BACKGROUND Immunization programs' resilience to shocks is central to their success, but little empirical evidence documents resilience in action. We sought to characterize the decline of HPV vaccination in Denmark after negative media coverage and recovery during a national information campaign. METHODS We conducted a population-based retrospective cohort study of all girls born in Denmark from 1997 to 2006 (N = 328,779), aged 12-15. The outcome measure was HPV vaccine uptake (first dose), as reported to the Danish national health registry from 2009 to 2019, when HPV vaccine was freely available to girls in primary care clinics in Denmark. Events that created 4 natural time periods for study were HPV vaccine reaching the uptake of other vaccines in the national program (2009), some negative media coverage of HPV vaccination (2013), extensive negative media coverage (2015), and a national information campaign about the vaccine's safety and effectiveness (2017-2019). RESULTS In the period with some negative media coverage, HPV vaccine uptake fell to 83.6% (95% CI:78.0%-89.7%) of baseline uptake. In the period with extensive negative media coverage, uptake fell even further to 49.6% (95% CI:44.5%-55.2%) of baseline uptake. After the information campaign, HPV vaccine uptake recovered to its baseline level (109.2%, 95% CI:90.1%-132.4%) due in part to catch-up doses. Despite the recovery, an estimated 26,000 fewer girls initiated the vaccine than if uptake had not declined. CONCLUSIONS The experience in Denmark offers one of the first opportunities to document how a nation grappled with negative media coverage of HPV vaccination and the steadying impact of action by national authorities.

中文翻译：

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丹麦人乳头瘤病毒疫苗摄取的复原力：下降和恢复。

背景技术免疫程序对冲击的适应性是其成功的关键，但是很少有经验证据证明行动中的适应性。在全国性的宣传运动中，由于媒体的负面报道和恢复，我们试图描述丹麦的HPV疫苗接种量下降。方法我们对1997年至2006年在丹麦出生的所有女孩（N = 328,779）进行了一项基于人群的回顾性队列研究，年龄为12-15岁。结果度量是HPV疫苗摄入量（第一剂），据2009年至2019年向丹麦国家健康登记局报告，当时丹麦初级保健诊所的女孩可免费获得HPV疫苗。创造了四个自然研究时期的事件包括：HPV疫苗达到了国家计划中其他疫苗的接受水平（2009年），HPV疫苗接种的一些负面报道（2013年），广泛的负面媒体报道（2015），以及关于疫苗安全性和有效性的全国宣传运动（2017-2019）。结果在一些媒体报道为阴性的时期内，HPV疫苗摄入量降至基线摄入量的83.6％（95％CI：78.0％-89.7％）。在广泛的负面媒体报道期间，摄取量进一步下降至基准摄取量的49.6％（95％CI：44.5％-55.2％）。开展宣传运动后，部分由于追补剂量的缘故，HPV疫苗的吸收恢复至基线水平（109.2％，95％CI：90.1％-132.4％）。尽管恢复了，但接种疫苗的女孩估计比不减少的情况下少接种了26,000名女孩。