Chantal Sauvageau

Human Papilloma Virus vaccine and cervical cancer screening acceptability among adults in Quebec, Canada

BackgroundThe Pap test has been used for cervical cancer screening for more than four decades. A human papillomavirus (HPV) vaccine has been approved for use in Canada and is commercially available now. These two preventive interventions should be considered simultaneously. General population support is an important factor for the successful combination of these interventions. The study had two objectives: 1) To assess practices, beliefs, and attitudes regarding Pap test screening and HPV immunization; 2) To identify socio-demographic factors for Pap screening and vaccine acceptability.MethodsIn 2006, 500 adults were invited to participate in a telephone survey in the region of Quebec City (urban and rural population, 600 000), Canada. Some neutral and standardized information on Pap test and HPV was provided before soliciting opinions.Results471 adults (18–69 year-olds) answered the questionnaire, the mean age was 45 years, 67% were female, and 65% had college or university degree. Eighty-six percent of women had undergone at least one Pap-test in their life, 55% in the last year, and 15% from 1 to 3 years ago. Among screened women, the test had been performed in the last three years in 100% of 18–30 year-olds, but only in 67% of 60–69 year-olds (P < 0.0001). Only 15% of respondents had heard of HPV. Eighty-seven percent agreed that HPV vaccines could prevent cervical cancer, 73% that the vaccine has to be administered before the onset of sexual activity, 89% would recommend vaccination to their daughters and nieces. Among respondents < 25 years, 91% would agree to receive the vaccine if it is publicly funded, but only 72% would agree to pay

Cervical cancer prevention by vaccination: nurses' knowledge, attitudes and intentions.

100/dose.ConclusionThere is an important heterogeneity in cervical cancer screening frequency and coverage. Despite low awareness of HPV infection, the majority of respondents would recommend or are ready to receive the HPV vaccine, but the cost could prevent its acceptability.

Canadian family physicians' and paediatricians' knowledge, attitudes and practices regarding A(H1N1) pandemic vaccine

AIMnThis paper is a report of a survey: (1) to document nurses knowledge, attitudes and information needs regarding human papillomavirus prevention and (2) to determine factors associated with their willingness to recommend human papillomavirus vaccines.nnnBACKGROUNDnPersistent infection with human papillomavirus has been causally linked to cervical cancer. Two human papillomavirus vaccines have recently been approved for use in more than 65 countries. Nurses level of support for the prevention of human papillomavirus related diseases by vaccination has not been researched.nnnMETHODSnA survey was conducted in 2007. Self-administered questionnaires were mailed to 1799 randomly selected nurses. Descriptive statistics were generated for all variables. Multivariable logistic regression models were estimated to determine variables associated with the willingness to recommend human papillomavirus vaccines.nnnRESULTSnA total of 946 questionnaires were analyzed and showed that: 97% of nurses perceived routinely recommended vaccines as very useful; 93% would support human papillomavirus vaccination if it is publicly funded; 85% would recommend human papillomavirus vaccines to their patients; 33%, 46% and 61% expect the vaccination to permit screening to begin later in life, reduction of the frequency of screening, and reduction of the number of postscreening interventions, respectively. Respondents knowledge score was 3.8 out of 7. Several modifiable factors, including knowledge, perceived self-efficacy, and societal and colleagues support were associated with willingness to recommend vaccines.nnnCONCLUSIONnMost nurses support human papillomavirus vaccination, but their active involvement should not be taken for granted. Targeted educational efforts are needed to ensure nurses involvement in the prevention of human papillomavirus-related diseases.

Attitudes of nurses toward current and proposed vaccines for public programs: A questionnaire survey

BackgroundOne of the main determinants of public immunization success is health professionals support and recommendations. Little is known about the physicians level of support and intentions regarding A(H1N1) pandemic influenza vaccination. The aim of this survey was to document Canadian family physicians and paediatricians knowledge, attitudes and practices (KAP) as well as their intentions regarding A(H1N1) pandemic influenza vaccines right before the beginning of the largest immunization campaign in Canadian history.FindingsA self-administered, anonymous, mail-based questionnaire was sent to a random sample of family physicians and to all paediatricians practicing in Canada. All 921 questionnaires received by October 29 2009 were included in the analysis. Between 72% and 92% of respondents agreed with the statements regarding vaccine safety, effectiveness and acceptability. More than 75% of respondents intended to recommend the A(H1N1) pandemic influenza vaccine to their patients and to get vaccinated themselves. The most significant factors associated with the intention to recommend A(H1N1) pandemic vaccines were physicians intention to be vaccinated against influenza themselves and the perceived acceptability of the vaccine by the vaccinators.ConclusionsMost Canadian family physicians and paediatricians surveyed were supportive of the A(H1N1) pandemic influenza vaccination before its implementation and large media coverage.

Setting priorities for new vaccination programs by using public health officers and immunization managers opinions

BACKGROUNDnIn most countries registered nurses play a key role in vaccination. The number of recommended childhood vaccines has increased and several other new vaccines are in the implementation phase or are being considered for public programs. Little is known about nurses perceived usefulness of recommended vaccines and no recent study has assessed nurses opinions regarding new candidate vaccines for the public programs.nnnOBJECTIVESnThe main purpose of this survey was to assess nurses opinions regarding already recommended and new candidate vaccines for public programs; based on nurses responses, to assess the perceived priority of implementation of new vaccination programs, and to determine factors associated with the intention to recommend a new vaccine.nnnDESIGNnCross-sectional survey.nnnSETTING AND PARTICIPANTSnThe survey was conducted in June-July 2008 with registered nurses (N=299) randomly sampled from the Quebec Order of Nurses registry.nnnRESULTSnThe great majority (97.8%) of nurses somewhat or strongly agreed that the vaccines recommended by public health authorities are very useful. The proportion of nurses that perceived different recommended vaccines as useful varied from 80% to 99%. A high heterogeneity was observed among nurses opinions regarding the safety and efficacy profile of different new vaccines. From 35% to 69% of nurses self-estimated the information they received on new vaccines as sufficient for their needs. The priority rating of new vaccines was as follows: (1) combined hepatitis A and B vaccine; (2) measles mumps rubella and varicella vaccine; (3) hexavalent diphtheria-tetanus-pertussis based vaccine; (4) pneumococcal 10-valent vaccine; (5) meningococcal ACYW-135 vaccine; (6) human papillomavirus vaccine and (7) Rotaviral vaccine. The willingness to recommend a new vaccine was consistently associated with the perceived vaccine safety, usefulness of a potential immunization program and the perceived professional support of a new vaccine.nnnCONCLUSIONnThe general attitudes of nurses toward vaccines recommended by public health authorities are positive and were not negatively affected by the recent implementation of the pneumococcal, varicella and influenza vaccines in the childhood vaccination program. Important differences are observed when comparing the perceived usefulness, safety, efficacy, acceptability, and intention to recommend new vaccines. Nurses clearly give their priority to combined vaccines and to vaccines they had received more information about. The delivery of clear evidence-based information about the new immunization program targets and vaccine safety, as well as professional support fostering would increase nurses willingness to recommend new vaccines.

Clinicians' opinions on new vaccination programs implementation.

The objective of this work was to assess the opinions of public health professionals (PHPs) about routinely recommended and new vaccines, and to evaluate the feasibility of using a modified Basic Priority Rating System (BPRS) approach to prioritize new immunization programs. One hundred and thirty six PHPs were invited to participate in the survey and 101 responded. Ninty-eight percent of respondents agreed that recommended vaccines are very useful (mean score=9.5 out of 10). Between 47% and 100% of respondents agreed with statements about usefulness, safety, effectiveness and acceptability of seven new vaccines (mean scores 5.7-9.7). The highest BPRS scores were observed for MMRV (7.3), DTaP-IPV-HBV-Hib (7.0), and conjugate ACYW-135 (5.4), followed by HPV (4.8), HAV (4.4), rotavirus (1.6) and zoster vaccine (1.5%). The results demonstrate that PHPs perceive presently recommended vaccines as very useful tools in infection prevention. On the other hand, the perceived usefulness, safety, effectiveness, and acceptability of new vaccines are heterogeneous. This heterogeneity is indicative of the complexity of decision-making around implementation of new immunization programs and the need for tools facilitating program prioritization. The modified BPRS approach using survey responses to five statements on program usefulness, vaccine safety, effectiveness, and acceptance by vaccinators and the population is a simple, feasible and inexpensive method of prioritizing new immunization programs. The method we propose is flexible in choosing target groups and allows a large number of professionals to be involved in the decision-making process about new immunization programs.

Immunization services offered in Québec (Canada) pharmacies

In Canada, several new vaccines were recently approved for clinical use or are expected to be soon. Decision-makers are faced with the choice whether or not to include these vaccines in publicly funded vaccination programs. The aim of this study was to assess Canadian pediatricians and family physicians opinions regarding 7 new vaccines, and perceived priority for the introduction of new programs. A self-administered, anonymous, mail-based questionnaire was sent during fall 2009 to a random sample of 1182 family physicians and to all 1852 Canadian pediatricians. Responses to 8 statements regarding frequency and severity of the diseases, efficacy and safety of the vaccines as well as feasibility of immunization programs were used to calculate priority scores to rank the 7 potential new vaccination programs (calculated scores ranging from 0 to 100). Overall response rate was 43%. The majority of respondents perceived the health and economic burden of diseases prevented by the seven new vaccines as important and considered new vaccines to be safe and effective. More than 90% of physicians strongly agreed or agreed that the new vaccines would be or are currently well accepted by the public and by the health professionals who administer vaccines, except for the HPV and rotavirus vaccines (respectively 30% and 29% strongly agreed or agreed). Mean priority scores were: 77.4 out of 100 for the measles, mumps, rubella and varicella (MMRV) combined vaccine; 75.6 for the hexavalent (DTaP-IPV-Hib-HBV) vaccine; 73.1 for the new pneumococcal conjugate vaccines; 69.8 for the meningococcal ACYW135; 68.9 for the combined hepatitis A and B; 63.5 for the human papillomavirus vaccine and 56.9 for the rotavirus vaccine. Health professionals opinion is an important element to consider in the decision-making process regarding implementation of new immunization programs. Without health professional support, the introduction of a new vaccination program may be unsuccessful. In this study, the MMRV and the hexavalent (DTaP-IPV-Hib-HBV) vaccines received the highest ratings.

A(H1N1) pandemic influenza and its prevention by vaccination: Paediatricians' opinions before and after the beginning of the vaccination campaign

Canadian Pharmacists are easy to reach. Although Québec pharmacists are not allowed to administer vaccines, they can: (1) promote vaccination, (2) counsel patients on vaccination, (3) sell vaccines and (4) provide vaccine administration by a nurse. Our objectives were to describe immunization services given in Québec pharmacies and assess the potential relation between, on one hand, pharmacy characteristics and difficulties perceived by pharmacists and, on the other hand, vaccine administration. In 2008–09, an anonymous questionnaire was mailed to all Québec pharmacy owners (n = 1663). Among the 1102 (66%) respondents, 90% stated that vaccines were sold, 27% that a nurse administered vaccines in their pharmacy and 44% were planning to offer vaccine administration in the next five years. Three out of four stated they were doing vaccine promotion and 65%, vaccine counselling. Half of respondents said they would be willing to administer vaccines themselves if legislative modifications were made. Recommendations for cold chain maintenance were followed in 23% of pharmacies selling vaccines. Presence of another health professional in the pharmacy, higher number of opening hours, not being located in the same building than a medical clinic and having an agreement to collaborate with a public health unit or a medical clinic for immunization were positively associated with vaccine administration in multivariate analysis. Higher perceived difficulties with lack of demand from patients were negatively associated with vaccine administration. Most pharmacists are willing to increase their involvement in immunization. Collaboration between public health professionals and pharmacists should be reinforced.

HPV vaccination for MSM: Synthesis of the evidence and recommendations from the Quebec Immunization Committee.

BackgroundIn June 2009, the World Health Organization declared an A(H1N1) influenza pandemic. In October 2009, the largest vaccination campaign in Canadian history began. The aim of this study was to document paediatricians knowledge, attitudes and practices (KAP) regarding A(H1N1) pandemic influenza and its prevention by vaccination just after the beginning of the A(H1N1) vaccination campaign and to compare the results with those obtained before campaign initiation.MethodsA self-administered mail-based questionnaire was sent to all Canadian paediatricians. Questionnaires were analyzed in two subsets: those received before and after the beginning of the vaccination campaign.ResultsOverall the response rate was 50%. Respondents characteristics were comparable between the two subsets. Before the beginning of the campaign, 63% of paediatricians perceived A(H1N1) pandemic infection as a serious disease, that would occur frequently without vaccination compared to more than 75% after. Before the vaccination campaign, half of respondents or less thought that the A(H1N1) vaccine was safe (50%) and effective (35%) compared to 77% and 72% after. The proportion of paediatricians who reported they had received sufficient information on A(H1N1) vaccine increased from 31% before to 73% after the beginning of the vaccination campaign. The majority of respondents intended to get vaccinated against A(H1N1) influenza themselves (84% before and 92% after). Respondents intention to recommend the A(H1N1) vaccine to their patients increased from 80% before the beginning of the campaign to 92% after. In multivariate analysis, the main determinants of paediatricians intention to recommend the A(H1N1) vaccine were their intention to get vaccinated against A(H1N1) influenza themselves and a belief that A(H1N1) vaccine would be well accepted by health professionals who administer vaccines to the public.ConclusionResults of this study show important increases in physicians level of confidence about A(H1N1) vaccines safety and immunogenicity and their willingness to recommend this vaccine to their patients. These changes could be explained, at least partially, by the important effort done by public health authorities to disseminate information regarding A(H1N1) vaccination.

Low prevalence of vaccine-type HPV infections in young women following the implementation of a school-based and catch-up vaccination in Quebec, Canada

ABSTRACT Diseases associated with the human papilloma virus (HPV) are particularly common among men who have sex with men (MSM). Unlike heterosexual men, MSM do not benefit from the herd protection provided by the vaccination of girls. In this review, we synthesize the available evidence on HPV vaccination for MSM. We also present the recommendations of the Québec Immunization Committee (CIQ) in this regard, which are: to provide targeted vaccination for MSM up to 26 years of age and in-school vaccination of preadolescent boys since this is the best approach to take to have a real impact on the burden related to HPV in the MSM population and to provide direct protection for all men.