14年，不来梅公共卫生部门在一项学校计划中提供HPV疫苗接种，目标人群为所有八年级学生。我们旨在评估该计划，重点关注弱势群体。在一项回顾性队列研究设计中，我们分析了2015/16年至2018/19年（女孩）以及2022/23年（女孩和男孩）所有八年级学生的疫苗接种状况和接种率。亚组分析基于学校社会指数（SSI），该指数范围从1（社会经济地位较高，SEP）到5（社会经济地位较低，SEP），考虑了贫困、移民和生活环境等因素。该研究纳入了来自56所学校1440个班级的13550名学生。在之前未接种疫苗的学生中，每年有26%-35%的女孩和39%的男孩接受并接种了基于学校的HPV疫苗。与社会经济地位较高学校的学生相比，社会经济地位较低学校的学生接种率更高（SSI 5：37% 对比 SSI 1：30%，p = 0.022）。未接种疫苗的学生的疫苗接种率随时间保持稳定，三分之一的学生在学校至少接种了一剂HPV疫苗。其余三分之二未接种疫苗的学生没有利用学校提供的疫苗接种服务。需要调查这是否可能是由于疫苗犹豫或对基于实践的疫苗接种的偏好。虽然学校疫苗接种计划可以提高接种率，但在德国实施全国性计划将具有挑战性，并且可能无法解决所有现有的主要接种障碍。
