Easy access to vaccination was important for adherence during the 2016-2019 HPV catch-up vaccination in Norway.

Between September and October 2019, the Norwegian Institute for Public Health (NIPH) surveyed women born between 1991 and 1996 who were offered catch-up vaccination for human papilloma virus (HPV). The aim was to identify determinants of vaccine schedule adherence. A random sample of 10,000 women who were offered catch-up vaccination were invited to participate in the survey. We defined adherence as receiving all three doses. Determinants of HPV vaccination adherence were investigated using descriptive, univariable and multivariable logistic regression analyses providing adjusted odds ratios (aOR). Data from 3,762 respondents who received at least one dose were included. Overall, 92.1% (95% CI = 89.3-91.9) of those initiating vaccination adhered to the complete schedule. The following factors were significantly associated with HPV vaccination adherence compared to non-adherence: country of origin (aOR = 0.43; 95% CI = 0.47-0.97), having children (aOR = 0.51; 95% CI = 0.35-0.73), ease of finding out where to get vaccinated (aOR = 1.94; 95% CI = 1.69-2.23), preference for receiving information from health authorities (aOR = 1.37; 95% CI = 1.04-1.81) and vaccination being readily available (aOR = 2.28; 95% CI = 1.50-3.37). Information from NIPH via SMS and social media were negatively associated for Norwegians (aOR = 0.68, 95% CI = 0.46-1.01) and positively associated for those whose country of origin was not Norway (aOR = 1.48, 95% CI = 0.69-3.14; not significant). Those who did not adhere to the full vaccination schedule reported that they had forgotten (40.4%; 95% CI = 33.5-47.8) or had no time (32.9%; 95% CI = 26.2-40.4). Despite NIPH's targeted communication campaign, the main barriers for HPV vaccination adherence were difficulty to find out where to get the vaccine, forgetting to take the vaccine or not having time to complete the schedule.

Sociodemographic determinants of catch-up HPV vaccination completion between 2016-2019 in Norway.

Between 2016 and 2019, a catch-up human papillomavirus (HPV) vaccination took place in Norway for women born between 1991 and 1996. The aim of this study was to identify sociodemographic determinants of complete vaccination (3 doses) and partial vaccination (1-2 doses). A random sample of 10,000 women who were offered catch-up HPV vaccination were invited. We assessed the association between sociodemographic characteristics and vaccination completion using univariable and multivariable multinomial logistic regression.Of 4,967 respondents, 3,464 (63%) received complete vaccination and 298 (7%) received partial vaccination. 30% did not receive any vaccination and functioned as reference group. Compared with having Norwegian caregivers, having a caregiver from non-western countries decreased the odds of partial and complete vaccination (aOR = 0.57; 95%CI = 0.35-0.95 and aOR = 0.57; 95%CI = 0.44-0.74). Having a caregiver from other western countries decreased the odds of complete vaccination (aOR = 0.72; 95%CI = 0.52-0.98). Residing in Norway for 10 years or longer significantly increased the odds of complete vaccination (aOR = 2.65; 95%CI = 1.58-4.43). Being in a relationship significantly increased the odds of partial vaccination compared with being single (aOR = 1.50; 95%CI = 1.02-2.21). Being married (aOR = 0.66; 95%CI = 0.50-0.86) and having children (aOR = 0.53; 95%CI = 0.42-0.68) decreased the odds of complete vaccination. Having university education increased the odds of both partial and complete vaccination (aOR = 2.19; 95%CI = 1.47-3.25 and aOR = 4.11; 95%CI = 3.33-5.06).Having a caregiver born outside of Norway, having children and being married decreased the odds of receiving complete HPV vaccination. This highlights the need to target communication around HPV vaccination toward different ethnic communities and include more specific messaging that having children and being married does not necessarily prevent HPV infections.

Multidrug-resistant tuberculosis in Norway: a nationwide study, 1995-2014.

SETTING: The management of multidrug-resistant tuberculosis (MDR-TB) is strictly regulated in Norway. However, nationwide studies of the epidemic are lacking. OBJECTIVE: To describe the MDR-TB epidemic in Norway over two decades. DESIGN: Retrospective analysis of data on MDR-TB cases in Norway, 1995-2014, obtained from the national registry, patient records and the reference laboratory, with genotyping and cluster analysis data. Data for non-MDR-TB cases were collected from the national registry. RESULTS: Of 4427 TB cases, 89 (2.0%) had MDR-TB, 7% of whom had extensively drug-resistant TB (XDR-TB) and 24% pre-XDR-TB. Of the 89 MDR-TB cases, 96% were immigrants, mainly from the Horn of Africa or the former Soviet Union (FSU); 37% had smear-positive TB; and 4% were human immunodeficiency virus co-infected. Of the 19% infected in Norway, the majority belonged to a Delhi/Central Asian lineage cluster in a local Somali community. Among the MDR-TB cases, smear-positive TB and FSU origin were independent risk factors for XDR/pre-XDR-TB. Treatment was successful in 66%; 17% were lost to follow-up, with illicit drug use and adolescence being independent risk factors. Forty-four per cent of patients treated with linezolid discontinued treatment due to adverse effects. CONCLUSION: MDR-TB is rare in Norway and is predominantly seen in immigrants from the Horn of Africa and FSU. Domestic transmission outside immigrant populations is minimal.

Interventions to enhance maternal awareness of decreased fetal movement: a systematic review.

BACKGROUND: Decreased fetal movement is associated with adverse pregnancy and birth outcomes; timely reporting and appropriate management may prevent stillbirth. OBJECTIVES: Determine effects of interventions to enhance maternal awareness of decreased fetal movement. SEARCH STRATEGY: Cinahl, The Cochrane Library, EMBASE, MEDLINE, PsycINFO and SCOPUS databases; without limitation on language or publication year. SELECTION CRITERIA: Randomised or non-randomised studies evaluating interventions to enhance maternal awareness of decreased fetal movement. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed quality. MAIN RESULTS: We included 23 publications from 16 studies of fair to poor quality. We were unable to pool results due to substantial heterogeneity between studies. Three randomised controlled trials (RCTs) and five non-randomised studies (NRSs), involving 72 888 and 115 435 pregnancies, respectively, assessed effects of interventions on stillbirth and perinatal death. One large cluster RCT (n = 68 654) reported no stillbirth reduction, one RCT (n = 3111) reported significant stillbirth reduction, and one RCT (n = 1123) was small with no deaths. All NRSs favoured intervention over standard care; three studies (n = 31 131) reported significant reduction, whereas two studies (n = 84 304) reported non-significant reductions in stillbirth or perinatal deaths. Promising results from NRSs warrant further research. We found no evidence of increased maternal concern following interventions. No cost-effectiveness data were available. CONCLUSIONS: We found no clear evidence of benefit or harm; indirect evidence suggests improved pregnancy and birth outcomes. The optimal approach to support women in monitoring their pregnancies needs to be established. Meanwhile, women need to be informed about the importance of fetal movement for fetal health. TWEETABLE ABSTRACT: The benefits and risks of interventions to increase pregnant women's awareness of fetal movement are unclear.

Analysis of 'count-to-ten' fetal movement charts: a prospective cohort study.

OBJECTIVE: We aimed to describe patterns of maternally perceived fetal movement (FM) counts in normal third-trimester pregnancies and present associations between published limits of decreased fetal movement (DFM) and FM patterns in the total population. DESIGN: Prospective cohort study. SETTING: Norway, in 2005-2007 and 2007-2009. POPULATION: The total population of women with singleton pregnancies. METHODS: Using a 'count-to-ten' approach, women counted FMs daily from pregnancy week 28 until delivery. Data on maternal characteristics and birth outcomes were obtained from the Medical Birth Registry of Norway and hospital records. We measured the observed mean counting time and used chi-square and Mann-Whitney U-tests to examine differences between normal pregnancies and pregnancies with suboptimal outcomes. MAIN OUTCOME MEASURES: Fetal movements in normal pregnancies and in pregnancies ending in a small-for-gestational-age baby, preterm birth or non-elective caesarean section. RESULTS: A total of 1786 women were included. The mean time to perceive ten movements was approximately 10 minutes in normal pregnancies, with a <2-minute increase in the mean towards term. Fixed limits for DFMs had low predictive values. Overall, the mean counting time in pregnancies with suboptimal outcomes did not differ markedly from normal pregnancies. CONCLUSIONS: This study does not support the notion that FM counts decrease at term in normal pregnancies. A standard approach to FM counting, applying the currently best-founded definition of DFM, was not useful as a screening tool for at-risk pregnancies in this population. Further research is needed to improve measurements of DFM.

Predictive values of QuantiFERON-TB Gold testing in screening for tuberculosis disease in asylum seekers.

Screening with chest X-ray and the Mantoux test (the tuberculin skin test [TST]) is compulsory for adult asylum seekers who arrive in Norway. In 2005-2006, we included 823 asylum seekers in a study of the QuantiFERON-TB Gold test (QFT-G), and followed them for 23-32 months. Eight subjects with a positive and one with a negative QFT-G test were diagnosed with tuberculosis (TB). The positive (PPV) and negative predictive values (NPV) for TB were respectively 3.3% and 99.8%. The PPV was 2.3% and the NPV 99.1% for TST >or= 15 mm, and the NPV was 99.5% for TST >or= 6 mm in combination with a negative QFT-G.

Tuberculosis in contacts need not indicate disease transmission.

BACKGROUND: Traditional contact investigation is an important tool for controlling tuberculosis. It may also help to indicate drug susceptibility patterns when Mycobacterium tuberculosis cultures are not available. Such investigations often underestimate the degree of transmission found by genotyping, but overestimation may also occur. This report is the result of a routine successive DNA restriction fragment length polymorphism (RFLP) analysis of M tuberculosis isolated in Norway. METHOD: Fifteen immigrants belonging to the same community were notified with tuberculosis during February to September 2003. The mycobacterial isolates were analysed by RFLP. RESULTS: All 15 patients had social contact with each other and 13 belonged to the same church community. A total of 14 cultures were positive for M tuberculosis. Among these isolates, six different genotypes were found. Five patients had not acquired the infection from the putative source. CONCLUSIONS: Reactivation of tuberculosis may occur in contacts during the development of an outbreak. In such situations, traditional contact investigations may overestimate the rate of transmission found by genotyping of M tuberculosis. When cultures are unavailable and presumed drug susceptibility patterns are based on that of contacts, such overestimation may lead to incorrect treatment of a patient. Contact investigations must be combined with genotyping of M tuberculosis to conclude how tuberculosis is transmitted. This is especially important in persons with several risk factors for infection.