THE SUBSTANTIAL VARIATION in the uptake of the HPV vaccine rates from county to county requires further investigation, according to a new report. 

The Department of Health report documents a broad range of health service issues, including vaccination rates. 

The latest report finds that there is a significant difference in the HPV vaccination rates across the country, ranging from just 40% uptake in Kerry to 74% uptake in the Dublin south east area. 

No areas achieved the national target of 80%.

The report finds that uptake in HPV immunisation rates among girls in first year of secondary school “declined substantially” from 2014 to 2016, from 87% in 2014/2015 to 72% in 2015/2016 and 51% in the 2016/2017 academic year.

The HSE has confirmed that the current uptake rate for the HPV vaccine is now at 70% nationally, marking an increase of 19 percentage points in just over two years. 

However, the department’s annual National Healthcare Quality Reporting System states that the uptake variation between counties “requires further investigation at local level”. 

It notes that “public views about some media coverage about this vaccine may have adversely impacted uptake levels in recent years”.

The HPV (Human Papilloma Virus) represents a family of very common viruses that are passed on during sex. Most people will get a HPV infection in their lifetime and it usually clears up by itself.

For women, ongoing HPV infections can cause abnormal changes to the lining of the cervix that, if left untreated, can lead to cervical cancer. Most cervical cancers are caused by the HPV virus.

Comparing figures from 2015-2016 and also figures from 2016-2017, respectively, one of the areas with the highest rates was in Dublin South City, which had a rate of 82.5% which then dropped to a rate of 60.4%.

Dublin South West had a rate of 73.9% but fell two years later to 47.4%.

In Dublin West there was a rate of 71.1% which fell to 47.2%, while Kildare/West Wicklow had a rate of 81.2% which fell to 52.4%.

Areas which were in the lower bracket of uptake were Laois/Offaly which initally had a rate of 76.6% which plummeted to 48.1% in 2016/2017.

Longford/Westmeath had a rate of 69.4% which then fell to 48.5%, while Louth had a high uptake rate of 83.5% which then fell to 50.4%. Meath had a rate of 69.3% which fell to 48.5%.

These statistics are all recorded prior to the most recent HSE data which states that overall, the national uptake rate has risen.

Failure to meet national targets

The report also looks at the vaccination rates for influenza, the MMR vaccine as well as the Meningitis C vaccine.  

The report also raises particular concerns about the amount of healthcare staff getting the flu vaccine, stating that it has fallen below 40%.

A survey of 52 hospitals, including four private hospitals, found the percentage of vaccinated healthcare workers dropped to just over 39%. This is a decrease from the year previous, which had a vaccination rate of 44%.

There is a significant difference in uptake across healthcare sector jobs. 

While 42% of medical and dental staff availed of the vaccine, just 30% of nursing staff did so.

The majority of staff categories increased their flu vaccine uptake rate as compared to last year, but uptake varied substantially across some hospitals.

Of the 52 hospitals, 35  exceeded the 40% target. In particular, the Children’s Hospital Group achieved over 50% immunisation rate.

The report also found that the flu vaccine uptake for the population aged over 65 years has not yet been achieved to date.

The uptake rate over the past four years has not exceeded 60%, and provisional data for the 2018/2019 season suggests that uptake was approximately 56%.

MMR vaccine

The report also looks at the MMR vaccine which vaccinates against measles, mumps and rubella.

Two doses of the MMR vaccine are given in Ireland. The first dose is given at 12 months of age and the second dose is given at four to five years of age.

However, the report notes that anti-vaccine campaigners are impacting on some population groups that are not reaching the vaccination rate required for community protection or ‘herd immunity’.

The report notes:

In 2018, an outbreak of measles affected at least 85 people across Ireland; of those who were eligible for vaccination (all of those 12 months of age or older), 72% had not been vaccinated.

Measles outbreaks were reported in a number of European countries including Romania, Italy, France and Greece in 2018.

Although the national target of 95% has not been achieved, the national immunisation rate increased over the ten-year period by 3%, from 89% in 2008 to 92% in 2017.

For 2016, 2017 and 2018 the MMR vaccine uptake rate remained static at 92%.

The report notes that this requires ongoing review to ensure vaccine confidence is maintained.

The highest uptake of the MMR vaccine in 2018 for children at 24 months was in Roscommon, standing at 96% while the lowest rate was in Wicklow at 84%.

The MenC vaccine national target for the three doses is 95%. 

Although national uptake rates increased to a peak of 93% in 2009, this was not sustained. However, the rate of 85% in 2018 is the highest rate seen since 2009.

Commenting on the report, Health Minister Simon Harris said Ireland’s national uptake of the MMR and Meningitis C vaccines are below target.

“Vaccination hesitancy is one of the greatest threats to public health today,” he said. The minister plans to bring forward a motion this week on vaccinations, and is urging all TDs to back it. 

As reported previously by Noteworthy, the HSE has said falling take-up rates for a childhood vaccination against a dangerous type of meningitis are of “critical concern” in internal briefings. 

In some parts of the country, targets for immunisation were over 20% below what they were supposed to be, with serious problems identified in West Cork, Wicklow, and parts of Dublin.

A series of detailed performance reports – which were released to Noteworthy after a Freedom of Information request – show how “anti-vaccine sentiment” is now having a serious impact.

The reports warn that “herd immunity” against meningitis C is now being compromised based on the number of cases being reported in the community.

The National Healthcare report also looks at issues such as the use of medication on patients and caesarean sections, adding that there is “room for improvement” in these areas.

Ireland’s caesarean section rates continues to rise year on year, states the report, adding that it is above the OECD average.

Ireland’s national chronic use of benzodiazepine medications in people aged 65 years and older in the community is high compared with international averages, with the report stating that more women than men are taking them. 

The report also found that many patients said they did not feel they received the emotional support they needed while being cared for in our hospitals.

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