School-Level Variation in Coverage of Co-Administered dTpa and HPV Dose 1 in Three Australian States.

Heather Gidding,Meredith Temple-Smith,Lena Sanci,Karen Canfell,Michael Kidd,Megan A Smith ,John Kaldor,Mark Veitch,Rebecca Guy,A Venn ,Jana Sisnowski,Cassandra Vujovich-Dunn,Vicky Sheppeard,Handan Wand,Paul V Effler ,Sharyn Burns,Cristyn Davies,Jane Hocking,Dennis Meijer,Chloe Thomson ,Melissa Kang,Sonya Ennis,Linda Selvey ,Lisa J Whop,Julie Leask,N Lane ,Julia Brotherton,Rebecca Lorch

doi:10.3390/vaccines9101202

Abstract

Background: Australian adolescents are routinely offered HPV and dTpa (diphtheria, tetanus, pertussis) vaccines simultaneously in the secondary school vaccination program. We identified schools where HPV initiation was lower than dTpa coverage and associated school-level factors across three states. Methods: HPV vaccination initiation rates and dTpa vaccination coverage in 2016 were calculated using vaccine databases and school enrolment data. A multivariate analysis assessed sociodemographic and school-level factors associated with HPV initiation being >5% absolute lower than dTpa coverage. Results: Of 1280 schools included, the median school-level HPV initiation rate was 85% (interquartile range (IQR):75–90%) and the median dTpa coverage was 86% (IQR:75–92%). Nearly a quarter (24%) of all schools had HPV vaccination initiation >5% lower than dTpa coverage and 11 % had >10% difference. School-level factors independently associated with >5% difference were remote schools (aOR:3.5, 95% CI = 1.7–7.2) and schools in major cities (aOR:1.8, 95% CI = 1.0–3.0), small schools (aOR:3.3, 95% CI = 2.3–5.7), higher socioeconomic advantage (aOR:1.7, 95% CI = 1.1–2.6), and lower proportions of Language-background-other-than-English (aOR:1.9, 95% CI = 1.2–3.0). Conclusion: The results identified a quarter of schools had lower HPV than dTpa initiation coverage, which may indicate HPV vaccine hesitancy, and the difference was more likely in socioeconomically advantaged schools. As hesitancy is context specific, it is important to understand the potential drivers of hesitancy and future research needs to understand the reasons driving differential uptake.

Highlights

Human papillomavirus (HPV) is the most common sexually transmissible infection (STI) globally and is associated with significant morbidity and mortality due to cervical and other cancers and genital warts, with 50–80% of the general population acquiring HPV infection with one or more types at some point in their life [1]
Of 1327 schools in the dataset, we excluded 39 schools with no 2016 enrolment data, two not located in a participating jurisdiction, and the remainder because the school name was not available in both the numerator and denominator data to enable matching of the datasets with the National HPV Vaccination Program Register (NHPVR)
We found that in 32% of schools dTpa coverage was lower than HPV, which may potentially be explained by adolescents having received a diphtheria tetanus vaccine previously for tetanus prevention, if a child or adolescent had a recent cut or wound that could have been in contact with soil, or routine travel vaccination

Summary

Introduction

Human papillomavirus (HPV) is the most common sexually transmissible infection (STI) globally and is associated with significant morbidity and mortality due to cervical and other cancers and genital warts, with 50–80% of the general population acquiring HPV infection with one or more types at some point in their life [1]. We identified schools where HPV initiation was lower than dTpa coverage and associated school-level factors across three states. HPV initiation rate was 85% (interquartile range (IQR):75–90%) and the median dTpa coverage was. A quarter (24%) of all schools had HPV vaccination initiation >5% lower than dTpa coverage and 11 % had >10% difference. School-level factors independently associated with >5% difference were remote schools (aOR:3.5, 95% CI = 1.7–7.2) and schools in major cities (aOR:1.8, 95% CI = 1.0–3.0), small schools (aOR:3.3, 95% CI = 2.3–5.7), higher socioeconomic advantage (aOR:1.7, 95% CI = 1.1–2.6), and lower proportions of Language-background-other-than-English (aOR:1.9, 95% CI = 1.2–3.0). Conclusion: The results identified a quarter of schools had lower HPV than dTpa initiation coverage, which may indicate HPV vaccine hesitancy, and the difference was more likely in socioeconomically advantaged schools. As hesitancy is context specific, it is important to understand the potential drivers of hesitancy and future research needs to understand the reasons driving differential uptake

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