Environmental factors associated with human papillomavirus vaccine coverage in adolescents: 2016-2020 analysis

Abstract

Objective: to analyze the association between the factors of the social environment and the coverage rates of the human papillomavirus (HPV) vaccine in adolescents, in the State of Minas Gerais, Brazil. Method: this is an epidemiological, ecological study, with panel and trend analysis from 2016 to 2020. The population consisted of adolescents aged 9 to 13 years. The environmental variables were coverage rates, the municipal index of human development, income, education, and longevity; and the rate of violence. The Prais-Winsten autoregression and the panel regression model were used, in addition to the estimate of the mean annual percentage variation. Results: the vaccination coverage rates are below the goals recommended by the Ministry of Health for all regions analyzed. Moreover, these rates are associated with factors related to the application of the first dose and to aspects inherent to the social environment, such as the rate of violence. Conclusion: our findings showed that, although tenuous, aspects of the environment, in addition to individual characteristics, provide relevant information to understand the occurrence of health outcomes, since this vaccination campaign presents a strong influence of the environment and age as factors associated with the low rates.

A comprehensive narrative review of challenges and facilitators in the implementation of various HPV vaccination program worldwide

“…School‐based vaccination is the delivery of vaccines to school‐aged children using the school as a venue for delivery via a variety of providers, including nurses, doctors, or community health workers 24 . In developed countries, for instance Australia, Canada, and Sweden, who opted for the school‐based HPV vaccine delivery strategy, vaccination coverage remained adequate and sustained 25 . Although global experience exemplifies that school‐based vaccination programs are competent, but may be compromised by an array of aspects including parents' knowledge and attitude, teachers' and health workers' misinformation and disengagement and negative media coverage 26 .…”

Current HPV Vaccination Strategies in Brazil

“…In March 2014, the HPV vaccine was incorporated into the SUS and began to be offered, at no direct cost, in basic health units, public and private schools for girls aged 11 to 13 years. In the work by Luvisaro et al [9], the coverage achieved with the first and second doses indicated that younger cohorts had a greater chance of being vaccinated. Therefore, it is a relevant factor in vaccination against HPV, as the younger population benefits from this immunobiological, both due to a greater response to the vaccine and the presumption of non-exposure to HPV, which makes the vaccine have greater power of efficacy and immunogenicity [9].…”

“…In more developed countries, such as Australia, Canada and Sweden, which opted for the school strategy, vaccination coverage remained high and sustained [9].…”

“…Geographical barriers can also influence the reduction of access to vaccination, which may be related, for example, to hesitation to vaccinate. Luvisaro et al [9] demonstrated that the population was instructed to receive the vaccine, but hesitated when going to the health center or access was difficult, which is the most frequent reason among adolescents enrolled in public schools. This finding was…”

“…Warning that cervical cancer is a preventable disease, but still has a high incidence and mortality, the WHO (World Health Organization) launched, in August 2020, a campaign for the eradication of cervical cancer in the world by the year 2030 and FEBRASGO (Brazilian Federation of Gynecology and Obstetrics Associations) joined the initiative [9]. WHO's proposed strategy to accelerate the elimination of cervical cancer is based on three goals: 1) to ensure that 90% of girls receive the HPV vaccine by the age of 15; 2) to ensure that 70% of women perform a screening test with effective test up to 35 years and another up to 45 years of age; and 3) to certify that 90% of women identified with precursor lesions or invasive cancer receive treatment [10].…”