Community-based interventions to improve HPV vaccination coverage among 13- to 15-year-old females: measures implemented by local governments in Japan

Abstract

The purpose of this study was to examine the effect of various community-based interventions in support of HPV vaccination implemented by cities and towns within Tochigi prefecture, Japan with a view to identifying useful indicators which might guide future interventions to improve HPV vaccination coverage in the prefecture. A postal questionnaire survey of all 27 local governments in Tochigi Prefecture was conducted in December 2010. All 27 responded, and 22 provided the exact numbers of the targeted and vaccinated populations of 13- to 15-year-old girls from April to December 2010. The local governments also answered questions on the type of interventions implemented including public subsidies, school-based programs, direct mail, free tickets and recalls. Local governments that conducted a school-based vaccination program reported 96.8% coverage for the 1(st) dose, 96.2% for the 2(nd) dose, and 91.2% for the 3(rd) dose. Those that provided subsidies without school-based programs reported a wide range of vaccination rates: 45.7%-95.0% for the 1(st) dose, 41.1%-93.7% for the 2(nd) dose and 3.1%-90.1% for the 3(rd) dose. Among this group, the combination of a free ticket, direct mail and recall was most effective, with 95.0% coverage for the 1(st) dose, 93.7% for the 2(nd) dose, and 90.1% for the 3(rd) dose. The governments that did not offer a subsidy had the lowest vaccination coverage, with 0.8%-1.4% for the 1(st) dose, 0.0%-0.8% for the 2(nd) dose, and 0.1%-0.1% for the 3(rd) dose. The results of this survey indicate that school-based vaccinations and public subsidies are the most effective method to improve HPV vaccination coverage; however, the combination of a free ticket, direct mail, and recalls with public subsidies are also important measures in increasing the vaccination rate. These data may afford important indicators for the successful implementation of future HPV vaccination programs.

Figure 1. HPV Vaccination Survey.

The HPV Vaccination Survey was sent to all 27 local government entities (cities and towns) in Tochigi prefecture, Japan in October 2010 requesting data for April through December 2010. Complete responses were received from 22 local governments. Supplementary data was obtained by follow-up telephone surveys.

Figure 2. Direct Mail & Free Ticket.

Direct mail, usually including 3 free tickets, were independently or cooperatively designed and mailed by the 27 local government entities in Tochigi prefecture, Japan. Direct mail was conducted once prior to the start of a vaccination program. The sample provided here is an anonymized translation from Japanese of a direct mail campaign with free tickets by one city that collaborated with two towns.

Figure 3. Recall.

Recall notices were mailed once to people who after several months did not respond to the direct mail campaign by scheduling a vaccination. The sample provided here is an anonymized translation from Japanese of a recall notice by one city that collaborated with two towns.

Figure 4. HPV vaccination coverage among 13- to 15-year-old females according to combinations of interventions.

The local governments that conducted a school-based vaccination program with subsidy achieved the highest coverage: 96.8% for the 1^st dose, 96.2% for the 2^nd dose, and 91.2% for the 3^rd dose. SUB: subsidy, FT: free ticket, DM: direct mail, RC: recall, ( / ): Number of local government/total number of targeted population. *p<0.001, * *p<0.01, ***p<0.05, NS: not significant.