title: Evidence of effective delivery of the human papillomavirus (HPV) vaccine through a publicly funded, school-based program: the Ontario Grade 8 HPV Vaccine Cohort Study.
abstract: BACKGROUND
  Proper administration of the human papillomavirus (HPV) vaccine (three doses at 0, 2, and 6 months) will likely influence the vaccine's effectiveness and the impact of vaccination programs on health outcomes. Therefore, we assessed HPV vaccine series completion and on-time dosing in Canada's largest publicly funded, school-based HPV vaccination program.
  
  
  METHODS
  Using administrative health and immunization databases, we identified a population-based cohort of girls eligible for Ontario's Grade 8 HPV vaccination program in the 2007/08-2009/10 program years who received at least one dose of the vaccine. We determined the number of doses received and calculated the percentage of girls that completed the three-dose series in Grade 8 and Grades 8-9. To assess on-time dosing, the number of days between doses 1-2, 2-3, and 1-3 was calculated and categorized (e.g., too short, on schedule, too long) based on the manufacturer's recommendations. Analyses were also stratified by program year.
  
  
  RESULTS
  We identified a cohort of 55,798 girls who initiated the vaccination series. Series completion was high in the Grade 8 window (81.8%) and increased by approximately 6% in Grade 9. Series completion was similar across the three program years. 70.8%, 98.5%, and 86.1% of girls were classified as 'on schedule' for dosing intervals 1-2, 2-3, and 1-3, respectively; 70.0% of girls received all three doses in perfect accordance with dosing recommendations. Stratification revealed that on-time dosing was highest in the first two years of the program (85.6% and 80.6%), but dropped to 42.1% in the 2009/10 year when H1N1 vaccination programs were prioritized.
  
  
  CONCLUSIONS
  Our study demonstrates that delivery of the HPV vaccine through a free, school-based program is an effective method of ensuring high completion and on-time dosing, but may not be sufficient to guarantee high coverage.
authors.forename: W Ting
authors.initials: WT
authors.lastname: Lim
authors.forename: Kim
authors.initials: K
authors.lastname: Sears
authors.forename: Leah M
authors.initials: LM
authors.lastname: Smith
authors.forename: Guoyuan
authors.initials: G
authors.lastname: Liu
authors.affiliation: Department of Public Health Sciences, Queen's University, Kingston, Ontario K7L 3N6, Canada. linda.levesque@queensu.ca.
authors.forename: Linda E
authors.initials: LE
authors.lastname: Lévesque
mesh_terms: D000293:Adolescent; D002170:Canada; D015331:Cohort Studies; D005260:Female; D005380:Financing, Government; D006801:Humans; D017589:Immunization Programs / Q000592:standards*; D009864:Ontario; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D012572:School Health Services
chemical_list: D053918:Papillomavirus Vaccines