Abstract
The English national human papillomavirus (HPV) immunisation programme has offered vaccination to girls aged 12 years at the start of each school year since September 2008. A catch-up programme has offered vaccination to girls up to 18 years. Delivery is predominantly school-based, with some general practitioner (GP)-based immunisation. The relationship between HPV immunisation coverage and deprivation (index of multiple deprivation, IMD) was assessed by geographical area (N=151) for each school year offered the HPV vaccine between 2008 to 2011 using the Spearman’s rank correlation coefficient, and compared to that for adequate cervical screening of women aged 25 to 49 years. Coverage at age 12 showed no significant association with IMD at the area-level (p=0.12). Within the catch-up years, there was some suggestion of higher deprivation being associated with lower coverage. This was not significant for girls offered immunisation under 16 years (in compulsory education) (p=0.09), but was more marked and statistically significant for older girls (p<0.0001). The proportion of women aged 25 to 49 years with an adequate cervical screen was negatively associated with deprivation (p<0.0001). School-based HPV immunisation delivery appears to be successfully reducing inequalities in cervical cancer control at area-level. However, the catch-up cohorts above the age of compulsory education may face increased inequality. Further investigation is needed into individual-level factors associated with coverage.
Highlights
The human papillomavirus (HPV) immunisation programme was launched in England in September 2008, offering all girls aged 12 years HPV vaccination as part of the routine immunisation schedule
The Spearman’s rank correlation coefficient between three-dose HPV immunisation coverage and rank of average index of multiple deprivation (IMD) by PCT was 0.3094 (p=0.12) (Figure 1), showing that there was no significant correlation between PCT-level HPV immunisation coverage and deprivation
Whilst the HPV immunisation coverage was lowest in the lowest quintile of rank average IMD score, there was no trend towards increasing coverage across the quintiles (Table)
Summary
The human papillomavirus (HPV) immunisation programme was launched in England in September 2008, offering all girls aged 12 years HPV vaccination as part of the routine immunisation schedule. There was more reliance on GPs in the first year of the catch-up programme for 17 year-old girls, which had originally been planned to start in September 2009 but was implemented sooner following a cost analysis of the programme. This allowed an extra cohort to be offered the vaccine from September 2008 but the acceleration of the catch-up programme meant GPs had a relatively short time to prepare to deliver that part of the programme [1]. High coverage has been achieved across England for HPV immunisation, with coverage nationally of 89% for one dose and 84% for all three doses in the routine programme in 2010/11 and of 66% for all three doses for all routine and catch-up cohorts combined [1]
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