The purpose of this evaluation is to assess the effectiveness of the modifications made by the University of Toronto Postgraduate Medical Education to improve medical trainee compliance with the immunization standards set forth in national guidelines, provincial regulations and protocols and university policy. Trainee compliance with immunization requirements were evaluated as of January 2003, 2004 and 2005. Statistically significant increases in compliance rates for all required immunizations--hepatitis B virus, measles, rubella and chicken pox--and tuberculosis skin tests were observed. University of Toronto postgraduate medical trainees are now highly compliant with the Hospital Management Regulation 965 of the Ontario Public Hospitals Act, Canadian Immunization Guide, Public Health Agency of Canada guidelines for prevention and control of occupational infections in healthcare and the University of Toronto Faculty of Medicine immunization policy.
Oropharyngeal squamous cell carcinoma (OPSCC) is associated with the sexually transmitted human papillomavirus (HPV), smoking and alcohol. In Greenland, a high rate of HPV-induced cervical cancer and venereal diseases are found, which exposes the population for high risk of HPV infection. In Greenland, only girls are included in the mandatory HPV vaccination program.
To investigate the annual incidence of OPSCC and the proportion of HPV-associated OPSCC (HPV+ OPSCC) in Greenland in 1994-2010.
At Rigshospitalet, University of Copenhagen, we identified all Greenlandic patients diagnosed and treated for OPSCC from 1994 to 2010. Sections were cut from the patient's paraffin-embedded tissue blocks and investigated for p16 expression by immunohistochemistry. HPV analyses were performed with 2 sets of general HPV primers and 1 set of HPV16-specific primer. HPV+ OPSCC was defined as both >75% p16+ cells and PCR positive for HPV.
Of 26 Greenlandic patients diagnosed with OPSCC, 17 were males and 9 were females. The proportion of HPV+ OPSCC in the total study period was 22%, without significant changes in the population in Greenland. We found an increase in the proportion of HPV+ OPSCC from 14% in 1994-2001 to 25% in 2002-2010 (p=0.51). Among males from 20 to 27% (p=0.63) and in females from 0 to 20% (p=0.71). The annual OPSCC incidence increased from 2.3/100,000 (CI=1.2-4.2) in 1994-2001 to 3.8/100,000 (CI=2.4-6.2) in 2002-2010: among males from 2.4/100,000 (CI=1.0-5.7) to 5.0/100,000 (CI=2.9-8.9).
Even though the population is at high risk of HPV infection, the proportion of 22% HPV+ OPSCC in the total study period is low compared to Europe and the United States. This might be explained by our small study size and/or by ethnic, geographical, sexual and cultural differences. Continuing observations of the OPSCC incidence and the proportion of HPV+ OPSCC in Greenland are needed.
Notes
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This study examines the accuracy, completeness, and consistency of human papilloma virus (HPV) vaccine related physical risks disclosed in documents available to parents, legal guardians, and girls in Canadian jurisdictions with school-based HPV vaccine programs.
We conducted an online search for program related HPV vaccine risk/benefit documents for all 13 Canadian jurisdictions between July 2008 and May 2009 including follow-up by e-mail and telephone requests for relevant documents from the respective Ministries or Departments of Health. The physical risks listed in the documents were compared across jurisdictions and against documents prepared by the vaccine manufacturer (Merck Frosst Canada), the National Advisory Committee on Immunization (NACI), the Society of Obstetricians and Gynecologists of Canada (SOGC), and a 2007 article in Maclean's Magazine.
No jurisdiction provided the same list of vaccine related physical risks as any other jurisdiction. Major discrepancies were identified.
Inaccurate, incomplete, and inconsistent information can threaten the validity of consent/authorization and potentially undermine trust in the vaccine program and the vaccine itself. Efforts are needed to improve the quality, clarity, and standardization of the content of written documents used in school-based HPV vaccine programs across Canada.
A survey was undertaken in September 1991 to document current immunization practice across Canada. Information was obtained during interviews with provincial epidemiologists and key persons involved in immunization programs and recorded on standard data collection forms. Variations in practice are described in five areas: public/private health administration; legislation; monitoring system/coverage rates/surveillance; vaccine management and costs. As changes are being considered to immunization programs, a critical examination of issues such as standardization (in coding, in assessment of waste, in assessment of coverage), surveillance systems and the use of serosurveys would be beneficial.
