HPV vaccine coverage is increasing in Australia

In 2016, the tenth year of quadrivalent human papillomavirus (HPV) vaccine delivery in Australia by the national immunisation program, it is encouraging to report recent increases in HPV vaccine coverage recorded by the National HPV Vaccination Program Register (NHVPR). The program commenced in April 2007, with a catch-up program for all females aged 12–26 years until the end of 2009, and routine school vaccination at age 12–13 thereafter. In 2013, routine immunisation of boys (12–13 years) against HPV commenced, with a 2-year catch-up program for boys up to 15 years old. Quadrivalent HPV vaccine is routinely given at school to both girls and boys aged 12–13 years, with a three-dose schedule. The NHVPR maintains records of HPV vaccinations, and there is almost complete notification of school doses. Coverage is routinely reported at age 15, as recommended by the World Health Organization and to facilitate consistency in national reporting (the age of vaccination and course completion varies slightly between states and territories). The NHVPR uses Australian Bureau of Statistics estimated resident population data as the denominator for calculating coverage. Notification of doses delivered in general practice is not compulsory, resulting in some undernotification.1

As shown in the Box, HPV vaccine coverage in girls by age 15 had in 2015 reached 86%, 83% and 78% for doses 1, 2 and 3 respectively. Coverage in 14-year-old girls in 2015 was 87%, 85% and 79%, indicating that coverage at age 15 will increase further. This improvement has occurred in the context of systematic assessment and action to identify barriers to completing the HPV vaccine course in school-based vaccination programs, in the light of relatively stable coverage since the program commenced; research has found that logistical barriers in program delivery are the major problem.2-4 It is notable that coverage for the third HPV vaccine dose increased by 10 percentage points in New South Wales by moving the catch-up of missed doses into the school program of the next school year, rather than relying on delivery by a general practitioner.4 Coverage of boys by age 15 in 2015 for the three doses was 78%, 75% and 67% respectively; at 14 years it was 82%, 79% and 74%.

It is likely that coverage will continue to improve, especially if a two-dose HPV vaccine schedule, now recommended by the WHO as clinically equivalent for those under 15 at the first dose, is implemented in Australia.5 Further, the expansion of Australia’s immunisation registers into a whole-of-life system, with complete electronic capture of all vaccine doses, promises to streamline reporting of GP-delivered doses of HPV vaccine, reducing the current problem of under-reporting. As first-dose coverage has been relatively stable over time, barriers to consent need to be further investigated and overcome. The availability of up-to-date information explaining the rationale for HPV vaccination and providing data that support its safety and effectiveness are also important. Our sex-neutral HPV vaccination program will hopefully become a routine rite of passage for all pre-adolescents as a safe and effective cancer prevention strategy.

Box – National human papillomavirus (HPV) vaccination coverage for girls at age 15, by dose number and year, Australia, 2007–2015*

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* Data as held on the National HPV Vaccination Program Register on 19 January 2017 (available in online Appendix). Age is at date of Australian Bureau of Statistics (ABS) estimated resident population (30 June) for the specified year. Coverage estimates have been revised from earlier reports because of revised vaccination data and finalised ABS population estimates (except 2015), resulting in an increase in coverage estimates for most years.