title: Public health impact of Infanrix hexa (DTPa-HBV-IPV/Hib) reimbursement: A study programme in France. Part 1: Evolution of hepatitis B vaccine coverage rates in infants aged less than 27 months, in the general population - the PopCorn study.
abstract: BACKGROUND
  Reimbursement of the hexavalent vaccine (Infanrix hexa) comprising the DTPa-IPV-Hib components and the hepatitis B valence in a single vaccine was decided in March 2008 in France. The impact of its reimbursement on the hepatitis B vaccine coverage rate was assessed in a study conducted in the general population prior to and after implementation of the reimbursement policy.
  
  
  METHODS
  The PopCorn study (NCT01782794) was a national, cross-sectional and repeated study, with four assessment periods over 3 years, from 2009 to 2012, to assess the hepatitis B vaccine coverage in 12- to 15- and 24- to 27-month-old children, vaccinated between 2007 and 2011 and selected by the quota sampling method. Face-to-face interviews were conducted at their homes and vaccination status was collected using their child's health record. Parents were also interviewed on their perceptions and acceptance of hepatitis B vaccination. Three indicators were calculated to assess hepatitis B vaccination coverage: proportions of infants with at least one dose before 6 months of age, with at least two doses before 6 months of age and with a complete schedule at 24 months of age.
  
  
  RESULTS
  A total of 4903 children were enrolled in the study. An overall significant increase (P-value [P<0.05]) of the three indicators of interest over the four periods of time was observed for both age groups. The proportion of children receiving hepatitis B vaccination before 6 months increased from 21% at baseline (before vaccine reimbursement) to almost 75% at the last assessment period in 2012. More than 60% of 24- to 27-month-old children received a complete schedule in 2012 compared to 33% at baseline. No significant increases in the proportions of parents "favourable" and "moderately in favour" of hepatitis B vaccination were observed across the four evaluation periods (respectively, 17-22% and 48-50%, P=0.09).
  
  
  CONCLUSIONS
  The rapid increase of hepatitis B vaccination coverage suggests a significant change in hepatitis B vaccination practice related to the hexavalent vaccine's reimbursement. This change was observed in a context of stability regarding parents' perceptions and acceptance of hepatitis B vaccination and of coverage rates for other infant vaccinations.
authors.affiliation: Service de pédiatrie générale, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris (AP-HP), avenue du 14-Juillet, 93140 Bondy, France. Electronic address: joel.gaudelus@jvr.aphp.fr.
authors.forename: J
authors.initials: J
authors.lastname: Gaudelus
authors.affiliation: Association française de pédiatrie ambulatoire (AFPA), Commission scientifique, 67, rue Alexandre-Dumas, 73100 Aix-les-Bains, France.
authors.forename: F
authors.initials: F
authors.lastname: Vié le Sage
authors.affiliation: Service de protection maternelle et infantile Paris, Direction des familles et de la petite enfance, 94/96, quai de la Râpée, 75570 Paris cedex 12, France.
authors.forename: V
authors.initials: V
authors.lastname: Dufour
authors.affiliation: Institut national de la santé et de la recherche médicale (Inserm), Centre de recherche en épidémiologie et santé (CESP), 14, avenue Paul-Vaillant-Couturier, 94807 Villejuif, France.
authors.forename: F
authors.initials: F
authors.lastname: Lert
authors.affiliation: Kappa Santé, 4, rue de Cléry, 75002 Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Texier
authors.affiliation: Kappa Santé, 4, rue de Cléry, 75002 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Pouriel
authors.affiliation: GSK, PharmacoÉpidémiologie et Modélisations Médico-Économiques, 100, route de Versailles, 78163 Marly-le-Roi, France.
authors.forename: B
authors.initials: B
authors.lastname: Tehard
authors.affiliation: Université Pierre et Marie Curie, Institut national de la santé et de la recherche médicale (Inserm U1153), 53, avenue de l'Observatoire, 75013 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Bréart
mesh_terms: D002675:Child, Preschool; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000191:economics* / Q000627:therapeutic use*; D005239:Fear / Q000523:psychology; D005602:France; D018073:Haemophilus Vaccines / Q000191:economics* / Q000627:therapeutic use*; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006509:Hepatitis B / Q000191:economics / Q000517:prevention & control* / Q000523:psychology; D017325:Hepatitis B Vaccines / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000706:statistics & numerical data; D010290:Parents / Q000523:psychology; D011054:Poliovirus Vaccine, Inactivated / Q000191:economics* / Q000627:therapeutic use*; D011634:Public Health / Q000191:economics*; D014611:Vaccination / Q000191:economics* / Q000523:psychology / Q000706:statistics & numerical data; D017778:Vaccines, Combined / Q000191:economics / Q000627:therapeutic use
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D018073:Haemophilus Vaccines; D017325:Hepatitis B Vaccines; D011054:Poliovirus Vaccine, Inactivated; D017778:Vaccines, Combined; C541235:diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae b conjugate-hepatitis B vaccine
keywords: Children; Couverture vaccinale; Enfants; France; General population; Hepatitis B; Hépatite B; Population générale; Public Health; Reimbursement; Remboursement; Santé publique; Vaccine coverage