Adolescent and young adult HPV vaccination in Australia: Achievements and challenges

Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.
Preventive Medicine (Impact Factor: 3.09). 10/2011; 53 Suppl 1:S29-35. DOI: 10.1016/j.ypmed.2011.08.015
Source: PubMed


Australia commenced an ongoing school based government funded human papillomaviruses (HPV) (cervical cancer prevention) vaccination program in April 2007 for adolescent females aged 12-13 years. In addition, up to December 31, 2009, a catch-up program for young females 13-26 years of age was offered: a school-based vaccination program was used to offer HPV vaccine to girls enrolled in school (14-17 years), and general practitioners or other community health provider offered vaccine to young women aged 18-26 years. To date, only the quadrivalent vaccine (HPV 6/11/16/18) has been utilized in the funded program. Acceptance of the vaccine is high with coverage of 3 doses of the HPV vaccine in the school age cohort around 70%, and just over 30% in the older age cohort. Since the vaccination program was initiated, a reduction in new cases of genital warts of 73% among vaccine eligible age females has been evidenced in STI clinics across Australia. A reduction of 44% of new cases in young males (not a part of the free program) was also documented during this same time period, suggesting significant herd immunity. Similarly, in the state of Victoria, a small but significant decrease in high grade abnormalities in Pap screening findings has been reported in young women<18 years for the period 2007-9, as compared to pre-vaccination. Challenges for the future include how we can sustain and improve HPV vaccination coverage in young Australian women, while maintaining cervical cancer screening participation and reviewing cervical cancer screening methods.

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Available from: S. Rachel Skinner, Jan 02, 2014
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    • "B. Gunasekaran et al. / Vaccine xxx (2014) xxx–xxx programme available to 13–26 year old women through general practice and community-based programmes [2]. Presently, there is an ongoing school-based vaccination programme providing the HPV vaccine free to all boys and girls aged 12 to 13 years, with a two year catch-up programme for 14–15 year old boys until the end of 2014 [3]. "
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    ABSTRACT: Australia was the first country to implement a government-funded National Human Papillomavirus (HPV) Vaccination Program. We assessed HPV vaccine knowledge, uptake (self-reported and Register validated) and attitudes of young women post-implementation of the program. Females, aged 16 to 25 years living in Victoria, Australia, were recruited using targeted advertising on Facebook from May-September 2010, to complete a web-based questionnaire. Geographic distribution, Indigenous and socio-economic status of the 278 participants were representative of the target population. Overall, 210/278 (76%) had heard of HPV vaccines, with 203 (97%) of them knowing that Pap smears were ongoing despite vaccination and 191 (92%) aware that Pap abnormalities may occur post-vaccination. While 162/278 (58%) reported receipt of at least one dose of vaccine, 54 (19%) were unsure. Verification of HPV vaccination status of 142 participants (51%) showed 71% had received at least one dose. Main reasons for vaccination were for protection against HPV infection and cervical cancer (96%) and because it was free (87%), whereas unvaccinated women were uncertain of their eligibility (50%), concerned about adverse reactions (32%), or perceived that vaccination was not needed if they were monogamous (32%). HPV vaccine knowledge among participants was relatively high suggesting the national program has successfully communicated to the majority of eligible women, the purpose and limitations of the vaccine. Vigilance is needed to ensure that young women follow through with Pap testing in vaccine eligible cohorts. The potential utility of a vaccination register in the context of a national program is apparent from the large proportion of young women who were unsure of their vaccine status. The ongoing vaccination program for pre-adolescent girls and boys should communicate to parents that those with one sexual partner can still acquire HPV and that the safety of the vaccine is now well demonstrated. Copyright © 2014. Published by Elsevier Ltd.
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    • "Please cite this article as: Zimet, G.D., et al., Beliefs, behaviors and HPV vaccine: Correcting the myths and the misinformation, Preventive Medicine (2013), demonstrated by the high rates of vaccination achieved in Australia, the U.K., and Canada (Franceschi, 2010; Garland et al., 2011; Shearer, 2011). Another policy-based approach would be for insurance companies to establish practice guidelines with high rates of HPV vaccination identified as a benchmark for successful provision of health care. "
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    ABSTRACT: Objective: Human papillomavirus (HPV) vaccine uptake in many countries has been sub-optimal. We examine several issues associated with non-vaccination that have received particular attention, including fears about sexual risk compensation, concerns about vaccine safety, inadequate vaccination recommendations by health care providers (HCPs), and distrust due to the perceived "newness" of HPV vaccines. Methods: Selective review of behavioral and social science literature on HPV vaccine attitudes and uptake. Results: There is no evidence of post-vaccination sexual risk compensation, HPV vaccines are quite safe, and they can no longer be considered "new". Nonetheless, research findings point to these issues and, most importantly, to the failure of HCPs to adequately recommend HPV vaccine as major drivers of non-vaccination. Conclusion: Most fears related to HPV vaccine are more related to myth than reality. In the absence of major health policy initiatives, such as those implemented in Canada, the U.K., and Australia, a multi-level, multi-faceted approach will be required to achieve high rates of HPV vaccination. It will be essential to focus on the education of HCPs regarding indications for HPV vaccination and approaches to communicating most effectively with parents and patients about the safety and benefits of vaccination and the risks associated with non-vaccination.
    Preventive Medicine 05/2013; 57(5). DOI:10.1016/j.ypmed.2013.05.013 · 3.09 Impact Factor
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    • "In contrast, the literature has systematically indicated low coverage or uptake rates for the HPV vaccine in non-school-based programs [20], [26]–[31], [33]. In Australia, vaccination in the community did not achieve results that were as significant as those achieved with the school-based strategy [20], [21]. "
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    ABSTRACT: The implementation of a public HPV vaccination program in several developing countries, especially in Latin America, is a great challenge for health care specialists. To evaluate the uptake and the three-dose completion rates of a school-based HPV vaccination program in Barretos (Brazil). THE STUDY INCLUDED GIRLS WHO WERE ENROLLED IN PUBLIC AND PRIVATE SCHOOLS AND WHO REGULARLY ATTENDED THE SIXTH AND SEVENTH GRADES OF ELEMENTARY SCHOOL (MEAN AGE: 11.9 years). A meeting with the parents or guardians occurred approximately one week before the vaccination in order to explain the project and clarify the doubts. The quadrivalent vaccine was administered using the same schedule as in the product package (0-2-6 months). The school visits for regular vaccination occurred on previously scheduled dates. The vaccine was also made available at Barretos Cancer Hospital for the girls who could not be vaccinated on the day when the team visited the school. Among the potential candidates for vaccination (n = 1,574), the parents or guardians of 1,513 girls (96.1%) responded to the invitation to participate in the study. A total of 1,389 parents or guardians agreed to participate in the program (acceptance rate = 91.8%). The main reason for refusing to participate in the vaccination program was fear of adverse events. The vaccine uptake rates for the first, second, and third doses were 87.5%, 86.3% and 85.0%, respectively. The three-dose completion rate was 97.2%. This demonstrative study achieved high rates of vaccination uptake and completion of three vaccine doses in children 10-16 years old from Brazil. The feasibility and success of an HPV vaccination program for adolescents in a developing country may depend on the integration between the public health and schooling systems.
    PLoS ONE 04/2013; 8(4):e62647. DOI:10.1371/journal.pone.0062647 · 3.23 Impact Factor
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