School vaccination programmes to increase HPV vaccination coverage - Experiences from Bremen, Germany

Area of Science:

• Public Health
• Immunization Programs
• Epidemiology

Background:

• Germany's opportunistic immunization system has resulted in low Human Papillomavirus (HPV) vaccine coverage since its 2007 introduction.
• School-based vaccination is an international strategy to improve HPV vaccine uptake.

Purpose of the Study:

• To evaluate the effectiveness of a school-based HPV vaccination program in Bremen, Germany.
• To assess HPV vaccine uptake among vulnerable student populations based on socio-economic position.

Main Methods:

• Retrospective cohort study analyzing vaccination status of 8th-graders from 2015/16 to 2018/19 (girls) and 2022/23 (girls and boys).
• Sub-analyses utilized the School Social Index (SSI) to assess socio-economic disparities.
• Included 13,550 students across 56 schools.

Main Results:

• Annual uptake of school-based HPV vaccination among unvaccinated students was 26-35% for girls and 39% for boys.
• Vaccine uptake was significantly higher in lower socio-economic position schools (SSI 5: 37%) compared to higher SEP schools (SSI 1: 30%).
• One-third of unvaccinated students received at least one HPV vaccine dose at school, while two-thirds did not utilize the offer.

Conclusions:

• School-based HPV vaccination programs can increase vaccine uptake, particularly in lower socio-economic groups.
• Significant barriers to HPV vaccination persist, as two-thirds of students did not accept the school-based offer.
• Nationwide implementation in Germany faces challenges and may not overcome all uptake barriers, necessitating further investigation into vaccine hesitancy and preferences.