Human papillomavirus vaccination and genital warts in young Indigenous Australians: national sentinel surveillance data

Hammad Ali, Hamish McManus, Catherine C O'Connor, Denton Callander, Marlene Kong, Simon Graham, Dina Saulo, Christopher K Fairley, David G Regan, Andrew Grulich, Nicola Low, Rebecca J Guy and Basil Donovan
Med J Aust 2017; 206 (5): 204-209. || doi: 10.5694/mja16.00597


Objectives: To examine the impact of the national human papillomavirus (HPV) vaccination program (available to girls and women [12–26 years] since 2007 and to boys [12–15 years] since 2013) on the number of diagnoses of genital warts in Australian Aboriginal and Torres Strait Islander (Indigenous) people.

Design, setting, participants: Analysis of routinely collected data from patients attending 39 sexual health clinics (SHCs) in the Genital Warts Surveillance Network for the first time.

Major outcome: The average annual proportion of Indigenous and non-Indigenous SHC patients diagnosed with genital warts during the pre-vaccination (2004–2007) and vaccination periods (2008–2014), stratified by age group and sex.

Results: 7.3% of the 215 599 Australian-born patients with known Indigenous status and seen for the first time at participating SHCs during 2004–2014 were Indigenous Australians. The average proportion of female Indigenous patients diagnosed with warts was lower during the vaccination period than during the pre-vaccination period (in those under 21, summary rate ratio [SRR], 0.12; 95% CI, 0.07–0.21; P < 0.001); in 21–30–year olds: SRR, 0.41; 95% CI, 0.27–0.61; P < 0.001); there was no significant difference for women over 30 (SRR, 0.84; 95% CI, 0.51–1.36; P = 0.47). The proportion of male Indigenous heterosexual SHC patients under 21 diagnosed with warts was also lower during the vaccination period (SRR, 0.25; 95% CI, 0.12–0.49; P < 0.001), with no significant changes among older Indigenous men over 30.

Conclusions: There were marked declines in the proportions of diagnoses of genital warts in young Indigenous women and men attending SHCs after the introduction of the HPV vaccination program. If high levels of HPV vaccine coverage are sustained, HPV-related cancer rates should also decline.

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  • Hammad Ali1
  • Hamish McManus1
  • Catherine C O'Connor2
  • Denton Callander1
  • Marlene Kong1
  • Simon Graham3
  • Dina Saulo1
  • Christopher K Fairley4
  • David G Regan1
  • Andrew Grulich1
  • Nicola Low5
  • Rebecca J Guy1
  • Basil Donovan1

  • 1 The Kirby Institute, University of New South Wales, Sydney, NSW
  • 2 Sexual Health Service, Sydney Local Health District, Sydney, NSW
  • 3 University of Melbourne, Melbourne, VIC
  • 4 Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, VIC
  • 5 Institute of Social and Preventive Medicine, Universität Bern, Bern, Switzerland



The Genital Warts Surveillance Network receives funding from Seqirus (formerly bioCSL) and the Australian Department of Health. Hammad Ali, Rebecca Guy and Basil Donovan are supported by National Health and Medical Research Council fellowships. Simon Graham is supported by a McKenzie Postdoctoral Fellowship and by the Melbourne Poche Centre for Indigenous Health at the University of Melbourne. We acknowledge the staff members of the clinics that provided data for this study. Site investigators for Genital Warts Surveillance Network clinics include: Eva Jackson (Nepean and Blue Mountains Sexual Health and HIV Clinics), Darren Russell (Cairns Sexual Health Clinic), Emanuel Vhalkis (Coffs Harbour and Grafton Sexual Health Clinics), Manoji Gunathilake (Clinic 34, Alice Springs and Darwin), Alison Nikitas (Murrumbidgee and Southern NSW Sexual Health Services), Maree O’Sullivan (Gold Coast Sexual Health Service), Debbie Allen (Hold Street Clinic), Nathan Ryder (Hunter New England Sexual Health Clinics), Katherine Brown (Illawarra and Shoalhaven Sexual Health Clinics), David Smith (Lismore and Tweed Heads Sexual Health Services), Yoges Paramsothy (Liverpool and Campbelltown Sexual Health Clinics), Christopher Fairley (Melbourne Sexual Health Centre), Cheryn Palmer (Princess Alexandra Hospital Sexual Health Clinic), Stephen Davies (Clinic 16, Royal North Shore Hospital), Catherine C. O’Connor (RPA Sexual Health Clinic), Anna McNulty (Sydney Sexual Health Centre), Arun Menon (Townsville Sexual Health Services), and David Lewis (Western Sydney Sexual Health Centre).

Competing interests:

Christopher Fairley owns shares in CSL Pty Ltd. Basil Donovan, Christopher Fairley, David Regan, Hammad Ali, Andrew Grulich and Rebecca Guy currently receive research funding and have previously received honoraria from CSL Biotherapies. Basil Donovan and Rebecca Guy have received honoraria from Sanofi Pasteur MSD. Basil Donovan, Christopher Fairley and AEG have received honoraria from Merck. Andrew Grulich sits on the Australian advisory board for the Gardasil vaccine.

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