Human Papillomavirus (HPV) Vaccination

  • Charts and Tables

    Charts and Tables

    Table 1.1

    Percentage of girls in immunizing grade who completed human papillomavirus vaccine series based on provincially/territorially recommended vaccination schedules,† by province/territory — most recent vaccination year

     Vaccination Uptake
    Province / Territory School Grade School Year 1st dose 2nd dose 3rd dose
    British Columbia 6 2013-2014 – 65.8% N/A
    Alberta 5 2013-2014 74.2% – 64.9%
    Saskatchewan Age 13 2012-2013 80.3% 78.4% 73.7%
    Manitoba 6 2014-2015 70.1% 65.8% 58.6%
    Ontario 8 2012-2013 – – 80.2%
    Quebec 4  2014-2015 78.2% 74.4% N/A
    New Brunswick 7 2014-2015 >73.0% >73.0% 73.0%
    Nova Scotia 7 2013-2014 88.8% 84.5% 75.0%
    Prince Edward Island 6  2013-2014 90.6% 88.7% 84.9%
    Newfoundland & Labrador 6 2013- 2014 92.8% 93.7% 88.7%
    Northwest Territories 7 2013-2014 46.7% 44.2% 39.3%
    Yukon – – – – –
    Nunavut – – – – –

    † Full course of vaccination is two doses in BC and QC and three doses in all other provinces/‌territories.
    “—” Data not available.
    NT: Vaccination occurs in grades 4–6. Vaccination uptake listed is for grade 7 girls.
    SK, ON: HPV vaccination is offered in grade 6 and grade 8, respectively, but immunization information is not recorded by grade. Vaccination uptake is therefore assessed at age 13.
    Data source: Cervical Cancer Screening Guidelines Across Canada: Environmental Scan, July 2015; Canadian Partnership Against Cancer HPV Immunization Survey, July 2015; BC Centre for Disease Control; PEI Chief Public Health Office.

  • About this indicator

    About this indicator

    Key message

    Collecting consistently defined data to enable reporting of comparable pan-Canadian indicators of HPV vaccination remains a challenge. The available data suggest there is considerable variation in HPV vaccination uptake across Canada.

    Indicator definition

    The percentage of girls in the age group (or school grades) targeted for immunization who have completed the HPV vaccine series based on the provincially/territorially recommended vaccination schedule. †

    Measured since

    The 2011 Cancer System Performance Report.

    In 2016, the Partnership changed the indicator definition reported in the Cancer System Performance Reports from first dose to completion of the HPV vaccine series, as defined in provincial/territorial vaccination schedules. This was the first year all reporting provinces/territories were able to provide this information.

    Why measure this?

    HPV is a common sexually transmitted infection. Approximately 75% of sexually active people acquire an HPV infection at some point in their lives, though most people clear the infection within two years.1-3 As of July 2015, three HPV vaccines are currently approved for use in Canada.4 All protect against high-risk HPV types 16 and 18, which are responsible for over 70% of cervical cancer cases, 92% of anal cancers, 63% of penile cancers and 89% of oral cavity and oropharyngeal cancers.5-7 As of 2010, all provinces and territories had implemented organized school-based HPV immunization programs. Measuring and reporting on HPV vaccination uptake helps to inform opportunities for increased efforts in prevention activities.

    What are the key findings?

    • HPV vaccination uptake (full course of vaccination) ranged from 39.3% in the Northwest Territories to 88.7% in Newfoundland and Labrador (Table 1.1).
    • Vaccination uptake through organized HPV immunization programs varied considerably by province and territory, both in terms of uptake and target populations (i.e., age/grade of girls being vaccinated).

    Why do these findings matter?

    There is clear evidence that infection with high-risk strains of HPV will influence the burden of several cancers in the future. Given that, there is critical value in continued persistent efforts to optimize vaccine uptake across Canada. Several countries have already begun to show the benefit of national HPV vaccination programs. The United States, the United Kingdom and Australia have experienced a substantial decrease in the prevalence of vaccine-type HPV infections in girls and women as a result of their programs.8-11

    Some of the variation in HPV vaccination uptake across the country could be a result of differing immunization program start dates and health promotion practices in different provinces/territories. It is important to note, however, that it is currently challenging to gather consistent, standardized data on HPV vaccination across Canada because provinces and territories collect and report data on uptake differently. In the future, standardized data collection and reporting on HPV vaccination could result in more comparable uptake rates and the ability to more accurately assess prevention and health promotion efforts and the impact of vaccination on subsequent cancer outcomes.

    There are two current developments in Canada related to HPV vaccination—vaccinating males and moving to a two-dose vaccination schedule.12 These changes could help to reduce infections caused by HPV and the subsequent risk of cervical, oropharyngeal, penile and anal cancers.

     

    Notes

    † Two doses of HPV vaccine in BC and QC, three doses in all other provinces/territories at the time data were collected.

    References

    1. Government of Canada. Human papillomavirus (HPV) [Internet]. Ottawa (ON): Government of Canada; 2013 [updated 2013 Apr 02; cited 2015 Nov 30]. Available from: http://healthycanadians.gc.ca/diseases-conditions-maladies-affections/disease-maladie/hpv-vph-eng.php.
    2. Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. 1998 Feb 12;338(7):423-8.
    3. Tota JE, Chevarie-Davis M, Richardson LA, Devries M, Franco EL. Epidemiology and burden of HPV infection and related diseases: implications for prevention strategies. Prev Med. 2011 Oct;53 Suppl 1:S12-21.
    4. Health Canada. Drug Product Database Online Query [Internet]. Ottawa (ON): Health Canada; 2015 [updated 2015 Jul 17; cited 2016 Feb 9]. Available from: http://webprod5.hc-sc.gc.ca/dpd-bdpp/start-debuter.do?lang=eng.
    5. Parkin DM, Bray F. Chapter 2: The burden of HPV-related cancers. Vaccine. 2006;24 Suppl 3:11-25.
    6. Watson M, Saraiya M, Ahmed F, Cardinez CJ, Reichman ME, Weir HK, et al. Using population-based cancer registry data to assess the burden of human papillomavirus-associated cancers in the United States: overview of methods. Cancer. 2008 Nov 15;113(10 Suppl):2841-54.
    7. Canadian Immunization Committee. Recommendations for Human Papillomavirus Immunization Programs. Ottawa (ON): Public Health Agency of Canada; 2014 Apr. 52 p.
    8. Tabrizi SN, Brotherton JM, Kaldor JM, Skinner SR, Cummins E, Liu B, et al. Fall in human papillomavirus prevalence following a national vaccination program. J Infect Dis. 2012;206(11):1645-51.
    9. Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, McQuillan G, et al. Reduction in human papillomavirus (HPV) prevalence among young women following HPV vaccine introduction in the United States, National Health and Nutrition Examination Surveys, 2003-2010. J Infect Dis. 2013;208(3):385-93.
    10. Mesher D, Soldan K, Howell-Jones R, Panwar K, Manyenga P, Jit M, et al. Reduction in HPV 16/18 prevalence in sexually active young women following the introduction of HPV immunisation in England. Vaccine. 2013;32(1):26-32.
    11. Markowitz LE, Liu G, Hariri S, Steinau M, Dunne EF, Unger ER. Prevalence of HPV After Introduction of the Vaccination Program in the United States. Pediatrics. 2016.
    12. Public Health Agency of Canada. National Advisory Committee on Immunization (NACI) statement: Update on the recommended Human Papillomavirus (HPV) vaccine immunization schedule. Ottawa (ON): Public Health Agency of Canada; 2015 Feb. 32 p.
  • Data specifications

    Data specifications

    Definition: The percentage of girls in the age group (or school grades) targeted for immunization who have completed the HPV vaccine series based on the provincially/territorially recommended vaccination schedule

    Numerator: Number of girls who have received the final dose (second or third dose, depending on the province/territory) of the HPV vaccination through the provincially/territorially organized program

    Denominator: Number of girls in the target grade/age group in schools for the provincial/territorial school-based HPV vaccination program.

    Data Source: Cervical Cancer Screening Guidelines Across Canada: Environmental Scan, July 2015; Canadian Partnership Against Cancer HPV Immunization Survey, July 2015; BC Centre for Disease Control; PEI Chief Public Health Office

    Measurement timeframe: 2012/2013 school year for ON and SK; 2013/2014 school year for BC, AB, NS, PE, NL, NT; 2014/2015 school year for MB, QC, NB

    Stratification variables: Province/territory

    Provinces/territories with data available: BC, AB, SK, MB, ON, QC, NB, NS, PE, NL, NT

    Province specific notes:

    • SK, ON: HPV vaccination is offered in grade 6 and grade 8, respectively, but immunization information is not recorded by grade. Vaccination uptake is therefore assessed at age 13.
    • ON: Complete-for-age logic was used to estimate coverage, which may result in overestimation, as it includes individuals who may not have completed the series, but who are not yet overdue for their subsequent dose.
    • NT: Vaccination occurs in grades 4–6. The vaccination uptake listed is for grade 7 girls.

    Notes:

    1. The target grade and age group varies by province/territory.
    2. Full course of vaccination is two doses in BC and QC and three doses in all other provinces/territories.
    3. The denominator does not necessarily represent the entire female population within the target age range for the province.
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