Update on HPV vaccination in Australia

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Cancer Screening Group, Prince of Wales Clinical School, UNSW, Australia.


Abstract

Australia implemented a national, publicly-funded vaccination program against human papillomavirus (HPV) in 2007. Initially the program targeted females aged 12-13 years, with catch-up of females aged 13-26 years to 2009. Since 2013, males aged 12-13 years have also been included in the program, with a two-year catch-up for males aged to 14-15 years. Three-dose coverage in 12-13 year-old females is approximately 71%, and estimated coverage rates over the female catch-up program were 70% in the school-based program (females 12-17 years) and ~30-50% in the primary-care-based program (female 18-26 years). Early data on cervical abnormalities, genital warts and HPV prevalence in cervical specimens suggest the impact of this program has been rapid and substantial, and that it also provided some indirect protection for young unvaccinated females and young males. Almost seven million doses of HPV vaccine have been delivered in Australia, and the vaccine safety profile remains favorable and comparable to that of other vaccines. Ongoing monitoring of coverage, impact and safety will be critical for the ongoing success of the program. It is important to emphasise that female cohorts offered vaccination should continue to attend cervical screening, since current generation vaccines do not protect against all types of HPV implicated in cervical cancer.


Australia was the first country to introduce a national, publicly-funded vaccination program against human papillomavirus (HPV), and the first country to fully fund HPV vaccination of males. The National HPV Vaccination Program (NHVP) was implemented in Australia from 2007, with routine school-based vaccination of 12-13 year-old females and catch-up in females aged 13-26 years to 2009, delivered through schools and primary care. The NHVP was extended to include routine school-based vaccination of 12-13 year-old males and a two-year catch-up program for males aged 14-15 years from 2013. The quadrivalent HPV vaccine (Gardasil®, Merck&Co., Whitehouse Station, NJ US) used within the program is delivered over a three-dose course, and provides protection against two oncogenic types (HPV 16/18),1 estimated to be associated with approximately 78% of cervical cancer in Australia,2 and two other types (HPV 6/11) associated with approximately 90% of anogenital warts,3 and of juvenile-onset recurrent respiratory papillomatosis.

Coverage

Doses delivered through the NHVP are recorded on the NHVP Register, although completeness of recording is likely to be higher for doses delivered through the school-based program than through primary care.4,5 Three-dose coverage in the school-based program as recorded in the NHVP Register ranged from 74% (females aged 12 years in 2007) to 62% (females aged 17 years in 2007).6 Reported three-dose uptake in the catch-up program delivered through primary care was lower at 41% (females aged 18 years in 2007) to 17% (females aged 26 years in 2007), yielding 32% across this group,5 although under-reporting to the NHVP Register is likely for this component of the program, and survey data suggest an overall coverage rate closer to 50% in women aged 18-26 years in 2007.5 Early data suggest that uptake in the school-based program has been similar across different socioeconomic status strata.7 This is encouraging in terms of increasing health equity, as cervical screening participation and cervical cancer incidence are known to vary by socioeconomic status in Australia.8 National coverage data by Indigenous status are not available, but recent data from Queensland and the Northern Territory suggest that three-dose uptake is lower in Indigenous females (by 15% and 9% respectively).6 Coverage data are not yet available for uptake in males.

While coverage in Australia is relatively high compared to many other countries, the most recent data