Quality assessment of fish vaccine data in the Norwegian Veterinary Prescription Register (VetReg)

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Dean, Ingunn Sommerset, Kari Olli Helgesen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4472914/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Jan, 2025 Read the published version in BMC Veterinary Research → Version 1 posted 10 You are reading this latest preprint version Abstract Background Vaccination of farmed salmonids has been an integral part of preventing infectious diseases in Norway’s aquaculture industry. The Norwegian government regulates the use of vaccines and there is a need to monitor vaccine usage for both regulatory and research purposes, at local and national scales. The Norwegian Veterinary Prescription Register (VetReg) is a national database that includes all prescriptions of medicines to animals dispensed by pharmacies and all medicines used for food producing animals by veterinarians. The purpose of our study was to evaluate the quality of fish vaccination data reported to VetReg in 2016–2022. We considered the following attributes: completeness, validity, and timeliness. For external validation, we compared the data in VetReg to wholesaler statistics. Results Pharmacies reported fish vaccines to VetReg in a variety of quantity units, including doses and volumes, which required us to harmonize the data to a single unit. Harmonization was not possible for nine percent of the records, which were mainly bath vaccines reported in doses. We identified specific issues that required manual editing of the units of 1 percent of the records. After exclusions, we validated individual variables such as product codes and location identifiers using external registers. Some variables, such as the ‘number of animals’, were inconsistent for 31 percent of the records. The coverage of vaccine data in VetReg ranged from 81 to 113 percent for the ten most sold vaccines in 2020–2022 as compared to wholesales statistics. For the timeliness, we found that 75 percent of the records were submitted within 25 days for all years. Conclusions Overall, we found that the fish vaccination data in VetReg was of sufficient quality to monitor injectable vaccine usage at hatcheries after 2020. We identified issues at the product level, with bath vaccines, and with single variables (number of animals, weight, and species). We recommend that quality can be improved by reporting all vaccines in volume rather than doses, reporting a single vaccine prescription per report, and including a deadline for pharmacies to report in the legislation. Aquaculture vaccination data validation animal health data salmon biosecurity secondary data Figures Figure 1 Figure 2 Figure 3 Background In Norway, aquaculture production of Atlantic salmon and rainbow trout is an economically important industry that continues to expand. Norway is currently the world’s largest producer of Atlantic salmon with an export of 1.2 million tons in 2023 ( 1 , 2 ). The intensification of salmonid farming would not have been possible without effective disease control and prevention measures. In the late 1980s and early 1990s, vaccination contributed significantly to the growth of salmonid aquaculture, as well as, the low antibiotic usage seen for many years in Norwegian fish farming ( 3 , 4 ). However, diseases caused by parasites, bacteria and viruses, continue to threaten the fish health and welfare of Atlantic salmon and rainbow trout ( 5 ). The production of Atlantic salmon and rainbow trout mimics their natural history as anadromous fish. Farmed salmonids begin their lives in freshwater hatcheries, where they are kept until they have smoltified. After smoltification, the fish are physiologically adapted to a life in seawater. The smolts are then transferred to seawater facilities where they are kept until they are slaughtered. In 2022, hatcheries sold 418 million Atlantic salmon and 26 million rainbow trout to on-growing sea farms ( 6 ). Nearly all of these fish were vaccinated against one or more pathogens, which takes place at the hatcheries ( 5 ). Today, there are several vaccines available against important bacterial and viral pathogens causing diseases in farmed salmonids, but very few vaccines exist against parasitic diseases. The law regulates the use of vaccines for farmed salmonids in Norway. At a basic level, all medicines (including vaccines) prescribed for fish must have marketing authorization in Norway or be granted a special license from the Norwegian Medical Product Agency (NoMA). Vaccines for fish additionally require permission for use by the national competent authority on fish health and welfare, the Norwegian Food Safety Authority (NFSA) ( 7 ). The regulation of vaccines covers both the use of certain vaccines and the prohibition of others. Presently, the NFSA states that farmers should vaccinate Atlantic salmon and rainbow trout against vibriosis, furunculoses, and cold-water vibriosis ( 8 ). On the contrary, it is illegal in Norway to vaccinate against certain diseases where early detection and eradication is important ( 7 ). Along these lines, it is possible to make it illegal to vaccinate against certain diseases in specific geographic areas or compartments if there is a goal of obtaining “free-status”. Disease-free status can be important for gaining access to specific markets internationally due to import restrictions. With hundreds of millions of salmonids being vaccinated in Norway every year, there is a need to monitor vaccine usage for several reasons. Firstly, it is important to know the vaccination status of the farmed fish in order to evaluate to what extent the farmers follow the legislation. Secondly, the vaccination status of the fish is an important factor to understand the underlying reasons for the prevalence and spread of infectious diseases. For example, knowledge of vaccination status is required to understand how well a vaccine protects against a certain disease and to compare the efficacies of different vaccines for the same disease ( 9 ). Finally, some vaccines may cause harmful side effects to the fish and therefore it is important to monitor their usage to protect fish welfare ( 10 ). For example, the vaccination status is needed in order to evaluate side effects of specific vaccines and combinations of vaccines. Studies of vaccine side effects are mainly conducted by pharmaceutical companies during clinical and field trials. Information about vaccine usage in salmonids in Norway can be obtained from multiple sources including wholesaler statistics, the national prescription register, and farm records. Sales can be followed at a national level through the wholesalers' statistics reported annually to the Norwegian Institute of Public Health (NIPH), where wholesalers of medicines are obliged to enter their medicine sales ( 11 ). Vaccine sales can be obtained from the veterinary prescription registry (VetReg), owned by the NFSA ( 12 ). Pharmacies are obliged to report all sales of prescribed medicines for all animals and medicines sold directly to veterinarians. For veterinarians and authorized fish health personnel it is mandatory to report the use of medicines for food-producing animals, including fish. Reports to VetReg are per prescription or delivery to veterinarians (for pharmacies) or per treatment of an animal or group of animals for veterinarians. Reporting to VetReg has been mandatory for medicines used for fish since 2011. Finally, records at hatcheries also contain detailed information about the vaccine status of each fish group, although these may be harder to obtain at a national level. The national statistics generally do not have information about autogenous vaccines, which are vaccines produced for a specific farm against a variant of a pathogen found in the same farm. These vaccines can only be used if there are no commercial vaccines with marketing authorization available against the pathogen or the available vaccines have low or insufficient efficacy. It is difficult to follow the vaccine status of autogenous vaccines at any level because these vaccines are not authorized in any country. This means that there are no publicly available data for the active substances, dosage regime, route of administration, and target species. VetReg can be an appropriate source to provide timely and accurate information about vaccinations used in Norwegian aquaculture for Atlantic salmon and rainbow trout. The quality of the register has been assessed previously for antibiotic use data and for data on anti-parasitics used against salmon lice ( 4 , 13 , 14 ). However, there are no previous studies performing quality assessment or validation of fish vaccination data in VetReg. Birkegård et al. (2018) proposed a framework for assessing the data quality of nationwide animal health registers, including a description of the register, use of relevant quality attributes, and identification and communication of quality issues ( 15 ). Here we use this framework to evaluate VetReg for fish vaccination data in Norway from 2016–2022. Based on our evaluation, we make recommendations for using and improving the VetReg data for fish vaccines. Methods VetReg VetReg covers all prescriptions of medicines for animals dispensed to animal owners from pharmacies, including all medicines sold from pharmacies to veterinarians. In addition, it covers all prescription medicines used for food-producing animals (including horses) and voluntary reports for animals kept for other purposes, reported by veterinarians ( 12 ). The deadline for reporting is seven days for veterinarians, while it is to the best of our knowledge not stated for pharmacies. In general, access to the register data is restricted and we obtained the data through an existing agreement between the Norwegian Veterinary Institute and the NFSA. We received the VetReg data as a comma separated (.csv) file, extracted by the NFSA from their centralized database on 17 Jan 2024. The extracted data included variables originating from VetReg (report ID and date of registration), from the national product registry (Anatomical Therapeutic Chemical (ATC) code, national product ID, product name, pack size, pack size units), and from pharmacies or veterinarians (quantity, quantity units, animal species, number of animals, weight of the animals, date of delivery, name of pharmacy and animal health professional, information about the owner of the animal(s) (only for food producing animals), identification number of the animal(s), reason for prescription and diagnosis). From the complete dataset, we filtered the data based on the date of delivery for the study period for each individual year from 2016–2022 and ATC codes associated with fish vaccines for salmon or rainbow trout, QI10A and QI10B. We did not find any records of autogenous vaccines in VetReg. Each row of the data represented a registration made by a pharmacy, veterinarian/animal health professional, or feed mill. For fish vaccines, we expected that all registrations to VetReg to be marked as “Delivery from pharmacies to animal owners/husbandry.” However, there were records marked as “Notification of animal health professional’s use of medicinal products” in all years of the study period except in 2017 and 2020. According to the regulations, animal health personnel should only report the use of medicines first dispensed to themselves by a pharmacy ( 12 ). Upon investigation, we did not find any records of animal health personnel buying any fish vaccines from pharmacies except a single record in 2018. The relevant veterinarian had not reported the use of these vaccines. Therefore, we removed all entries marked “Notification of animal health professional’s use of medicinal products” as likely duplicates to those already reported by pharmacies. Wholesaler data Wholesaler data are nationwide data on medicines sold from wholesalers and from producers of medicated feed. Wholesalers sell to pharmacies, while producers of medicated feed sell to animal owners. These data are collected by the Norwegian Institute of Public Health (NIPH) and are mandatory to report according to regulation ( 11 ). The deadline for this report is 15th of January the following year. We asked the NIPH for wholesaler data for ATC code QI (vaccines for animals including fish) for 2016 to 2022. We received the wholesale data on 3 Jan 2024 as an excel file. The data we received contained information with the year, ATC-code, national product ID, product name, pack size, number of packages sold per year and whether or not the product was marketed in Norway or imported via special license. We filtered the data for ATC-codes QI10A and QI10B. We excluded entries for the vaccine “IZOVAC ENCEPHALOMYELITS” due to incorrect ATC coding. For this vaccine, the correct ATC-code is QI01AD02 ( 16 ). We further excluded data for autogenous vaccines (two vaccines reported in 2016). Validity In the context of data quality assessment, validity refers to “whether or not the register includes the true value” ( 15 ). For VetReg, we evaluated the internal and external validity as appropriate for different variables in the dataset. We checked the reported quantities and quantity units for unexpected values. We validated the national product ID numbers and we converted reports for injectable vaccines in doses to ml using the information given for each national product ID in the Summary of Product Characteristics (SPC) found using the medicine database “legemiddelsøk” administrated by the Norwegian Medicinal Products Agency (NoMA) ( 17 ). We checked that the reported species was reasonable. Furthermore, we also checked what year the vaccine was authorized for use in Norway, although vaccines can also be imported from another county where they are authorized via special license from NoMA. We further checked the owner information against location numbers for fish farms in the Norwegian Aquaculture Register. Finally, we compared the number of vaccine doses used to the column for the ‘number of animals’, as a means of internal validation. Completeness The ECDC (2014) defines completeness of reporting as the “absence of underreporting” ( 18 ). We assessed external completeness by comparing the yearly number of fish vaccines reported in VetReg to wholesaler-based statistics of pharmaceutical sales obtained from the Norwegian Public Health Institute. To perform the comparison, we converted the wholesales data to units, where \(units=pack size \times number of packs\) and we considered the wholesale numbers of packs sold as the reference standard. To account for errors reported at the product ID level, we performed the comparison at both the product ID level and the vaccine name level. Timeliness The timeliness of a register refers to the time between an event occurring and the registration of that event. To assess the timeliness of the register, we calculated the difference between the date of dispensing and the date of registration in VetReg. For 2016–2022, we graphed the timeliness as the percentage of new reports by the time since dispensing. We also investigated changes in timeliness from year to year. Results Data description For 2016–2022, there were 7,443 reports of fish vaccines in VetReg. The yearly number of reports during this period ranged from 715-1,283. We removed 12 entries that were recorded as “Notification of animal health personnel’s use of medicinal products.” There were 7,431 records remaining of fish vaccines dispensed by pharmacies. All of the reports to animal owners were submitted by four pharmacies. Validity The dataset included 18 different fish vaccines with 23 unique national product IDs. Tables 1 and 2 describe the vaccines and their reporting to VetReg by national product ID. We added “Bath” at the end of the name for bath vaccines to differentiate those from injectable vaccines of the same name. Table 1 Characteristics of fish vaccines reported in VetReg in 2016–2022 including the national product ID, ATC code, vaccine name, pack size, dose, type, and years authorized in Norway. Product ID ATC code Vaccine name Pack size Dose Type Authorization years 480101 QI10AB04 Alpha Erm Salar Bath 1000 ml Bath 2016 – Present 556139 QI10AB04 Alpha Erm Salar 250 ml 0.025 ml Injection 2020 – Present 429437 QI10AB04 Alpha Erm Salar 500 ml 0.025 ml Injection 2021 – Present 130772 QI10AB02 Alpha Ject 3000 500 ml 0.1 ml Injection 2009 – Present 101148 QI10AB03 Alpha Ject 5 − 3 500 ml 0.1 ml Injection 2011 – Present 101159 QI10AL02 Alpha Ject 6 − 2 500 ml 0.1 ml Injection 2010 – Present 027475 QI10AL02 Alpha Ject Micro 6 1 x 500 ml 0.05 ml Injection 2011 – Present 027464 QI10AL02 Alpha Ject Micro 6 1 x 250 ml 0.05 ml Injection 2011 – Present 034501 QI10AA01 Alpha Ject micro 1 PD 500 ml 0.05 ml Injection 2017 – Present 034490 QI10AA01 Alpha Ject micro 1 PD 250 ml 0.05 ml Injection 2017 – Present 167812 QI10AB03 Alpha Ject micro 5 1 x 500 ml 0.05 ml Injection 2022 – Present 465067 QI10AL04 Alpha Ject micro 7 ILA 500 ml 0.05 ml Injection 2019 – Present 090235 QI10AL04 Alpha Ject micro 7 ILA 250 ml 0.05 ml Injection 2019 – Present 560340 QI10AL02 Aquavac 6 500 ml 0.1 ml Injection 2016–2023 189864 QI10AA01 Aquavac PD 500 ml 0.1 ml Injection 2017–2021 193107 QI10AL05 Aquavac PD7 500 ml 0.1 ml Injection 2015 – Present 61902 QI10BB03 Aquavac Relera Bath 1000 ml Bath 2012–2023 472689 QI10AA02 Clynav 1 x 250 ml 0.05 ml Injection 2018 – Present 169401 QI10BB02 Lipogen Duo 500 ml 0.1 ml Injection 2006–2018 130420 QI10BB02 Lipogen Duo 1000 ml 0.1 ml Injection 2006–2018 515591 QI10AA01 Norvax Compact PD 1 x 500 ml 0.1 ml Injection 2012–2022 099126 QI10AL02 Norvax Minova 6 500 ml 0.1 ml Injection 2010–2017 130519 QI10AL02 Pentium Forte Plus 500 ml 0.1 ml Injection 2007 – Present Table 2 Overview of reporting in VetReg for fish vaccines in 2016–2022 including the national product ID, vaccine name, number of records, years present, units, species. Product ID Vaccine name No. records Years Units Species 480101 Alpha Erm Salar 680 2016–2022 stk, ml, kg Atlantic salmon, Rainbow trout, Brown trout 556139 Alpha Erm Salar 380 2020–2022 ml, stk Atlantic salmon 429437 Alpha Erm Salar 187 2021–2022 ml, stk, g Atlantic salmon 130772 Alpha Ject 3000 94 2016–2022 ml, stk Turbot fish, Rainbow trout, Atlantic salmon, Brown trout 101148 Alpha Ject 5 − 3 267 2016–2022 stk, ml Rainbow trout, Atlantic salmon, Brown trout, Ornamental fish, Cyclopterus 101159 Alpha Ject 6 − 2 249 2016–2022 stk, ml Atlantic salmon, Rainbow trout, Brown trout, Other farmed fish, Ornamental fish 027475 Alpha Ject Micro 6 2,670 2016–2022 ml, stk, g, kg Atlantic salmon, Brown trout, Ornamental fish, Bivalve molluscs, Rainbow trout 027464 Alpha Ject Micro 6 97 2016–2022 stk, ml Atlantic salmon, Ornamental fish 034501 Alpha Ject micro 1 PD 860 2017–2022 ml, stk, kg Atlantic salmon, Rainbow trout, Brown trout, Ornamental fish, Bivalve molluscs 034490 Alpha Ject micro 1 PD 43 2017–2019, 2021–2022 stk, ml Atlantic salmon, Brown trout 167812 Alpha Ject micro 5 1 2022 stk Atlantic salmon 465067 Alpha Ject micro 7 ILA 220 2020–2022 stk, ml Atlantic salmon 090235 Alpha Ject micro 7 ILA 17 2020–2022 ml, stk Atlantic salmon 560340 Aquavac 6 200 2016–2022 stk, ml Atlantic salmon, Rainbow trout, Brown trout 189864 Aquavac PD 5 2018, 2020–2021 ml, stk Atlantic salmon 193107 Aquavac PD7 464 2016–2021 ml, stk Atlantic salmon, Brown trout, Bivalve molluscs 061902 Aquavac Relera 14 2016–2017, 2020–2022 stk, ml Atlantic salmon, Rainbow trout, Brown trout 472689 Clynav 495 2020–2022 stk, ml Atlantic salmon, Other farmed fish, Brown trout 169401 Lipogen Duo 13 2016–2017 ml Atlantic salmon, Brown trout, Rainbow trout 130420 Lipogen Duo 1 2016 ml Brown trout 515591 Norvax Compact PD 136 2016–2021 ml, stk, kg Atlantic salmon 099126 Norvax Minova 6 1 2017 ml Atlantic salmon 130519 Pentium Forte Plus 336 2016–2021 stk, ml Atlantic salmon, Rainbow trout The pharmacies mainly reported usage in units of ‘stk’ (which is dose) or ‘ml’, but some entries were in ‘g’ and ‘kg’. For injectable vaccines reported in doses, we used information linked to the national product ID to convert doses to ml for 3,129 entries. For records reported in ‘g’ and ‘kg’, we tried to ascertain if the wrong reporting unit was used and if the actual reporting unit was the corresponding volume unit (‘ml’ and ‘L’, respectively) or ‘stk’. After manually correcting five entries, there were three entries in kg that could not be ascertained. The register included reports for two different bath vaccines, which are dissolved in water before administration. For bath vaccines, the number of doses given from each preparation can vary, thus it is not possible to convert them from doses to ml. In 2016 and 2017, both types of bath vaccines contained entries with a mixture of reporting units in doses and ml, which were excluded from further analysis. In 2020–2022, the Aquavac Relera vet bath vaccine was reported exclusively in ‘ml’. The VetReg data included information about the species, weight, animal owner, and number of animals. As expected, the most commonly reported species associated with the vaccines were Atlantic salmon, rainbow trout, and brown trout. In addition, some reports had other species listed and these could represented off-label usage; for animal species which have not been documented as target animals during registration of the vaccines. The listing of other species could also be caused by incorrect entries. The reported fish weights were between 0.001 and 1,685,000. However, we could not find a unit associated with this column. For records reported in 2020–2022, an animal owner was reported for 98 percent of the records. For salmonids, we assumed that the animal owners are hatchery locations, where the fish are vaccinated before being put to sea, identified by an official location number. We found that all of the records with reported animal owners matched to a hatchery location in the Norwegian aquaculture register. To assess the validity of the ‘number of animals’ column, we used the number of doses reported within each record. As we compared based on the number of doses, this did not include bath vaccines that could not be converted from mL back to doses. For the injectable vaccines, the Summary of Product Characteristics (SPC) leaflets specified that every injectable vaccine here should be given as 1 dose per fish. Thus, the number of doses should be equal to the number of animals. However, we found that the number of animals reported was not consistent with the number of doses for 31 percent of the records investigated. We tried to identify any systematic causes of the inconsistent records. We found that there were higher odds, odds ratio of 1.86 (95% CI 1.62–2.14) of inconsistent reports when pharmacies reported multiple vaccines under the same report ID, meaning the same prescription. For example, pharmacies reported the same number of animals even when different quantities of doses for different vaccines were sold. In some other cases, pharmacies reported the number of animals as the sum of all the doses sold for the different vaccines under the same report ID. Supplementary Fig. 1 shows examples of these two issues. An additional source of inconsistency between the number of doses and number of animals was related to probable errors in the reported units. In these cases, the units were reported as doses but should have been ml, and vice versa. We manually corrected 35 records where the number of animals exactly matched the number of doses calculated from quantity given in ml (doses incorrectly coded as ml) or the number of animals exactly matched the number of doses (ml incorrectly coded as doses). Completeness To assess completeness, we compared the usage data in VetReg to wholesaler-based statistics at both at the national product ID level and per vaccine name for 2016–2022. Figure 1 and Table 3 give an overview of records included, excluded, or corrected for cross-validation. Due to reporting of quantity units in doses for bath vaccines, we removed 684 records, including those for the bath vaccine Alpa Erm Salar (national product ID: 480101) from all the years and all records for bath vaccine Aquavac Relera vet (national product ID: 061902) from years 2016 and 2017. Furthermore, due to invalid reporting of quantity units in ‘kg’ for injectable vaccines we removed three more entries from the cross-validation below. Therefore, the comparison was conducted on 6,744 entries (Table 3 ) from 22 product numbers (17 different vaccines). Figure 1 Data-flow diagram. Diagram of records included and excluded from cross-validation for fish vaccines reported in VetReg. Table 3 Overview of the number of records included, corrected, or excluded from cross-validation for fish vaccines reported in VetReg from 2016–2022. Year Total Records Excluded reported by vet Excluded bath vaccines Excluded incorrect units Reports with manually corrected units Final records in cross-validation g to ml kg to L ml to stk stk to ml 2016 715 3 7 0 0 0 5 0 705 2017 939 0 79 0 0 0 9 0 860 2018 1060 1 144 0 0 0 3 0 915 2019 1010 2 257 0 1 3 10 1 751 2020 1172 0 114 0 0 0 0 1 1058 2021 1283 2 33 1 0 0 3 1 1247 2022 1264 4 50 2 1 0 2 0 1208 Total 7443 12 684 3 2 3 32 3 6744 We first compared coverage at the product ID level. In general, we found that coverage varied substantially between products and years (SI Fig. 2, SI Table 1 ). The total coverage for different products ranged from 35–283 percent. There were five vaccines with multiple product numbers due to them being sold in various pack sizes (Alpha Ject Micro 6, Alpha Ject micro 1 PD, Alpha ERM Salar, Alpha Ject micro 7 ILA, Lipogen Duo). We observed that within the same vaccines, individual product IDs were subject to under and over reporting. We repeated our analysis at the vaccine name level. Figure 2 and Table 4 provide an overview of total and yearly coverage for each vaccine. We found that combining product numbers improved the overall coverage of the vaccines with multiple product numbers. For example, Alpha Ject Micro 1 PD had product level coverage of 103 percent and 65 percent, but a combined coverage of 102 percent. In general, VetReg had good coverage for most of the vaccines at vaccine name level as compared to the wholesaler statistics. However, this was not the case for all vaccines over the entire study period. For example, Clynav vet inj and Alpha Ject Micro 7 ILA, were not reported in VetReg prior to 2020, even though these appear in wholesaler data prior to 2020. At the same time, Norvax Minova 6 vet inj, appeared in VetReg in 2017 but not the wholesaler data for any year. However, this vaccine was used in very small quantity and accounted for only one record. Figure 2 Data coverage. Yearly and total coverage for the ten most used fish vaccines, excluding bath vaccines, reported to VetReg in 2016–2022 as compared to wholesales statistics. Vaccines product IDs are shown in parentheses, those with multiple products are aggregated under a single vaccine name. Table 4 Summary of coverage (in percentage) for fish vaccines reported in VetReg for 2016–2022 as compared to wholesaler statistics. Dashes indicate that no data was reported in either VetReg or wholesaler data, ‘Not in sales’ indicates that usage was reported in VetReg but not in wholesaler data, ‘Excluded’ is used for bath vaccines reported to VetReg in mL that cannot be converted to doses. Name Product ID Yearly coverage (%) Total 2016 2017 2018 2019 2020 2021 2022 Alpha Ject Micro 6 027464, 027475 115.54 103.07 99.92 121.8 99.18 103.04 103.14 106.02 Pentium Forte Plus 130519 103.72 98.95 105.73 99.71 95.17 120.19 - 101.83 Alpha Ject micro 1 PD 034490, 034501 - 117.26 100.19 98.23 95.18 97.28 100.61 101.89 Clynav 472689 - - 0 0 87.48 108.05 99.92 81.17 Aquavac PD7 193107 105.75 102.33 345.22 93.86 94.35 100 - 112.57 Alpha Ject 5 − 3 101148 99.02 111.06 99.85 109.28 95.77 99.92 109.32 102.28 Alpha Ject 6 − 2 101159 99 94.61 96.4 100.45 101.89 90.61 100 97.67 Alpha ERM Salar 429437, 556139 - - - - 81.25 104.54 103.05 97.41 Alpha Ject micro 7 ILA 465067, 640117, 090235 0 0 0 0 85.19 111.1 95.38 93.14 Aquavac 6 560340 101.07 114.13 405.61 99.74 97.2 103.75 105.25 110.39 Norvax Compact PD 515591 98.94 106.1 145.78 99.26 73.16 100 - 102.07 Alpha Ject 3000 130772 223.57 129.82 106.25 96.16 121.02 124.46 105.15 116.8 Aquavac Relera Bath 061902 Excluded Excluded - - 85.93 100.00 100.00 Excluded Lipogen Duo 169401, 130420 99.75 64.5 - - - - - 81.25 Pentium Forte Plus ILA 1102444 0 - - - - - - 0 Aquavac PD 189864 - - 42.39 - Not in sales Not in sales - 283.15 Alpha Ject micro 5 167812 - - - - - - 100 100 Norvax Minova 6 099126 - Not in sales - - - - - Not in sales Timeliness For vaccine reports, the time it took for 95 percent of the records to be submitted ranged from 14–152 days per year in 2016–2022 (SI Table 2 ) and 13–152 days for 2020–2022 (Fig. 3). We observed that the timeliness was sporadic between years, with no trend. However, for all years, 75 percent of the reports were submitted in 25 days or less. Figure 3 Timeliness of data. Timeliness of reports to VetReg for fish vaccination data for 2020–2022. The number on each curve marks the point when 95 percent of records are received in a given year. Discussion Overall, the completeness of VetReg for injectable fish vaccines was adequate compared to sales data for 2020–2022. In these years, coverage in VetReg for different vaccines was 73 to 124 percent of the corresponding sales per year. The coverage was more consistent for the top ten vaccines sold in 2020–2022, ranging from 81 to 113 percent. We found that 2022 had the most complete records, with between 95 and 109 percent coverage for all vaccines. There was a marked increase in completeness after 2020, as compared to earlier years in the study (2016–2019). Due to the reporting of bath vaccines in doses, we could not evaluate the coverage of bath vaccines reported in VetReg to the wholesales data for all vaccines in all years. This is because it is not possible to convert dose units to mL for these vaccines, since a range of fish can be vaccinated using the same volume of bath vaccine. However, the completeness for one bath vaccine reported only in mL for 2020–2022 was 85–100 percent, within the range for the injectable vaccines. When comparing VetReg to wholesales data, we can expect some over- and under- reporting. This is due to fundamental differences between the two registers. Reports in VetReg include a date of delivery to a customer. By contrast, if wholesalers report through their accounting system and if there is a lag between when the medicines are delivered to customers and when they are billed, medicines can be delivered one year and reported sold the next. Although, we do not expect these differences to be large. We did find large differences between the two registers for some of the vaccines, particularly in 2016–2019. For example, two vaccines, Cylnav and Alpha Ject micro 7 ILA, were not in VetReg prior to 2020, despite having marketing authorization from 2018 and 2019, respectively. Autogenous vaccines were only found in the wholesaler data. We do not know the exact reason for these discrepancies in VetReg, but we can speculate that they arise from a systematic failure to register certain vaccines. In other cases, we found that the incorrect registration of quantity units also affected coverage. In this study, we assessed the validity of individual variables within VetReg. The data mainly contained two units for amounts sold (milliliter and doses) and we used vaccine-specific conversion factors (dose in ml) to summarize most VetReg-entries per package ID and vaccine name. We found that coverage improved when comparing data per vaccine name instead of per package ID, indicating that some reports had incorrect package IDs, but correct vaccine names. Within individual records, the number of animals vaccinated was not always equal to the number of doses sold. This occurred especially when multiple vaccines were issued on the same prescription. However, we could use the ‘number of animals’ variable to identify records with incorrect quantity units in cases where only one vaccine was issued per prescription. The need to convert, exclude, or correct quantity units to use the register highlights the importance of harmonizing how vaccine usage is reported. By comparison, all quantities are reported in packages from pharmacies in VetReg for the sale of antibiotics (Grave and Hopp 2017). The ‘weight’ variable was also problematic, since no specified units for weights rendered this information unusable. For timeliness, we found that the mean time to registration was not consistent between years, and there was no trend for improved timeliness in more recent years. Moreover, we could not find a legal deadline for when pharmacies have to report to VetReg. This implies that users of data from VetReg cannot know when to expect all records for a given period to be entered into VetReg. Previous studies have assessed the quality of VetReg for different purposes. Remen and Sætre (2018) investigated the quality of data on antiparasitics used against salmon lice in VetReg ( 14 ). They discovered issues with the validity of the amounts reported, for example, they found instances where the number of fish were reported as the amount of product ( 14 ). As with our study, they also found that data quality improved over the years ( 14 ). Grave et al (2020), who investigated the quality of antibiotics reporting in VetReg, found better coverage of VetReg data compared to sales data, for antibiotics prescribed to fish compared to antibiotics prescribed or used for land animals. Grave and Hopp (2017) also performed a quality assessment of VetReg data on antibiotics. They discovered two main quality issues, the validity of amounts reported from pharmacies (decimal numbers were not received by the system and only whole numbers were found in VetReg) and issues with units used for reporting by veterinarians. These units did not always match the strength unit for the same product, thereby making it difficult to calculate amounts used. Together with the findings of our study, this emphasizes the need to perform quality assessments of VetReg data per product category and to take into account the data provider. Quality should also be investigated on data from the entire relevant period, as it has been shown to change over time. In our opinion, VetReg data from 2020 are of sufficient quality to present the vaccine sales on a national level, with the exception of the bath vaccines. From the VetReg data, it is possible to evaluate if the hatcheries used only legal vaccines, as all vaccines are sold by pharmacies. This is with the potential exception of autogenous vaccines, because sales of such vaccines are only present in wholesaler data. Given the assumption that all fish are vaccinated with the vaccines NFSA considers irresponsible not to use, doses of those vaccines can be used as a denominator in calculating the coverage of various types of vaccines at a national, regional and hatchery level. The regional level is only valid for the hatcheries, because fish might be put to sea in another region than where the hatchery is located. Our inability to convert bath vaccines from doses to ml and vice versa creates a challenge for reporting usage of these products, which has been highlighted in a previous study by Bravo and Midtlyng (2007) on the vaccine usage in the Chilean aquaculture industry ( 19 ). The inaccuracy of the ‘number of animals’ column in VetReg means that there is no other source of information for the number of fish vaccinated with bath vaccines. There are no publically available data on the vaccine status on a sea farm level and it is not possible to trace which hatchery(ies) the fish in a farm originate from using register data. This means that some of the questions regarding vaccine side-effects, efficacy and the effects of vaccines on the spread and severity of disease outbreaks cannot be investigated on a farm-level using VetReg as a source of vaccine status. Therefore, farm-level vaccine status must be obtained through, for example, questionnaires or access to farm records, as was done in the study by Jensen et al (2012) ( 9 ). Conclusions The completeness of the data in VetReg for injection vaccines for Atlantic salmon and rainbow trout were considered to be adequate for the period 2020 to 2022, when evaluated per vaccine name. The validity of the units used for reporting had some quality issues, especially for bath vaccines. A uniform use of units (ml or packages) will improve the quality. The validity of the ‘number of animals’ variable was associated with prescriptions with multiple vaccines, and these could be a target for improvement. Almost all records included an owner location, which means that VetReg records can be used to present vaccine coverage at regional or hatchery level. Increased timeliness in fish vaccine records will expand the possible use of the most current records. VetReg, alone or in combination with other publically collected records, are currently not suited to describe vaccine status on a sea farm level. Abbreviations ATC-Anatomical Therapeutic Chemical NIPH-Norwegian Institute of Public Health NFSA-Norwegian Food Safety Authority NoMA-Norwegian Medicinal Products Agency SPC-Summary of Product Characteristics VetReg-Norwegian Veterinary Prescription Register Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Availability of data and materials The data that support the findings of this study are available from the NFSA (VetReg) and the NPHI (wholesaler data) but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data can however be requested from the same data providers by others. Competing Interests The authors declare that they have no competing interests. Funding This research was funded through the public basic funding of the Norwegian Veterinary Institute. Authors' contributions KRD and IS conceived the study. KOH and KRD designed the study and acquired the data. TU, KRD and KOH analyzed the data. All authors interpreted the results. KOH, KRD, and TU drafted the work. All authors read and approved the final manuscript. Acknowledgements We would like to acknowledge the NFSA and the NPHI for giving us access to the data used for this study, especially Christine Børnes at NFSA who met us to discuss the use of VetReg-data. References Food and Agriculture Organization of the United Nations. Statistical Query Panel: Global aquaculture production (Quantity): [Available from: https://www.fao.org/fishery/statistics-query/en/aquaculture. Accessed 19 March 2024. Norwegian Seafood Council. Record exports of Norwegian seafood in 2023 due to price growth and weak krone 2024 [Available from: https://en.seafood.no/news-and-media/news-archive/record-exports-of-norwegian-seafood-in-2023-due-to-price-growth-and-weak-krone/. Accessed 11 April 2024. Midtlyng PJ, Grave K, Horsberg TE. What has been done to minimize the use of antibacterial and antiparasitic drugs in Norwegian aquaculture? Aquac Res. 2011;42:28-34. Lillehaug A, Bornes C, Grave K. A pharmaco-epidemiological study of antibacterial treatments and bacterial diseases in Norwegian aquaculture from 2011 to 2016. Dis Aquat Organ. 2018;128(2):117-25. Sommerset I, Wikk-Nielsen J, Oliveira VHS, Moldal T, Haukaas A, Brun E. Norwegian Fish Health Report 2023. Norwegian Veterinary Institute; 2024. Available from: https://www.vetinst.no/rapporter-og-publikasjoner/rapporter/2024/fiskehelserapporten-2023. Fauske M. Nøkkeltall fra norsk havbruksnæring 2022 [Key figures from the Norwegian aquaculture industry 2022]. Fiskeridirektoratet; 2023. Available from: https://www.fiskeridir.no/Tall-og-analyse/Lisens-for-bruk-av-Fiskeridirektoratets-data Ministry of Agriculture and Food, Ministry of Trade Industry and Fisheries. Forskrift som utfyller dyrehelseforskriften med bestemmelser om forebygging og bekjempelse av smittsomme dyresykdommer [Regulation that supplements the animal health regulations with provisions on the prevention and control of infectious animal diseases], FOR-2022-04-06-634. Sect. Kapittel III. Utfyllende nasjonale bestemmelser – Vaksinasjon av akvatiske dyr [Chapter III. Supplementary national provisions – Vaccination of aquatic animals] (2022). Norwegian Food Safety Authority. Vaksiner til oppdrettsfisk [Vaccines for farmed fish] 2023 [Available from: https://www.mattilsynet.no/fisk-og-akvakultur/fiskesykdommer/vaksiner-til-oppdrettsfisk#kap-4-sykdommer-det-er-forbudt--vaksinere-mot. Accessed 19 March 2024. Jensen BB, Kristoffersen AB, Myr C, Brun E. Cohort study of effect of vaccination on pancreas disease in Norwegian salmon aquaculture. Dis Aquat Organ. 2012;102(1):23-U33. Aunsmo A, Larssen RB, Valle PS, Sandberg M, Evensen O, Midtlyng PJ, et al. Improved field trial methodology for quantifying vaccination side-effects in farmed Atlantic salmon ( Salmo salar L.). Aquaculture. 2008;284(1-4):19-24. Ministry of Health and Care Services. Forskrift om grossistvirksomhet med legemidler [Regulation on wholesale activities with medicinal products], FOR-1993-12-21-1219 (1993). Ministry of Health and Care Services, Ministry of Agriculture and Food, Ministry of Trade Industry and Fisheries. Forskrift om melding av opplysninger om utleverte og brukte legemidler til dyr [Regulation on the notification of information on dispensed and used medicinal products for animals], FOR-2009-07-03-971 (2009). Grave K, Hopp P, Wolff C, Olli Helgesen K. Rutinemessig publisering av forbruksdata for antibakterielle midler rapportert til VetReg [Routine publication of consumption data for antibacteria agents reported in VetReg]. Norwegian Veterinary Institute; 2020. Available from: https://www.vetinst.no/rapporter-og-publikasjoner/rapporter/2020/rutinemessig-publisering-av-forbruksdata-vetreg. Remen M, Kristin S. Medikamentbruk for kontroll av lakselus [Use of medications to control salmon lice]. Akvaplan NIVA; 2018. Report No.: 9183. Available from: https://akvaplan.no/en/document/remen-og-saeter-rapport-lusemiddelbruk-2012-2017-85410?download. Birkegård AC, Fertner ME, Jensen VF, Boklund A, Toft N, Halasa T, et al. Building the foundation for veterinary register-based epidemiology: A systematic approach to data quality assessment and validation. Zoonoses Public Hlth. 2018;65(8):936-46. Izovac Encefalomielite [Internet]. 2024. Available from: https://medicines.health.europa.eu/veterinary/en/600000096944. Legemiddlesøk [Internet]. 2024. Available from: https://www.legemiddelsok.no/. European Centre for Disease Prevention and Control. Data quality monitoring and surveillance system evaluation - A handbook of methods and applications. Stockholm: ECDC; 2014. Available from: https://www.ecdc.europa.eu/en/publications-data/data-quality-monitoring-and-surveillance-system-evaluation-handbook-methods-and. Bravo S, Midtlyng PJ. The use of fish vaccines in the Chilean salmon industry 1999-2003. Aquaculture. 2007;270(1-4):36-42. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFigure1.tiff Supplementary Figure 1. Example of reports in VetReg with the same report ID, showing (a) pharmacies sometimes reporting the same number of animals even when different quantities of doses for different vaccines were sold, (b) pharmacies reporting the number of animals as the sum of all the doses sold for the different vaccines under the same report ID. The report IDs have been anonymized and the names of the column names changed from Norwegian to English. SupplementaryFigure2.pdf Supplementary Figure 2. Yearly and total coverage for the ten most used fish vaccines by product ID, excluding bath vaccines, reported to VetReg in 2016-2022 as compared to wholesales statistics. SupplementaryTables.docx Cite Share Download PDF Status: Published Journal Publication published 13 Jan, 2025 Read the published version in BMC Veterinary Research → Version 1 posted Editorial decision: Revision requested 14 Nov, 2024 Reviews received at journal 12 Nov, 2024 Reviewers agreed at journal 21 Oct, 2024 Reviews received at journal 08 Aug, 2024 Reviewers agreed at journal 02 Aug, 2024 Reviewers invited by journal 17 Jul, 2024 Editor invited by journal 05 Jun, 2024 Editor assigned by journal 28 May, 2024 Submission checks completed at journal 28 May, 2024 First submitted to journal 24 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4472914","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":311846704,"identity":"2662790c-acb2-430d-b232-658b60d30f06","order_by":0,"name":"Trishang Udhwani","email":"","orcid":"","institution":"Norwegian Veterinary Institute","correspondingAuthor":false,"prefix":"","firstName":"Trishang","middleName":"","lastName":"Udhwani","suffix":""},{"id":311846706,"identity":"bb2af368-6765-4dbc-8d1b-25a68b1b8660","order_by":1,"name":"Katharine R. Dean","email":"","orcid":"","institution":"Norwegian Veterinary Institute","correspondingAuthor":false,"prefix":"","firstName":"Katharine","middleName":"R.","lastName":"Dean","suffix":""},{"id":311846707,"identity":"2ac01bd3-1d39-4daa-9c06-436b55b1b27c","order_by":2,"name":"Ingunn Sommerset","email":"","orcid":"","institution":"Norwegian Veterinary Institute","correspondingAuthor":false,"prefix":"","firstName":"Ingunn","middleName":"","lastName":"Sommerset","suffix":""},{"id":311846710,"identity":"88308a08-c505-4210-8907-7c38dabf95c8","order_by":3,"name":"Kari Olli Helgesen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDElEQVRIie2QvWrDMBRGrxE0y3W7KrhYryAj8GSaMa8RU1CXLN08BOrJXgJdUyjtW4SMAkG6qPQFuphCsrpk7NAqMRQ6yM2YQQc+0BUc7g+Ax3OCUBsVlHDZlYUNOVLBrjQAuFfUPwr8KkEF3atPGdavjQpWGbJx3XzcPul4NAj1roX32KVEeMNVYCQmxgjxsNQCybmkCjbCpcQg7S6VxmQxPYvCpcznBFM7mM5Ll3Kx2SvfmDxvt1/ho7yzimj7lIgeuihkFFISltkECXLapwwXtkteXSPHqYhwnSVzjSk1XDt3oW+StJ/VVczql2aHM8oG90a0RaGdFzswseHqzxfvFTqYa3SPx+Px/ADqo1GfFL3+BgAAAABJRU5ErkJggg==","orcid":"","institution":"Norwegian Veterinary Institute","correspondingAuthor":true,"prefix":"","firstName":"Kari","middleName":"Olli","lastName":"Helgesen","suffix":""}],"badges":[],"createdAt":"2024-05-24 13:56:53","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4472914/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4472914/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12917-024-04460-7","type":"published","date":"2025-01-13T15:57:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":58245339,"identity":"2edf32fe-e47c-4e42-add8-ab016f3b6d52","added_by":"auto","created_at":"2024-06-13 02:21:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":226068,"visible":true,"origin":"","legend":"\u003cp\u003eData-flow diagram. Diagram of records included and excluded from cross-validation for fish vaccines reported in VetReg.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4472914/v1/7331930cb95a9e82a3bc727d.png"},{"id":58244602,"identity":"16bf60cc-2bb9-4893-86eb-26a04e7a8917","added_by":"auto","created_at":"2024-06-13 02:13:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":121083,"visible":true,"origin":"","legend":"\u003cp\u003eData coverage. Yearly and total coverage for the ten most used fish vaccines, excluding bath vaccines, reported to VetReg in 2016-2022 as compared to wholesales statistics. Vaccines product IDs are shown in parentheses, those with multiple products are aggregated under a single vaccine name.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4472914/v1/42d62454a91ca9bc06cdc4b6.png"},{"id":58244604,"identity":"01d16fad-71a7-429a-9a8d-c0ccd709de02","added_by":"auto","created_at":"2024-06-13 02:13:07","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":58473,"visible":true,"origin":"","legend":"\u003cp\u003eTimeliness of data. Timeliness of reports to VetReg for fish vaccination data for 2020-2022. The number on each curve marks the point when 95 percent of records are received in a given year.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4472914/v1/9eeaed5d943353d7a88a34d0.png"},{"id":74284880,"identity":"1afa7d79-b7c1-47d3-b15b-9338dc28a306","added_by":"auto","created_at":"2025-01-20 16:13:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1374551,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4472914/v1/06d822d5-60f4-4890-849f-bc847515663d.pdf"},{"id":58244607,"identity":"7ac314ec-6db6-40eb-8d0e-1370895558dc","added_by":"auto","created_at":"2024-06-13 02:13:07","extension":"tiff","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":3920686,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary Figure 1. Example of reports in VetReg with the same report ID, showing (a) pharmacies sometimes reporting the same number of animals even when different quantities of doses for different vaccines were sold, (b) pharmacies reporting the number of animals as the sum of all the doses sold for the different vaccines under the same report ID. The report IDs have been anonymized and the names of the column names changed from Norwegian to English.\u003c/p\u003e","description":"","filename":"SupplementaryFigure1.tiff","url":"https://assets-eu.researchsquare.com/files/rs-4472914/v1/76972e11b3749f22e075c937.tiff"},{"id":58244603,"identity":"bd848852-4fe1-4bd4-ba22-468917aeabc2","added_by":"auto","created_at":"2024-06-13 02:13:07","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":10903,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary Figure 2. Yearly and total coverage for the ten most used fish vaccines by product ID, excluding bath vaccines, reported to VetReg in 2016-2022 as compared to wholesales statistics.\u003c/p\u003e","description":"","filename":"SupplementaryFigure2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4472914/v1/6189d2afafb8ed39dcff3f2f.pdf"},{"id":58244606,"identity":"46b6cacf-14bb-410a-98f4-0d4c9b8efe4e","added_by":"auto","created_at":"2024-06-13 02:13:07","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":21182,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTables.docx","url":"https://assets-eu.researchsquare.com/files/rs-4472914/v1/fe65ec39a70e93df0dd0c3c2.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Quality assessment of fish vaccine data in the Norwegian Veterinary Prescription Register (VetReg)","fulltext":[{"header":"Background","content":"\u003cp\u003eIn Norway, aquaculture production of Atlantic salmon and rainbow trout is an economically important industry that continues to expand. Norway is currently the world\u0026rsquo;s largest producer of Atlantic salmon with an export of 1.2\u0026nbsp;million tons in 2023 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The intensification of salmonid farming would not have been possible without effective disease control and prevention measures. In the late 1980s and early 1990s, vaccination contributed significantly to the growth of salmonid aquaculture, as well as, the low antibiotic usage seen for many years in Norwegian fish farming (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). However, diseases caused by parasites, bacteria and viruses, continue to threaten the fish health and welfare of Atlantic salmon and rainbow trout (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe production of Atlantic salmon and rainbow trout mimics their natural history as anadromous fish. Farmed salmonids begin their lives in freshwater hatcheries, where they are kept until they have smoltified. After smoltification, the fish are physiologically adapted to a life in seawater. The smolts are then transferred to seawater facilities where they are kept until they are slaughtered. In 2022, hatcheries sold 418\u0026nbsp;million Atlantic salmon and 26\u0026nbsp;million rainbow trout to on-growing sea farms (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Nearly all of these fish were vaccinated against one or more pathogens, which takes place at the hatcheries (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Today, there are several vaccines available against important bacterial and viral pathogens causing diseases in farmed salmonids, but very few vaccines exist against parasitic diseases.\u003c/p\u003e \u003cp\u003eThe law regulates the use of vaccines for farmed salmonids in Norway. At a basic level, all medicines (including vaccines) prescribed for fish must have marketing authorization in Norway or be granted a special license from the Norwegian Medical Product Agency (NoMA). Vaccines for fish additionally require permission for use by the national competent authority on fish health and welfare, the Norwegian Food Safety Authority (NFSA) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The regulation of vaccines covers both the use of certain vaccines and the prohibition of others. Presently, the NFSA states that farmers should vaccinate Atlantic salmon and rainbow trout against vibriosis, furunculoses, and cold-water vibriosis (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). On the contrary, it is illegal in Norway to vaccinate against certain diseases where early detection and eradication is important (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Along these lines, it is possible to make it illegal to vaccinate against certain diseases in specific geographic areas or compartments if there is a goal of obtaining \u0026ldquo;free-status\u0026rdquo;. Disease-free status can be important for gaining access to specific markets internationally due to import restrictions.\u003c/p\u003e \u003cp\u003eWith hundreds of millions of salmonids being vaccinated in Norway every year, there is a need to monitor vaccine usage for several reasons. Firstly, it is important to know the vaccination status of the farmed fish in order to evaluate to what extent the farmers follow the legislation. Secondly, the vaccination status of the fish is an important factor to understand the underlying reasons for the prevalence and spread of infectious diseases. For example, knowledge of vaccination status is required to understand how well a vaccine protects against a certain disease and to compare the efficacies of different vaccines for the same disease (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Finally, some vaccines may cause harmful side effects to the fish and therefore it is important to monitor their usage to protect fish welfare (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). For example, the vaccination status is needed in order to evaluate side effects of specific vaccines and combinations of vaccines. Studies of vaccine side effects are mainly conducted by pharmaceutical companies during clinical and field trials.\u003c/p\u003e \u003cp\u003eInformation about vaccine usage in salmonids in Norway can be obtained from multiple sources including wholesaler statistics, the national prescription register, and farm records. Sales can be followed at a national level through the wholesalers' statistics reported annually to the Norwegian Institute of Public Health (NIPH), where wholesalers of medicines are obliged to enter their medicine sales (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Vaccine sales can be obtained from the veterinary prescription registry (VetReg), owned by the NFSA (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Pharmacies are obliged to report all sales of prescribed medicines for all animals and medicines sold directly to veterinarians. For veterinarians and authorized fish health personnel it is mandatory to report the use of medicines for food-producing animals, including fish. Reports to VetReg are per prescription or delivery to veterinarians (for pharmacies) or per treatment of an animal or group of animals for veterinarians. Reporting to VetReg has been mandatory for medicines used for fish since 2011. Finally, records at hatcheries also contain detailed information about the vaccine status of each fish group, although these may be harder to obtain at a national level.\u003c/p\u003e \u003cp\u003eThe national statistics generally do not have information about autogenous vaccines, which are vaccines produced for a specific farm against a variant of a pathogen found in the same farm. These vaccines can only be used if there are no commercial vaccines with marketing authorization available against the pathogen or the available vaccines have low or insufficient efficacy. It is difficult to follow the vaccine status of autogenous vaccines at any level because these vaccines are not authorized in any country. This means that there are no publicly available data for the active substances, dosage regime, route of administration, and target species.\u003c/p\u003e \u003cp\u003eVetReg can be an appropriate source to provide timely and accurate information about vaccinations used in Norwegian aquaculture for Atlantic salmon and rainbow trout. The quality of the register has been assessed previously for antibiotic use data and for data on anti-parasitics used against salmon lice (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). However, there are no previous studies performing quality assessment or validation of fish vaccination data in VetReg. Birkeg\u0026aring;rd et al. (2018) proposed a framework for assessing the data quality of nationwide animal health registers, including a description of the register, use of relevant quality attributes, and identification and communication of quality issues (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Here we use this framework to evaluate VetReg for fish vaccination data in Norway from 2016\u0026ndash;2022. Based on our evaluation, we make recommendations for using and improving the VetReg data for fish vaccines.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eVetReg\u003c/h2\u003e \u003cp\u003eVetReg covers all prescriptions of medicines for animals dispensed to animal owners from pharmacies, including all medicines sold from pharmacies to veterinarians. In addition, it covers all prescription medicines used for food-producing animals (including horses) and voluntary reports for animals kept for other purposes, reported by veterinarians (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The deadline for reporting is seven days for veterinarians, while it is to the best of our knowledge not stated for pharmacies. In general, access to the register data is restricted and we obtained the data through an existing agreement between the Norwegian Veterinary Institute and the NFSA.\u003c/p\u003e \u003cp\u003eWe received the VetReg data as a comma separated (.csv) file, extracted by the NFSA from their centralized database on 17 Jan 2024. The extracted data included variables originating from VetReg (report ID and date of registration), from the national product registry (Anatomical Therapeutic Chemical (ATC) code, national product ID, product name, pack size, pack size units), and from pharmacies or veterinarians (quantity, quantity units, animal species, number of animals, weight of the animals, date of delivery, name of pharmacy and animal health professional, information about the owner of the animal(s) (only for food producing animals), identification number of the animal(s), reason for prescription and diagnosis).\u003c/p\u003e \u003cp\u003eFrom the complete dataset, we filtered the data based on the date of delivery for the study period for each individual year from 2016\u0026ndash;2022 and ATC codes associated with fish vaccines for salmon or rainbow trout, QI10A and QI10B. We did not find any records of autogenous vaccines in VetReg.\u003c/p\u003e \u003cp\u003eEach row of the data represented a registration made by a pharmacy, veterinarian/animal health professional, or feed mill. For fish vaccines, we expected that all registrations to VetReg to be marked as \u0026ldquo;Delivery from pharmacies to animal owners/husbandry.\u0026rdquo; However, there were records marked as \u0026ldquo;Notification of animal health professional\u0026rsquo;s use of medicinal products\u0026rdquo; in all years of the study period except in 2017 and 2020. According to the regulations, animal health personnel should only report the use of medicines first dispensed to themselves by a pharmacy (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Upon investigation, we did not find any records of animal health personnel buying any fish vaccines from pharmacies except a single record in 2018. The relevant veterinarian had not reported the use of these vaccines. Therefore, we removed all entries marked \u0026ldquo;Notification of animal health professional\u0026rsquo;s use of medicinal products\u0026rdquo; as likely duplicates to those already reported by pharmacies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eWholesaler data\u003c/h2\u003e \u003cp\u003eWholesaler data are nationwide data on medicines sold from wholesalers and from producers of medicated feed. Wholesalers sell to pharmacies, while producers of medicated feed sell to animal owners. These data are collected by the Norwegian Institute of Public Health (NIPH) and are mandatory to report according to regulation (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The deadline for this report is 15th of January the following year. We asked the NIPH for wholesaler data for ATC code QI (vaccines for animals including fish) for 2016 to 2022. We received the wholesale data on 3 Jan 2024 as an excel file. The data we received contained information with the year, ATC-code, national product ID, product name, pack size, number of packages sold per year and whether or not the product was marketed in Norway or imported via special license. We filtered the data for ATC-codes QI10A and QI10B. We excluded entries for the vaccine \u0026ldquo;IZOVAC ENCEPHALOMYELITS\u0026rdquo; due to incorrect ATC coding. For this vaccine, the correct ATC-code is QI01AD02 (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). We further excluded data for autogenous vaccines (two vaccines reported in 2016).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eValidity\u003c/h2\u003e \u003cp\u003eIn the context of data quality assessment, validity refers to \u0026ldquo;whether or not the register includes the true value\u0026rdquo; (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). For VetReg, we evaluated the internal and external validity as appropriate for different variables in the dataset. We checked the reported quantities and quantity units for unexpected values. We validated the national product ID numbers and we converted reports for injectable vaccines in doses to ml using the information given for each national product ID in the Summary of Product Characteristics (SPC) found using the medicine database \u0026ldquo;legemiddels\u0026oslash;k\u0026rdquo; administrated by the Norwegian Medicinal Products Agency (NoMA) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). We checked that the reported species was reasonable. Furthermore, we also checked what year the vaccine was authorized for use in Norway, although vaccines can also be imported from another county where they are authorized via special license from NoMA. We further checked the owner information against location numbers for fish farms in the Norwegian Aquaculture Register. Finally, we compared the number of vaccine doses used to the column for the \u0026lsquo;number of animals\u0026rsquo;, as a means of internal validation.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCompleteness\u003c/h3\u003e\n\u003cp\u003eThe ECDC (2014) defines completeness of reporting as the \u0026ldquo;absence of underreporting\u0026rdquo; (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). We assessed external completeness by comparing the yearly number of fish vaccines reported in VetReg to wholesaler-based statistics of pharmaceutical sales obtained from the Norwegian Public Health Institute. To perform the comparison, we converted the wholesales data to units, where \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(units=pack size \\times number of packs\\)\u003c/span\u003e\u003c/span\u003e and we considered the wholesale numbers of packs sold as the reference standard. To account for errors reported at the product ID level, we performed the comparison at both the product ID level and the vaccine name level.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eTimeliness\u003c/h2\u003e \u003cp\u003eThe timeliness of a register refers to the time between an event occurring and the registration of that event. To assess the timeliness of the register, we calculated the difference between the date of dispensing and the date of registration in VetReg. For 2016\u0026ndash;2022, we graphed the timeliness as the percentage of new reports by the time since dispensing. We also investigated changes in timeliness from year to year.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData description\u003c/h2\u003e \u003cp\u003eFor 2016\u0026ndash;2022, there were 7,443 reports of fish vaccines in VetReg. The yearly number of reports during this period ranged from 715-1,283. We removed 12 entries that were recorded as \u0026ldquo;Notification of animal health personnel\u0026rsquo;s use of medicinal products.\u0026rdquo; There were 7,431 records remaining of fish vaccines dispensed by pharmacies. All of the reports to animal owners were submitted by four pharmacies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eValidity\u003c/h2\u003e \u003cp\u003eThe dataset included 18 different fish vaccines with 23 unique national product IDs. Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e describe the vaccines and their reporting to VetReg by national product ID. We added \u0026ldquo;Bath\u0026rdquo; at the end of the name for bath vaccines to differentiate those from injectable vaccines of the same name.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of fish vaccines reported in VetReg in 2016\u0026ndash;2022 including the national product ID, ATC code, vaccine name, pack size, dose, type, and years authorized in Norway.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProduct ID\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eATC code\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVaccine name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePack size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDose\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eType\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAuthorization years\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e480101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AB04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlpha Erm Salar Bath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1000 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2016 \u0026ndash; Present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e556139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AB04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlpha Erm Salar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e250 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.025 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2020 \u0026ndash; Present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e429437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AB04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlpha Erm Salar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e500 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.025 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2021 \u0026ndash; Present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e130772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AB02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlpha Ject 3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e500 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2009 \u0026ndash; Present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e101148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AB03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlpha Ject 5\u0026thinsp;\u0026minus;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e500 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2011 \u0026ndash; Present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e101159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AL02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlpha Ject 6\u0026thinsp;\u0026minus;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e500 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2010 \u0026ndash; Present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e027475\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AL02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlpha Ject Micro 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 x 500 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2011 \u0026ndash; Present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e027464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AL02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlpha Ject Micro 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 x 250 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2011 \u0026ndash; Present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e034501\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AA01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlpha Ject micro 1 PD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e500 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2017 \u0026ndash; Present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e034490\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AA01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlpha Ject micro 1 PD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e250 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2017 \u0026ndash; Present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e167812\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AB03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlpha Ject micro 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 x 500 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2022 \u0026ndash; Present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e465067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AL04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlpha Ject micro 7 ILA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e500 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2019 \u0026ndash; Present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e090235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AL04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlpha Ject micro 7 ILA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e250 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2019 \u0026ndash; Present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e560340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AL02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAquavac 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e500 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2016\u0026ndash;2023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e189864\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AA01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAquavac PD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e500 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2017\u0026ndash;2021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e193107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AL05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAquavac PD7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e500 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2015 \u0026ndash; Present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e61902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10BB03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAquavac Relera Bath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1000 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2012\u0026ndash;2023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e472689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AA02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClynav\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 x 250 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2018 \u0026ndash; Present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e169401\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10BB02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLipogen Duo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e500 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2006\u0026ndash;2018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e130420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10BB02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLipogen Duo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1000 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2006\u0026ndash;2018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e515591\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AA01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNorvax Compact PD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 x 500 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2012\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e099126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AL02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNorvax Minova 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e500 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2010\u0026ndash;2017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e130519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQI10AL02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePentium Forte Plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e500 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInjection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2007 \u0026ndash; Present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverview of reporting in VetReg for fish vaccines in 2016\u0026ndash;2022 including the national product ID, vaccine name, number of records, years present, units, species.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProduct ID\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaccine name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo. records\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYears\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnits\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSpecies\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e480101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlpha Erm Salar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e680\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003estk, ml, kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon,\u003c/p\u003e \u003cp\u003eRainbow trout,\u003c/p\u003e \u003cp\u003eBrown trout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e556139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlpha Erm Salar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2020\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eml, stk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e429437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlpha Erm Salar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2021\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eml, stk, g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e130772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlpha Ject 3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eml, stk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTurbot fish,\u003c/p\u003e \u003cp\u003eRainbow trout,\u003c/p\u003e \u003cp\u003eAtlantic salmon,\u003c/p\u003e \u003cp\u003eBrown trout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e101148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlpha Ject 5\u0026thinsp;\u0026minus;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003estk, ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRainbow trout,\u003c/p\u003e \u003cp\u003eAtlantic salmon,\u003c/p\u003e \u003cp\u003eBrown trout,\u003c/p\u003e \u003cp\u003eOrnamental fish,\u003c/p\u003e \u003cp\u003eCyclopterus\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e101159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlpha Ject 6\u0026thinsp;\u0026minus;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003estk, ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon,\u003c/p\u003e \u003cp\u003eRainbow trout,\u003c/p\u003e \u003cp\u003eBrown trout,\u003c/p\u003e \u003cp\u003eOther farmed fish,\u003c/p\u003e \u003cp\u003eOrnamental fish\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e027475\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlpha Ject Micro 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,670\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eml, stk, g, kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon,\u003c/p\u003e \u003cp\u003eBrown trout,\u003c/p\u003e \u003cp\u003eOrnamental fish,\u003c/p\u003e \u003cp\u003eBivalve\u0026nbsp;molluscs,\u003c/p\u003e \u003cp\u003eRainbow trout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e027464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlpha Ject Micro 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003estk, ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon,\u003c/p\u003e \u003cp\u003eOrnamental fish\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e034501\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlpha Ject micro 1 PD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e860\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2017\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eml, stk, kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon,\u003c/p\u003e \u003cp\u003eRainbow trout,\u003c/p\u003e \u003cp\u003eBrown trout,\u003c/p\u003e \u003cp\u003eOrnamental fish,\u003c/p\u003e \u003cp\u003eBivalve\u0026nbsp;molluscs\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e034490\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlpha Ject micro 1 PD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2017\u0026ndash;2019, 2021\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003estk, ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon,\u003c/p\u003e \u003cp\u003eBrown trout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e167812\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlpha Ject micro 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003estk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e465067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlpha Ject micro 7 ILA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2020\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003estk, ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e090235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlpha Ject micro 7 ILA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2020\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eml, stk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e560340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAquavac 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003estk, ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon,\u003c/p\u003e \u003cp\u003eRainbow trout,\u003c/p\u003e \u003cp\u003eBrown trout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e189864\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAquavac PD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2018,\u003c/p\u003e \u003cp\u003e2020\u0026ndash;2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eml, stk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e193107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAquavac PD7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u0026ndash;2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eml, stk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon,\u003c/p\u003e \u003cp\u003eBrown trout,\u003c/p\u003e \u003cp\u003eBivalve\u0026nbsp;molluscs\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e061902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAquavac Relera\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u0026ndash;2017, 2020\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003estk, ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon,\u003c/p\u003e \u003cp\u003eRainbow trout,\u003c/p\u003e \u003cp\u003eBrown trout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e472689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClynav\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e495\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2020\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003estk, ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon,\u003c/p\u003e \u003cp\u003eOther farmed fish,\u003c/p\u003e \u003cp\u003eBrown trout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e169401\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLipogen Duo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u0026ndash;2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon,\u003c/p\u003e \u003cp\u003eBrown trout,\u003c/p\u003e \u003cp\u003eRainbow trout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e130420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLipogen Duo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBrown trout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e515591\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNorvax Compact PD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u0026ndash;2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eml, stk, kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e099126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNorvax Minova 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e130519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePentium Forte Plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u0026ndash;2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003estk, ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAtlantic salmon,\u003c/p\u003e \u003cp\u003eRainbow trout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe pharmacies mainly reported usage in units of \u0026lsquo;stk\u0026rsquo; (which is dose) or \u0026lsquo;ml\u0026rsquo;, but some entries were in \u0026lsquo;g\u0026rsquo; and \u0026lsquo;kg\u0026rsquo;. For injectable vaccines reported in doses, we used information linked to the national product ID to convert doses to ml for 3,129 entries. For records reported in \u0026lsquo;g\u0026rsquo; and \u0026lsquo;kg\u0026rsquo;, we tried to ascertain if the wrong reporting unit was used and if the actual reporting unit was the corresponding volume unit (\u0026lsquo;ml\u0026rsquo; and \u0026lsquo;L\u0026rsquo;, respectively) or \u0026lsquo;stk\u0026rsquo;. After manually correcting five entries, there were three entries in kg that could not be ascertained. The register included reports for two different bath vaccines, which are dissolved in water before administration. For bath vaccines, the number of doses given from each preparation can vary, thus it is not possible to convert them from doses to ml. In 2016 and 2017, both types of bath vaccines contained entries with a mixture of reporting units in doses and ml, which were excluded from further analysis. In 2020\u0026ndash;2022, the Aquavac Relera vet bath vaccine was reported exclusively in \u0026lsquo;ml\u0026rsquo;.\u003c/p\u003e \u003cp\u003eThe VetReg data included information about the species, weight, animal owner, and number of animals. As expected, the most commonly reported species associated with the vaccines were Atlantic salmon, rainbow trout, and brown trout. In addition, some reports had other species listed and these could represented off-label usage; for animal species which have not been documented as target animals during registration of the vaccines. The listing of other species could also be caused by incorrect entries. The reported fish weights were between 0.001 and 1,685,000. However, we could not find a unit associated with this column. For records reported in 2020\u0026ndash;2022, an animal owner was reported for 98 percent of the records. For salmonids, we assumed that the animal owners are hatchery locations, where the fish are vaccinated before being put to sea, identified by an official location number. We found that all of the records with reported animal owners matched to a hatchery location in the Norwegian aquaculture register.\u003c/p\u003e \u003cp\u003eTo assess the validity of the \u0026lsquo;number of animals\u0026rsquo; column, we used the number of doses reported within each record. As we compared based on the number of doses, this did not include bath vaccines that could not be converted from mL back to doses. For the injectable vaccines, the Summary of Product Characteristics (SPC) leaflets specified that every injectable vaccine here should be given as 1 dose per fish. Thus, the number of doses should be equal to the number of animals. However, we found that the number of animals reported was not consistent with the number of doses for 31 percent of the records investigated.\u003c/p\u003e \u003cp\u003eWe tried to identify any systematic causes of the inconsistent records. We found that there were higher odds, odds ratio of 1.86 (95% CI 1.62\u0026ndash;2.14) of inconsistent reports when pharmacies reported multiple vaccines under the same report ID, meaning the same prescription. For example, pharmacies reported the same number of animals even when different quantities of doses for different vaccines were sold. In some other cases, pharmacies reported the number of animals as the sum of all the doses sold for the different vaccines under the same report ID. Supplementary Fig.\u0026nbsp;1 shows examples of these two issues.\u003c/p\u003e \u003cp\u003eAn additional source of inconsistency between the number of doses and number of animals was related to probable errors in the reported units. In these cases, the units were reported as doses but should have been ml, and vice versa. We manually corrected 35 records where the number of animals exactly matched the number of doses calculated from quantity given in ml (doses incorrectly coded as ml) or the number of animals exactly matched the number of doses (ml incorrectly coded as doses).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eCompleteness\u003c/h2\u003e \u003cp\u003eTo assess completeness, we compared the usage data in VetReg to wholesaler-based statistics at both at the national product ID level and per vaccine name for 2016\u0026ndash;2022. Figure\u0026nbsp;1 and Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e give an overview of records included, excluded, or corrected for cross-validation. Due to reporting of quantity units in doses for bath vaccines, we removed 684 records, including those for the bath vaccine Alpa Erm Salar (national product ID: 480101) from all the years and all records for bath vaccine Aquavac Relera vet (national product ID: 061902) from years 2016 and 2017. Furthermore, due to invalid reporting of quantity units in \u0026lsquo;kg\u0026rsquo; for injectable vaccines we removed three more entries from the cross-validation below. Therefore, the comparison was conducted on 6,744 entries (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) from 22 product numbers (17 different vaccines).\u003c/p\u003e \u003cp\u003eFigure 1 Data-flow diagram. Diagram of records included and excluded from cross-validation for fish vaccines reported in VetReg.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverview of the number of records included, corrected, or excluded from cross-validation for fish vaccines reported in VetReg from 2016\u0026ndash;2022.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal Records\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eExcluded\u003c/p\u003e \u003cp\u003ereported by vet\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eExcluded\u003c/p\u003e \u003cp\u003ebath vaccines\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eExcluded\u003c/p\u003e \u003cp\u003eincorrect units\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eReports with manually corrected units\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFinal records in cross-validation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eg to ml\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ekg to L\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eml to stk\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003estk to ml\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e705\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e939\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e860\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e915\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e751\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1247\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1208\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e684\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e6744\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe first compared coverage at the product ID level. In general, we found that coverage varied substantially between products and years (SI Fig.\u0026nbsp;2, SI Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The total coverage for different products ranged from 35\u0026ndash;283 percent. There were five vaccines with multiple product numbers due to them being sold in various pack sizes (Alpha Ject Micro 6, Alpha Ject micro 1 PD, Alpha ERM Salar, Alpha Ject micro 7 ILA, Lipogen Duo). We observed that within the same vaccines, individual product IDs were subject to under and over reporting.\u003c/p\u003e \u003cp\u003eWe repeated our analysis at the vaccine name level. Figure\u0026nbsp;2 and Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e provide an overview of total and yearly coverage for each vaccine. We found that combining product numbers improved the overall coverage of the vaccines with multiple product numbers. For example, Alpha Ject Micro 1 PD had product level coverage of 103 percent and 65 percent, but a combined coverage of 102 percent. In general, VetReg had good coverage for most of the vaccines at vaccine name level as compared to the wholesaler statistics. However, this was not the case for all vaccines over the entire study period. For example, Clynav vet inj and Alpha Ject Micro 7 ILA, were not reported in VetReg prior to 2020, even though these appear in wholesaler data prior to 2020. At the same time, Norvax Minova 6 vet inj, appeared in VetReg in 2017 but not the wholesaler data for any year. However, this vaccine was used in very small quantity and accounted for only one record.\u003c/p\u003e \u003cp\u003eFigure 2 Data coverage. Yearly and total coverage for the ten most used fish vaccines, excluding bath vaccines, reported to VetReg in 2016\u0026ndash;2022 as compared to wholesales statistics. Vaccines product IDs are shown in parentheses, those with multiple products are aggregated under a single vaccine name.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of coverage (in percentage) for fish vaccines reported in VetReg for 2016\u0026ndash;2022 as compared to wholesaler statistics. Dashes indicate that no data was reported in either VetReg or wholesaler data, \u0026lsquo;Not in sales\u0026rsquo; indicates that usage was reported in VetReg but not in wholesaler data, \u0026lsquo;Excluded\u0026rsquo; is used for bath vaccines reported to VetReg in mL that cannot be converted to doses.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eName\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eProduct ID\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c9\" namest=\"c3\"\u003e \u003cp\u003eYearly coverage (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlpha Ject Micro 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e027464, 027475\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e103.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e99.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e121.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e99.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e103.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e103.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e106.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePentium Forte Plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e105.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e99.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e120.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e101.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlpha Ject micro 1 PD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e034490, 034501\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e117.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e98.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e97.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e100.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e101.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClynav\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e472689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e87.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e108.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e99.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e81.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAquavac PD7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e193107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e102.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e345.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e93.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e94.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e112.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlpha Ject 5\u0026thinsp;\u0026minus;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e99.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e109.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e99.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e109.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e102.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlpha Ject 6\u0026thinsp;\u0026minus;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e101.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e90.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e97.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlpha ERM Salar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e429437, 556139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e81.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e104.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e103.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e97.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlpha Ject micro 7 ILA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e465067, 640117, 090235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e85.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e111.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e95.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e93.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAquavac 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e560340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e405.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e99.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e97.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e103.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e105.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e110.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorvax Compact PD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e515591\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e145.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e99.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e73.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e102.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlpha Ject 3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e223.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e129.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e106.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e96.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e121.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e124.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e105.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e116.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAquavac Relera Bath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e061902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExcluded\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExcluded\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e85.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e100.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e100.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eExcluded\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLipogen Duo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e169401, 130420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e81.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePentium Forte Plus ILA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1102444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAquavac PD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e189864\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNot in sales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNot in sales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e283.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlpha Ject micro 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e167812\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorvax Minova 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e099126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot in sales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNot in sales\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTimeliness\u003c/h2\u003e \u003cp\u003eFor vaccine reports, the time it took for 95 percent of the records to be submitted ranged from 14\u0026ndash;152 days per year in 2016\u0026ndash;2022 (SI Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) and 13\u0026ndash;152 days for 2020\u0026ndash;2022 (Fig.\u0026nbsp;3). We observed that the timeliness was sporadic between years, with no trend. However, for all years, 75 percent of the reports were submitted in 25 days or less.\u003c/p\u003e \u003cp\u003eFigure 3 Timeliness of data. Timeliness of reports to VetReg for fish vaccination data for 2020\u0026ndash;2022. The number on each curve marks the point when 95 percent of records are received in a given year.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOverall, the completeness of VetReg for injectable fish vaccines was adequate compared to sales data for 2020\u0026ndash;2022. In these years, coverage in VetReg for different vaccines was 73 to 124 percent of the corresponding sales per year. The coverage was more consistent for the top ten vaccines sold in 2020\u0026ndash;2022, ranging from 81 to 113 percent. We found that 2022 had the most complete records, with between 95 and 109 percent coverage for all vaccines. There was a marked increase in completeness after 2020, as compared to earlier years in the study (2016\u0026ndash;2019). Due to the reporting of bath vaccines in doses, we could not evaluate the coverage of bath vaccines reported in VetReg to the wholesales data for all vaccines in all years. This is because it is not possible to convert dose units to mL for these vaccines, since a range of fish can be vaccinated using the same volume of bath vaccine. However, the completeness for one bath vaccine reported only in mL for 2020\u0026ndash;2022 was 85\u0026ndash;100 percent, within the range for the injectable vaccines.\u003c/p\u003e \u003cp\u003eWhen comparing VetReg to wholesales data, we can expect some over- and under- reporting. This is due to fundamental differences between the two registers. Reports in VetReg include a date of delivery to a customer. By contrast, if wholesalers report through their accounting system and if there is a lag between when the medicines are delivered to customers and when they are billed, medicines can be delivered one year and reported sold the next. Although, we do not expect these differences to be large. We did find large differences between the two registers for some of the vaccines, particularly in 2016\u0026ndash;2019. For example, two vaccines, Cylnav and Alpha Ject micro 7 ILA, were not in VetReg prior to 2020, despite having marketing authorization from 2018 and 2019, respectively. Autogenous vaccines were only found in the wholesaler data. We do not know the exact reason for these discrepancies in VetReg, but we can speculate that they arise from a systematic failure to register certain vaccines. In other cases, we found that the incorrect registration of quantity units also affected coverage.\u003c/p\u003e \u003cp\u003eIn this study, we assessed the validity of individual variables within VetReg. The data mainly contained two units for amounts sold (milliliter and doses) and we used vaccine-specific conversion factors (dose in ml) to summarize most VetReg-entries per package ID and vaccine name. We found that coverage improved when comparing data per vaccine name instead of per package ID, indicating that some reports had incorrect package IDs, but correct vaccine names. Within individual records, the number of animals vaccinated was not always equal to the number of doses sold. This occurred especially when multiple vaccines were issued on the same prescription. However, we could use the \u0026lsquo;number of animals\u0026rsquo; variable to identify records with incorrect quantity units in cases where only one vaccine was issued per prescription. The need to convert, exclude, or correct quantity units to use the register highlights the importance of harmonizing how vaccine usage is reported. By comparison, all quantities are reported in packages from pharmacies in VetReg for the sale of antibiotics (Grave and Hopp 2017). The \u0026lsquo;weight\u0026rsquo; variable was also problematic, since no specified units for weights rendered this information unusable.\u003c/p\u003e \u003cp\u003eFor timeliness, we found that the mean time to registration was not consistent between years, and there was no trend for improved timeliness in more recent years. Moreover, we could not find a legal deadline for when pharmacies have to report to VetReg. This implies that users of data from VetReg cannot know when to expect all records for a given period to be entered into VetReg.\u003c/p\u003e \u003cp\u003ePrevious studies have assessed the quality of VetReg for different purposes. Remen and S\u0026aelig;tre (2018) investigated the quality of data on antiparasitics used against salmon lice in VetReg (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). They discovered issues with the validity of the amounts reported, for example, they found instances where the number of fish were reported as the amount of product (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). As with our study, they also found that data quality improved over the years (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Grave et al (2020), who investigated the quality of antibiotics reporting in VetReg, found better coverage of VetReg data compared to sales data, for antibiotics prescribed to fish compared to antibiotics prescribed or used for land animals. Grave and Hopp (2017) also performed a quality assessment of VetReg data on antibiotics. They discovered two main quality issues, the validity of amounts reported from pharmacies (decimal numbers were not received by the system and only whole numbers were found in VetReg) and issues with units used for reporting by veterinarians. These units did not always match the strength unit for the same product, thereby making it difficult to calculate amounts used. Together with the findings of our study, this emphasizes the need to perform quality assessments of VetReg data per product category and to take into account the data provider. Quality should also be investigated on data from the entire relevant period, as it has been shown to change over time.\u003c/p\u003e \u003cp\u003eIn our opinion, VetReg data from 2020 are of sufficient quality to present the vaccine sales on a national level, with the exception of the bath vaccines. From the VetReg data, it is possible to evaluate if the hatcheries used only legal vaccines, as all vaccines are sold by pharmacies. This is with the potential exception of autogenous vaccines, because sales of such vaccines are only present in wholesaler data. Given the assumption that all fish are vaccinated with the vaccines NFSA considers irresponsible not to use, doses of those vaccines can be used as a denominator in calculating the coverage of various types of vaccines at a national, regional and hatchery level. The regional level is only valid for the hatcheries, because fish might be put to sea in another region than where the hatchery is located. Our inability to convert bath vaccines from doses to ml and vice versa creates a challenge for reporting usage of these products, which has been highlighted in a previous study by Bravo and Midtlyng (2007) on the vaccine usage in the Chilean aquaculture industry (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The inaccuracy of the \u0026lsquo;number of animals\u0026rsquo; column in VetReg means that there is no other source of information for the number of fish vaccinated with bath vaccines.\u003c/p\u003e \u003cp\u003eThere are no publically available data on the vaccine status on a sea farm level and it is not possible to trace which hatchery(ies) the fish in a farm originate from using register data. This means that some of the questions regarding vaccine side-effects, efficacy and the effects of vaccines on the spread and severity of disease outbreaks cannot be investigated on a farm-level using VetReg as a source of vaccine status. Therefore, farm-level vaccine status must be obtained through, for example, questionnaires or access to farm records, as was done in the study by Jensen et al (2012) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe completeness of the data in VetReg for injection vaccines for Atlantic salmon and rainbow trout were considered to be adequate for the period 2020 to 2022, when evaluated per vaccine name. The validity of the units used for reporting had some quality issues, especially for bath vaccines. A uniform use of units (ml or packages) will improve the quality. The validity of the \u0026lsquo;number of animals\u0026rsquo; variable was associated with prescriptions with multiple vaccines, and these could be a target for improvement. Almost all records included an owner location, which means that VetReg records can be used to present vaccine coverage at regional or hatchery level. Increased timeliness in fish vaccine records will expand the possible use of the most current records. VetReg, alone or in combination with other publically collected records, are currently not suited to describe vaccine status on a sea farm level.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eATC-Anatomical Therapeutic Chemical\u003c/p\u003e\n\u003cp\u003eNIPH-Norwegian Institute of Public Health\u003c/p\u003e\n\u003cp\u003eNFSA-Norwegian Food Safety Authority\u003c/p\u003e\n\u003cp\u003eNoMA-Norwegian Medicinal Products Agency\u003c/p\u003e\n\u003cp\u003eSPC-Summary of Product Characteristics\u003c/p\u003e\n\u003cp\u003eVetReg-Norwegian Veterinary Prescription Register\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the NFSA (VetReg) and the NPHI (wholesaler data) but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data can however be requested from the same data providers by others.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting Interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded through the public basic funding of the Norwegian Veterinary Institute.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eKRD and IS conceived the study. KOH and KRD designed the study and acquired the data. TU, KRD and KOH analyzed the data. All authors interpreted the results. KOH, KRD, and TU drafted the work. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge the NFSA and the NPHI for giving us access to the data used for this study, especially Christine B\u0026oslash;rnes at NFSA who met us to discuss the use of VetReg-data. \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFood and Agriculture Organization of the United Nations. Statistical Query Panel: Global aquaculture production (Quantity): [Available from: https://www.fao.org/fishery/statistics-query/en/aquaculture. Accessed 19 March 2024.\u003c/li\u003e\n\u003cli\u003eNorwegian Seafood Council. Record exports of Norwegian seafood in 2023 due to price growth and weak krone 2024 [Available from: https://en.seafood.no/news-and-media/news-archive/record-exports-of-norwegian-seafood-in-2023-due-to-price-growth-and-weak-krone/. Accessed 11 April 2024.\u003c/li\u003e\n\u003cli\u003eMidtlyng PJ, Grave K, Horsberg TE. What has been done to minimize the use of antibacterial and antiparasitic drugs in Norwegian aquaculture? Aquac Res. 2011;42:28-34.\u003c/li\u003e\n\u003cli\u003eLillehaug A, Bornes C, Grave K. A pharmaco-epidemiological study of antibacterial treatments and bacterial diseases in Norwegian aquaculture from 2011 to 2016. Dis Aquat Organ. 2018;128(2):117-25.\u003c/li\u003e\n\u003cli\u003eSommerset I, Wikk-Nielsen J, Oliveira VHS, Moldal T, Haukaas A, Brun E. Norwegian Fish Health Report 2023. Norwegian Veterinary Institute; 2024. Available from: https://www.vetinst.no/rapporter-og-publikasjoner/rapporter/2024/fiskehelserapporten-2023.\u003c/li\u003e\n\u003cli\u003eFauske M. N\u0026oslash;kkeltall fra norsk havbruksn\u0026aelig;ring 2022 [Key figures from the Norwegian aquaculture industry 2022]. Fiskeridirektoratet; 2023. Available from: https://www.fiskeridir.no/Tall-og-analyse/Lisens-for-bruk-av-Fiskeridirektoratets-data\u003c/li\u003e\n\u003cli\u003eMinistry of Agriculture and Food, Ministry of Trade Industry and Fisheries. Forskrift som utfyller dyrehelseforskriften med bestemmelser om forebygging og bekjempelse av smittsomme dyresykdommer [Regulation that supplements the animal health regulations with provisions on the prevention and control of infectious animal diseases], FOR-2022-04-06-634. Sect. Kapittel III. Utfyllende nasjonale bestemmelser \u0026ndash; Vaksinasjon av akvatiske dyr [Chapter III. Supplementary national provisions \u0026ndash; Vaccination of aquatic animals] (2022).\u003c/li\u003e\n\u003cli\u003eNorwegian Food Safety Authority. Vaksiner til oppdrettsfisk [Vaccines for farmed fish] 2023 [Available from: https://www.mattilsynet.no/fisk-og-akvakultur/fiskesykdommer/vaksiner-til-oppdrettsfisk#kap-4-sykdommer-det-er-forbudt--vaksinere-mot. Accessed 19 March 2024.\u003c/li\u003e\n\u003cli\u003eJensen BB, Kristoffersen AB, Myr C, Brun E. Cohort study of effect of vaccination on pancreas disease in Norwegian salmon aquaculture. Dis Aquat Organ. 2012;102(1):23-U33.\u003c/li\u003e\n\u003cli\u003eAunsmo A, Larssen RB, Valle PS, Sandberg M, Evensen O, Midtlyng PJ, et al. Improved field trial methodology for quantifying vaccination side-effects in farmed Atlantic salmon (\u003cem\u003eSalmo salar\u003c/em\u003e L.). Aquaculture. 2008;284(1-4):19-24.\u003c/li\u003e\n\u003cli\u003eMinistry of Health and Care Services. Forskrift om grossistvirksomhet med legemidler [Regulation on wholesale activities with medicinal products], FOR-1993-12-21-1219 (1993).\u003c/li\u003e\n\u003cli\u003eMinistry of Health and Care Services, Ministry of Agriculture and Food, Ministry of Trade Industry and Fisheries. Forskrift om melding av opplysninger om utleverte og brukte legemidler til dyr [Regulation on the notification of information on dispensed and used medicinal products for animals], FOR-2009-07-03-971 (2009).\u003c/li\u003e\n\u003cli\u003eGrave K, Hopp P, Wolff C, Olli Helgesen K. Rutinemessig publisering av forbruksdata for antibakterielle midler rapportert til VetReg [Routine publication of consumption data for antibacteria agents reported in VetReg]. Norwegian Veterinary Institute; 2020. Available from: https://www.vetinst.no/rapporter-og-publikasjoner/rapporter/2020/rutinemessig-publisering-av-forbruksdata-vetreg.\u003c/li\u003e\n\u003cli\u003eRemen M, Kristin S. Medikamentbruk for kontroll av lakselus [Use of medications to control salmon lice]. Akvaplan NIVA; 2018. Report No.: 9183. Available from: https://akvaplan.no/en/document/remen-og-saeter-rapport-lusemiddelbruk-2012-2017-85410?download.\u003c/li\u003e\n\u003cli\u003eBirkeg\u0026aring;rd AC, Fertner ME, Jensen VF, Boklund A, Toft N, Halasa T, et al. Building the foundation for veterinary register-based epidemiology: A systematic approach to data quality assessment and validation. Zoonoses Public Hlth. 2018;65(8):936-46.\u003c/li\u003e\n\u003cli\u003eIzovac Encefalomielite [Internet]. 2024. Available from: https://medicines.health.europa.eu/veterinary/en/600000096944.\u003c/li\u003e\n\u003cli\u003eLegemiddles\u0026oslash;k [Internet]. 2024. Available from: https://www.legemiddelsok.no/.\u003c/li\u003e\n\u003cli\u003eEuropean Centre for Disease Prevention and Control. Data quality monitoring and surveillance system evaluation - A handbook of methods and applications. Stockholm: ECDC; 2014. Available from: https://www.ecdc.europa.eu/en/publications-data/data-quality-monitoring-and-surveillance-system-evaluation-handbook-methods-and.\u003c/li\u003e\n\u003cli\u003eBravo S, Midtlyng PJ. The use of fish vaccines in the Chilean salmon industry 1999-2003. Aquaculture. 2007;270(1-4):36-42.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-veterinary-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [BMC Veterinary Research](http://bmcvetres.biomedcentral.com/)","snPcode":"12917","submissionUrl":"https://submission.nature.com/new-submission/12917/3?","title":"BMC Veterinary Research","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Aquaculture, vaccination, data validation, animal health data, salmon, biosecurity, secondary data","lastPublishedDoi":"10.21203/rs.3.rs-4472914/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4472914/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eVaccination of farmed salmonids has been an integral part of preventing infectious diseases in Norway\u0026rsquo;s aquaculture industry. The Norwegian government regulates the use of vaccines and there is a need to monitor vaccine usage for both regulatory and research purposes, at local and national scales. The Norwegian Veterinary Prescription Register (VetReg) is a national database that includes all prescriptions of medicines to animals dispensed by pharmacies and all medicines used for food producing animals by veterinarians. The purpose of our study was to evaluate the quality of fish vaccination data reported to VetReg in 2016\u0026ndash;2022. We considered the following attributes: completeness, validity, and timeliness. For external validation, we compared the data in VetReg to wholesaler statistics.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003ePharmacies reported fish vaccines to VetReg in a variety of quantity units, including doses and volumes, which required us to harmonize the data to a single unit. Harmonization was not possible for nine percent of the records, which were mainly bath vaccines reported in doses. We identified specific issues that required manual editing of the units of 1 percent of the records. After exclusions, we validated individual variables such as product codes and location identifiers using external registers. Some variables, such as the \u0026lsquo;number of animals\u0026rsquo;, were inconsistent for 31 percent of the records. The coverage of vaccine data in VetReg ranged from 81 to 113 percent for the ten most sold vaccines in 2020\u0026ndash;2022 as compared to wholesales statistics. For the timeliness, we found that 75 percent of the records were submitted within 25 days for all years.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOverall, we found that the fish vaccination data in VetReg was of sufficient quality to monitor injectable vaccine usage at hatcheries after 2020. We identified issues at the product level, with bath vaccines, and with single variables (number of animals, weight, and species). We recommend that quality can be improved by reporting all vaccines in volume rather than doses, reporting a single vaccine prescription per report, and including a deadline for pharmacies to report in the legislation.\u003c/p\u003e","manuscriptTitle":"Quality assessment of fish vaccine data in the Norwegian Veterinary Prescription Register (VetReg)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-13 02:13:03","doi":"10.21203/rs.3.rs-4472914/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-14T07:58:01+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-13T04:58:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2024-10-21T06:56:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-08T23:09:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"200497749661865392602505520677899991317","date":"2024-08-02T12:46:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-17T16:50:45+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-05T04:29:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-28T12:20:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-28T12:20:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Veterinary Research","date":"2024-05-24T13:55:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-veterinary-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [BMC Veterinary Research](http://bmcvetres.biomedcentral.com/)","snPcode":"12917","submissionUrl":"https://submission.nature.com/new-submission/12917/3?","title":"BMC Veterinary Research","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8dc544cf-bcd1-42b8-b23c-d409fcccd61e","owner":[],"postedDate":"June 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-20T16:07:02+00:00","versionOfRecord":{"articleIdentity":"rs-4472914","link":"https://doi.org/10.1186/s12917-024-04460-7","journal":{"identity":"bmc-veterinary-research","isVorOnly":false,"title":"BMC Veterinary Research"},"publishedOn":"2025-01-13 15:57:50","publishedOnDateReadable":"January 13th, 2025"},"versionCreatedAt":"2024-06-13 02:13:03","video":"","vorDoi":"10.1186/s12917-024-04460-7","vorDoiUrl":"https://doi.org/10.1186/s12917-024-04460-7","workflowStages":[]},"version":"v1","identity":"rs-4472914","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4472914","identity":"rs-4472914","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}