Aims for public health surveillance of the HPV programme in Scotland

Transcription

1 Aims for public health surveillance of the HPV programme in Scotland To establish the body of evidence to Enable overall evaluation of the immunisation programme Uptake Safety Monitor the impact on cervical cancer Expected decrease in vaccine-type HPV Expected decrease in cervical cancer precursors Inform decisions about the future mix of screening, HPV testing and Immunisation needed to continue to effectively prevent, detect and treat cervical cancer in Scotland

2 Long term surveillance at least 12 years vaccine uptake adverse events & vaccine safety infection & disease precursors disease TIME

3 Gathering the body of evidence Overall Evaluation of the immunisation programme Monitoring Cervical Cancer & Precursors Vaccine Uptake Safety ISD MHRA HPV surveillance Cervical Screening Postal Testing Kits CIN biopsies Pre-cancers detected by screening SCCRS Cancers Deaths ISD GRO Immunisation Cervical Screening

4 Core elements 1. Vaccine uptake 2. Adverse events that may be associated with immunisation 3. The impact of the immunisation programme on HPV infection in the population 4. The impact of the immunisation programme on Cervical Cancer & Precursors (CIN+)

5 HPV Vaccine Uptake Figures in Scotland by cohort Routine S2; catchup cohorts at school (S5 & S6) and school leavers of equivalent age Immunisation year 2008/09 - reports to 10 th August 2009, Source Data: ISD st dose 2nd dose 3rd dose Routine S2 Catchup S5 Catchup S6 Catchup school leavers

6 The Inequalities dimension New cases of cervical cancer Cancer of the Cervix Uteri (ICD-10 C53): Scotland. Five-yearly figures by deprivation quintile Incidence [1] ( ) and mortality [2] ( ) Incidence / Mortaltity rates per 100, least deprived Incidence (EASR) SIMD quintiles Mortality (EASR) most deprived Sources: ONS Cancer atlas of the UK and Ireland, 2005 ISD Scottish Cancer Registry

7 Vaccine uptake for School girls by SIMD S2 girls S5/S6 girls Vaccine uptake (%) Vaccine uptake (%) st Dose 2nd Dose 3rd Dose st Dose 2nd Dose 3rd Dose Least deprived SIMD 2 SIMD 3 Simd 4 Most deprived SIMD Category 0 Least deprived SIMD 2 SIMD 3 Simd 4 Most deprived SIMD Category

8 Reports as at 22 nd October 2009 over 1.4 million doses administered Suspected reaction category Total reactions Total reports A: Injection site reactions B: Allergic reactions (including skin reactions not directly related to an injection-site reaction) C: Psychogenic events D: Other recognised reactions E: Suspected adverse reactions not currently recognised TOTAL reports / suspected reactions

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10 HPV surveillance SCCRS Screening system CHI CHSP-S Immunisation records Screening population ~35% non-attenders ~65% Incidence & Prevalence HPV related Disease Every year CIN2+ Biopsies 500 Every 2 nd year Secondary testing Residual LBC Baseline 2000 Every year Direct survey postal testing kits Pilot (n=1000) Every 2 nd year + other testing HPV testing and typing

11 Liquid-based Cytology Samples (LBCs) Surveillance Year: 2009 (baseline) Period of collections: March December 2009 Population: Women attending their first smear aged 20 Sample size required: 2, % (all 11 labs in Scotland) Total samples to date: 1655 booked in from 2640 eligible 6 laboratories have finished collection for 2009; 3 are completing collections 2 are collecting during November/December Tested samples to date: 792 Positivity rate: 43%

12 Biopsy Samples CIN 2+ Surveillance Year: 2005 (baseline) Period of collections: April June 2009 Population: Women aged Sample size required: % (all histopathology labs) Total samples to date: 480 Tested samples to date: 426 Positivity rate: 87%

13 Self-collected Postal Samples (PTKs) Surveillance Year: 2008 (baseline) Period of collections: March April 2009 Population: Women born in 1987 who were categorised as Defaulters in 2008 Testing kits sent: 5409 (2,707 Swab, 2,702 Urine) Sample size required: 1,000 (all 14 Health Board areas) Total samples to date: 727 (342 Swabs, 385 Urine) Progress Update: Testing completed Tested samples to date: 727 Positivity rate: 35%

14 Prevalence Study year olds Surveillance Year: 2008 (baseline) Period of collections: January May 2008 Population: Males and females in schools/colleges, yrs Sample size required: 2000 (urine) Total samples to date: 2575 Tested samples to date: 2396 Positivity rate: 5.8%

15 Gathering the body of evidence Overall Evaluation of the immunisation programme Monitoring Cervical Cancer & Precursors Future mix of screening, immunisation, HPV testing Vaccine Uptake Safety ISD MHRA HPV surveillance Cervical Screening Postal Testing Kits CIN biopsies CSO Health services Research CSO Biosciences Research National Archive Pre-cancers detected by screening SCCRS Test of cure Cancers ISD Reflex/Triage Deaths GRO Automated reading Immunisation Cervical Screening