presentation - Canadian Public Health Association

Vaccine coverage for Ontario's three
school-based vaccination programs:
2012/13 school year and recent trends
S Wilson, GH Lim, CY Seo, T Harris,
MA McIntyre, J Fediurek, SL Deeks
CPHA conference, Toronto, ON
May 27, 2014
• I have no financial or other conflicts of interest
Rationale for school-based
immunization delivery
• Provide a platform to reach adolescents
• Adolescents have low HCP attendance1, especially males2
• Improve compliance/coverage of multiple-dose vaccines
• Immunize before onset of risk behaviours
• Sexual debut, injection drug use, etc.
1. Rand et al. Pediatrics 2007;120:461e6.
2. Dempsey & Freed. Pediatrics 2010;125:43e9.
Benefits of school-based
immunization delivery
• Cost-effectiveness as compared to HCP-delivered
• Demonstrated for Hepatitis B1,2 and meningococcal conjugate3
• Convenience leading to increased coverage1
• Improved health equity?
• Reverse gradient found for HPV vaccine uptake in BC4, not ON5
• Peer support at the time of vaccination6
• Opportunity to evaluate new schedules7
1. Guay et al. CJPH 2003;94:64-67.
2. Dueson et al. Am J Public Health 1999;89:1722-27.
3. Trotter et al. BMJ 2002;324:809.
4. Ogilvie et al. PLoS Med. 2010 May 4;7(5):e1000270.
5. Smith et al. BMC Public Health. 2011 Aug 13;11:645.
6. Robbins et al. Sex Health 2010;7(3):271-78.
7. Eggertson L. CMAJ August 28, 2007 vol. 177 no. 5 doi:
Ontario’s school-based
immunization programs
• Hepatitis B vaccine (1994)
• 2 dose program
• Delivery in grade 7, extended eligibility until end of grade 8
• Invasive meningococcal disease (2005, MCV4 since 2009)
• 1 dose (Men-C program for toddlers)
• Delivery in grade 7, once eligible, always eligible
• Human papillomavirus (HPV, 2007)
• 3 dose program
• Delivery to grade 8 girls, extended eligibility until end of grade 12
National coverage targets
• Hepatitis B vaccine
• Achieve and maintain 95% hepatitis B immunization of populations targeted in
universal programs by 1997
• Meningococcal conjugate vaccine
• Coverage target of 90% for Men-C vaccine at age 17 by 2012
• No coverage target specific to MCV4 vaccine
• HPV vaccine
• Coverage targets of 80% within 2 years and 90% within 5 years
1. Health Canada. Canadian National Report on Immunization, 1996. CCDR 1997;23S4.
2.Public Health Agency of Canada. Final Report of Outcomes from the National Consensus Conference for VaccinePreventable Diseases in Canada. CCDR 2007;33S3:1-56.
3. Canadian Immunization Committee. Recommendations on a human papillomavirus immunization program. Ottawa, ON: Public Health Agency of Canada; December 2007.
• June 2013: PHUs contacted to request coverage data
• Immunizations received as of June 30, 2013 entered into the Immunization
Records Information System (IRIS)
• Coverage was expressed as the proportion of enrolled students who were
assessed to be “complete for age” using IRIS logic
• Assessed for each antigen and birth cohort
• Data validation with PHUs for 2010/11 to 2012/13 data
• PHU-specific data compiled to derive provincial estimates
• Temporal trend data
• Historical IRIS data with the exception of survey in 2011/12;
• Supplementary data on HPV via survey methodology (2007/8 to 2009/10)
Ontario Hepatitis B immunization
coverage: 2007/08 to 2012/13
Ontario adolescent meningococcal
immunization coverage:
2007/08 to 2012/13
Ontario HPV immunization
coverage: 2007/08 to 2009/10
Wilson SE, Harris T, Sethi P, Fediurek J, Macdonald L, Deeks SL. Coverage from Ontario,
Canada's school-based HPV vaccine program: The first three years.
Vaccine. 2013 Jan 21;31(5):757-62. doi: 10.1016/j.vaccine.2012.11.090. Epub 2012 Dec 13
School-based immunization
coverage: 2007/08 to 2012/13
• Coverage estimates reported here do not include extended eligibility
doses, with exception of HPV vaccine coverage survey
Likely underestimates true program uptake
• Completeness of denominator data
• Mismatch between program eligibility (grade-based) and coverage
calculation (age-based)
• Coverage reports not specific to vaccine products
Men-C vaccine versus MCV4
• School-based immunization delivery is an effective platform to achieve
high immunization coverage
• Ontario’s coverage estimates meets national coverage target for
meningococcal conjugate
Direction of recent trends encouraging for HPV and Hepatitis B
• New information system (Panorama) presents opportunities for more
detailed assessment of coverage and analysis of predictors of uptake
• VPD managers and staff at
Ontario’s 36 Public Health Units
• Immunization coverage team at PHO
Dr. Shelley Deeks
Jill Fediurek
Tara Harris
Gillian Lim
Margaret McIntyre
Chi Yon Seo
• Immunization Policy and Programs Section
of the Ontario Ministry of Health and Long-Term Care

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