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PLoS One. 2013 Dec 16;8(12):e84126. doi: 10.1371/journal.pone.0084126. eCollection 2013.

Community-based interventions to improve HPV vaccination coverage among 13- to 15-year-old females: measures implemented by local governments in Japan.

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Department of Obstetrics and Gynecology, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi, Japan.
Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.


The purpose of this study was to examine the effect of various community-based interventions in support of HPV vaccination implemented by cities and towns within Tochigi prefecture, Japan with a view to identifying useful indicators which might guide future interventions to improve HPV vaccination coverage in the prefecture. A postal questionnaire survey of all 27 local governments in Tochigi Prefecture was conducted in December 2010. All 27 responded, and 22 provided the exact numbers of the targeted and vaccinated populations of 13- to 15-year-old girls from April to December 2010. The local governments also answered questions on the type of interventions implemented including public subsidies, school-based programs, direct mail, free tickets and recalls. Local governments that conducted a school-based vaccination program reported 96.8% coverage for the 1(st) dose, 96.2% for the 2(nd) dose, and 91.2% for the 3(rd) dose. Those that provided subsidies without school-based programs reported a wide range of vaccination rates: 45.7%-95.0% for the 1(st) dose, 41.1%-93.7% for the 2(nd) dose and 3.1%-90.1% for the 3(rd) dose. Among this group, the combination of a free ticket, direct mail and recall was most effective, with 95.0% coverage for the 1(st) dose, 93.7% for the 2(nd) dose, and 90.1% for the 3(rd) dose. The governments that did not offer a subsidy had the lowest vaccination coverage, with 0.8%-1.4% for the 1(st) dose, 0.0%-0.8% for the 2(nd) dose, and 0.1%-0.1% for the 3(rd) dose. The results of this survey indicate that school-based vaccinations and public subsidies are the most effective method to improve HPV vaccination coverage; however, the combination of a free ticket, direct mail, and recalls with public subsidies are also important measures in increasing the vaccination rate. These data may afford important indicators for the successful implementation of future HPV vaccination programs.

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