MEB seminar: Dr Julia Brotherton
Title: HPV vaccination in Australia: a successful implementation of a new vaccine - coverage, public trust and where to next?
Speaker: Dr Julia Brotherton, Medical Director of National HPV Vaccination Program Register, VCS, East Melbourne, Victoria, Australia and Associate Professor at the School of Population and Global Health, University of Melbourne.
Australia is in its 10th year of HPV vaccination using 3 dose quadrivalent HPV vaccine. A catch-up program was delivered to all females 12 to 26 years of age from 2007-2009. In 2010-2012 routine vaccination was delivered at school to girls aged 12-13 years. In 2013 male vaccination commenced, with a two year catch-up to age 15 years. The National HPV Vaccination Program Register enables monitoring of vaccination coverage and supports measures of vaccine impact by making vaccination history available when studying outcome data, including data held by Australia’s cervical screening registries.
Over half of all women were vaccinated in the 2007-2009 catch up program. Reasons for non-participation in the catch-up program include lack of awareness, forgetting and concerns about vaccine safety. Failure to complete the course is largely due to logistic issues. Three dose coverage in the targeted age group (12-13 year olds) has risen over time to 76%. Male coverage is currently 10% lower than female coverage. Vaccine coverage is more equitable across socio-economic groups than cervical screening. HPV vaccine safety concerns in Australia, which have included anaphylaxis and multiple sclerosis, have been addressed rapidly and appropriately to date.
The high level of coverage has resulted in declines in genital warts, HPV prevalence, and progressive and ongoing declines in high grade cervical-intraepithelial neoplasia. Use of registry data has allowed timely and population based analyses of cervical screening related outcome data but linkage with HPV vaccination register data is not yet routine. Australia still does not have a unique health identifier in place and linkage of population datasets still depends upon probabilistic methods. Ethics clearances and processes required for approval of release of data for linkage have historically been challenging in Australia, limiting the use of our registers for linked data analyses. Aboriginal and Torres Strait Islander people have lower vaccine coverage, but similar dramatic declines in HPV prevalence and genital warts have been observed.
Future changes in Australia which will impact upon prevention of cervical cancer and other HPV-related diseases include new registries, a new cervical screening program commencing in May 2017, and the possible move to a 2 dose HPV vaccination schedule and/or the 9vHPV vaccine.