Factors associated with parental intention to vaccinate their child against influenza, Finland, February to March, 2022: a web-based survey.

BackgroundInfluenza vaccination for children aged 6 months to 6 years is included in the national vaccination programme in Finland. Although all vaccines in the programme are free of charge, national coverage of influenza vaccination among children under 3 years and 3-6 years during 2020/21 was 43% and 35% respectively, with regional differences.AimTo assess factors underlying parental vaccination intention in order to increase influenza vaccine uptake among children.MethodsWe conducted a web-based survey among parents (n = 17,844) of randomly selected eligible children (aged 6 months-6 years) in February-March 2022 in five Finnish municipalities from regions of high and low coverage. Logistic regressions were used to determine associations between vaccination intention and e.g. sociodemographic factors, attitudes and knowledge. Linkage to the national vaccination register was used to confirm realisation of vaccination intention after the study.ResultsParticipation rate was 13% (n = 2,322 parents). Influenza knowledge, trust in official information, responding parent's education level, adherence to the vaccination programme, number of children and changes in attitudes towards vaccination since COVID-19 were all associated with intention to vaccinate. Vaccination intention for children was 64%, and realised vaccination 51%.ConclusionDespite the low participation rate, both vaccinated and unvaccinated children were represented. Influenza vaccine uptake is not dependent on a single factor. Our results identified the need for open dialogue between parents and healthcare professionals, as the lack of vaccine being offered by healthcare professionals was the most reported reason for not vaccinating.

"If the nurse tells me this is a good thing, I trust her completely" - Exploring health system enablers of MMR vaccine uptake in the Finnish Somali community: A mixed method study.

BACKGROUND: Globally, migrant populations usually experience lower vaccine coverage than the general population. In Finland, the MMR vaccination coverage of Somalis has not been studied specifically, but existing evidence suggests that the MMR vaccination coverage is high. The aim of this study was to examine both vaccination coverage of Somali children and factors associated with the MMR vaccine uptake of Somali children living in Finland. METHODS: Twenty-seven mothers and seventeen public health nurses were interviewed using a semi-structured interview protocol. Audio-recorded interviews were transcribed and translated and analysed thematically after coding. The personal identity code of Somali children born in 2015 and 2020 were extracted from the Population Information System (PIS), and their vaccination coverage data was extracted from the national vaccination register (NVR) to calculate MMR vaccination coverage for Somali children. RESULTS: 96 % of Somali children born in 2015 and 81 % of those born in 2020 received their MMR vaccination. In contrast, the national average MMR vaccine uptake for children born in 2015 was 95 %, while 94 % of those born in 2020 were vaccinated against MMR. Somali mothers had poor knowledge of the MMR vaccine and the diseases it protects against. Trust towards the Finnish healthcare system, perceived benefits of vaccinating, positive attitudes towards vaccines, nurses' systematic approach to vaccine introduction, and nurses taking into account the cultural background of the clients were recognised as enablers positively affecting MMR vaccination uptake. CONCLUSION: Despite limited knowledge of vaccines, Somali immigrant mothers believe in the benefits of vaccination, and they displayed strong trust towards public health nurses. Further investigation is needed to understand why MMR vaccination coverage has declined among the younger Somali population.

Factors associated with parental Human Papillomavirus (HPV) vaccination intention of daughter: A national survey in Finland.

BACKGROUND: Human papillomavirus (HPV) vaccines are offered free of charge in Finland to 10-12-year-old children. Nationally about 80% of girls are vaccinated, with regional differences in first dose coverage varying from 62% to 82% in girls born in 2011. This study examined the factors associated with HPV vaccination intention. Furthermore, we assessed the realisation of HPV vaccination among the daughters of the participating parents. METHODS: A web-based survey was conducted for randomly selected parents of girls (N = 6 465) aged 10 to 14 years of age. Data was collected in February and March 2022 in five Finnish high and low coverage municipalities. The national vaccination register was employed to assess realisation of vaccination. RESULTS: Participation rate was 13.7% (n = 883 parents). Almost all parents were aware of the association between HPV and cervical cancer, but only one fifth was aware of other diseases associated with HPV. Adherence to the national vaccination programme, parents' mother tongue, and trusting in official information were associated with positive vaccination intention. The most often reported reason for non-vaccination was fear of adverse effects (22%). Overall, parental attitudes towards HPV vaccination were positive, with 83% of parents indicating their daughter had received or will receive the vaccination. Vaccination realisation was subsequently examined and 88% of the daughters were vaccinated. CONCLUSIONS: Despite low knowledge of HPV-related diseases overall, majority of parents held a positive intention to vaccinate their daughter. Realisation of intention was high in our study, higher than the national uptake. Foreign-origin parents had lower intention to vaccinate their daughters. As information on HPV and its vaccine is available in 11 languages, there is a need to re-think accessibility. In-depth interviews are needed to better explore the reasons behind non-vaccination.

Prices of paediatric vaccines in European vaccination programmes.

Objective: To compare the vaccine prices per vaccinated child under 18 and vaccine funding and procurement systems in the national vaccination programmes (NVPs) in Europe. Methods: The on-line survey targeted to NVP managers collected data referred to the information available on 31 December 2016. The prices of vaccines were categorised into three groups. The price per child 1) fully vaccinated comprised all vaccines and doses offered in the NVP; 2) vaccinated with standard vaccines comprised the vaccines included in the NVP in all countries; 3) vaccinated with recent vaccines comprised the pneumococcal conjugate, human papillomavirus and rotavirus vaccines. Results: In the 23 out of 32 countries that answered the survey, 17 funded the vaccines by taxes and six by social insurance. 18 countries procured the vaccines through public tenders or negotiations. Five countries purchased the vaccines by healthcare providers and reimbursed from the health insurance system.In the countries with vaccine procurement through public tenders the price per child vaccinated with standard vaccines ranged from €59 to €117 when using pentavalent and from €98 to €220 when using hexavalent vaccines. The mean price per child vaccinated with recent vaccines was €130 for the countries that offered pneumococcal conjugate and human papillomavirus vaccines and €142 for the countries that in addition included rotavirus vaccine.In the countries that purchased the vaccines by healthcare providers and reimbursed from the health insurance system the price per child vaccinated with standard vaccines ranged from €136 to €427. Conclusions: The vaccine prices differ notably in Europe. Prices were lower in countries where vaccines in the NVP were tax-funded and nationally or regionally procured. Improved procurement systems could lead to substantial savings or possibilities to introduce more vaccines into the NVP.

Decline in varicella cases contacting primary health care after introduction of varicella vaccination in Finland - A population-based register study.

A two-dose varicella vaccination programme at the age of 18 months and 6 years started in September 2017 in Finland with catch-up vaccinations, based on earlier modelling results, for children <12 years (born in 2006 or later) with no history of varicella. Nationwide population-based register data were used to assess the age-specific vaccination coverage and the annual incidence rates of varicella cases contacting public primary health care in 2014-2020. Age-specific incidence rates after (2022) and before (2014-2016) the implementation of the vaccination programme was compared by incidence rate ratios (IRR) with 95 % confidence interval. In 2019-2022, the first-dose coverage of varicella vaccination among children following the routine vaccination programme ranged from 85 to 87 % (children born in 2016 or later). The second-dose coverage was 58 % for the children born in 2016. The coverage of the catch-up vaccinations ranged from 18 % (children born in 2006) to 82 % (children born in 2015) for the first dose and from 10 % to 64 % for the second dose in the respective birth cohorts. In 2022, compared to the pre-vaccination period (2014-2016) the annual incidence rate of varicella cases contacting public primary health care declined in all age groups. The reduction ranged from 92 % to 98 % among the children eligible for the vaccinations (born 2006 or later). The 87 % reduction in the incidence rate among the unvaccinated children < 1 year suggests the indirect effect of the vaccinations. Introducing varicella vaccinations with catch-up was associated with rapid reduction in the varicella cases contacting primary health care in all ages. However, the coverage of the routine programme needs to be improved further as presently susceptibles accumulate and enable thus further outbreaks in coming decades.

Effectiveness of 10-valent pneumococcal conjugate vaccine estimated with three parallel study designs among vaccine-eligible children in Finland.

BACKGROUND: Ten-valent pneumococcal conjugate vaccine (PCV10) was introduced into the Finnish National Vaccination Programme (NVP) in 9/2010. We estimated the individual-level effectiveness (VE) of PCV10 in children during eight years of vaccine implementation. METHODS: Data on invasive pneumococcal disease (IPD) were collected from national, population-based surveillance, and vaccination status from the vaccination register. Vaccine-eligible children were followed from six months of age until end of 2018 (born 6/2010 or later, ages 6-102 months). VE was estimated with three parallel approaches: full cohort, nested case-control and indirect cohort designs adjusting with age-group, sex and calendar year. RESULTS: VE against PCV10 serotype IPD was estimated at 93% (95% credible interval 87-97%), 98% (90-100%) and 100% (98-100%), and against PCV10-related serotypes at 46% (-13-72%), 51% (-24-79%), and 78% (-7-97%), with the full cohort, nested case-control, and indirect cohort designs, respectively. The estimated VE against non-PCV10-related (neither PCV10 nor PCV10-related) serotypes was negative but included zero effectiveness (full cohort VE -67%, -711-52%; nested case-control VE -77%, -929-59%). VE against all IPD was estimated with these two methods at 54% (24-71%) and 61% (26-79%). Over time, VE against PCV10 IPD remained stable but VE against all IPD decreased. DISCUSSION: All designs provided estimates that were concordant with each other, but those with the full cohort design were usually the most precise. PCV10 offered sustained high VE against PCV10-serotype IPD on vaccinated children during the first decade after introduction into the programme.

Long-term impact of 10-valent pneumococcal conjugate vaccination on invasive pneumococcal disease among children in Finland.

BACKGROUND: The ten-valent pneumococcal conjugate vaccine (PCV10) was introduced into the Finnish National Vaccination Programme (NVP) in September 2010. The impact of PCV10 vaccination against invasive pneumococcal disease (IPD) in vaccine-eligible children has been high. We evaluated the long-term impact of PCV10 vaccination against IPD in vaccine-eligible and older, unvaccinated children six years after PCV10 introduction with a special focus on cross-protection against PCV10-related serotypes (serotypes in the same serogroups as the PCV10 types). METHODS: We used data on IPD from the national, population-based surveillance. A target cohort of vaccine-eligible children (born June 2010 or later) was followed from 3 months of age until the end of 2016. For the indirect effect, another cohort of older PCV10-ineligible children was followed from 2012 through 2016. IPD rates were compared with those of season- and age-matched reference cohorts before NVP introduction. RESULTS: Among vaccine-eligible children, the incidence of all IPD decreased by 79% (95% CI 74-83%). There was a statistically significant reduction in the incidence of 6A IPD, but for 19A, the reduction was non-significant and the incidence of 19A increased towards the end of the study period in the older vaccine-eligible children. The increase in non-PCV10 related serotypes was non-significant. In the unvaccinated older children, the incidence of all IPD decreased by 33% (95% CI 8-52%) compared to the reference cohort, and there was no impact on serotype 6A or 19A IPD. CONCLUSION: Overall, the impact of PCV10 vaccination on IPD was high in vaccine-eligible children, with a major reduction in vaccine-type disease, and without notable replacement by other serotype groups. Our data suggest that PCV10 results in long-lasting direct cross-protection against 6A IPD. For 19A, no net reduction was observed six years after NVP introduction in the vaccine-eligible cohort. The indirect impact on IPD in unvaccinated children sustained.

Cost-effectiveness of two-dose human papillomavirus vaccination in Singapore.

INTRODUCTION: Cervical cancer is the tenth most common cancer and the eighth most frequent cause of death among women in Singapore. As human papillomavirus (HPV) infection is the necessary cause of cervical cancer, the risk of cervical cancer can be substantially reduced through vaccination. This study was conducted to evaluate the cost-effectiveness of two-dose HPV vaccination as part of a national vaccination programme for 12-year-old girls in Singapore, from the perspective of the healthcare payer. METHODS: A lifetime Markov cohort model was used to evaluate the cost-effectiveness of introducing the AS04-adjuvanted HPV-16/18 vaccine (AS04-HPV-16/18v) to the current cervical screening programme in Singapore. Furthermore, the cost-effectiveness of the AS04-HPV-16/18v was compared with the HPV-6/11/16/18 vaccine (4vHPV). Model inputs were derived from local data, where possible, and validated by clinical experts in Singapore. RESULTS: Introduction of the AS04-HPV-16/18v in Singapore was shown to prevent 137 cervical cancer cases and 48 cervical cancer deaths when compared with screening alone. This resulted in an incremental cost-effectiveness ratio of SGD 12,645 per quality-adjusted life year (QALY) gained, which is cost-effective according to the World Health Organization threshold for Singapore. When discounted at 3%, AS04-HPV-16/18v was dominant over 4vHPV, with cost savings of SGD 80,559 and 28 additional QALYs gained. In the one-way sensitivity analysis, AS04-HPV-16/18v remained cost-effective compared with screening alone and dominant compared with 4vHPV. CONCLUSION: AS04-HPV-16/18v is the most cost-effective choice for reducing the burden of cervical cancer through universal mass vaccination for 12-year-old girls in Singapore.

Comparison of the reactogenicity of three different immunization schedules including diphtheria, tetanus, pertussis, Haemophilus influenza b and polio vaccine in Turkey.

BACKGROUND: In Turkey, several changes have been made in the vaccination schedule. Vaccines against diphtheria, tetanus, pertussis and poliomyelitis were applied as DTwP and OPV until the end of 2006. Hib vaccine was added to the schedule and was administered as a separate injection in 2007 as DPT + OPV + Hib. DTaP-IPV/Hib combined vaccine replaced them in 2008. The aim of this study was to evaluate the alterations in the frequency of adverse reactions of these different schedules in the consecutive three years. METHODS: A total of 2401 infants who were vaccinated in Gazi University Well Child Clinics during the first 3 months of each schedule were enrolled in the study. Local and systemic adverse events were recorded in diaries by the parents for the next three days. RESULTS: No significant differences existed between infants vaccinated with DPT + OPV and DPT + OPV + Hib regarding all adverse events detected. Frequency of local and systemic reactions were lower in infants vaccinated with DTaP-IPV/Hib combined vaccine (p < 0.001). Frequency of adverse events in infants vaccinated with DPT + OPV or DPT+ OPV + Hib were highest at booster doses. CONCLUSIONS: The original experience of the study is the demonstration of the adverse event profile for three different schedules which allowed us to draw the profile of the adverse events in a country with changing national schedules. Implementation of Schedule 3 reduced the adverse events of vaccination. Thus reduction in the number of injections and reactogenicity of pertussis vaccine contributed to an increase in the compliance to the vaccination program.