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

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

doi:10.3390/vaccines9101202

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

Vaccines (Basel). 2021 Oct 19;9(10):1202. doi: 10.3390/vaccines9101202.

Authors

Cassandra Vujovich-Dunn¹, Susan Rachel Skinner^{2

3}, Julia Brotherton^{4

5}, Handan Wand¹, Jana Sisnowski^{1

6}, Rebecca Lorch¹, Mark Veitch⁷, Vicky Sheppeard^{8

9}, Paul Effler¹⁰, Heather Gidding^{11

12

13

14}, Alison Venn¹⁵, Cristyn Davies^{2

3}, Jane Hocking⁵, Lisa J Whop^{6

16}, Julie Leask¹⁷, Karen Canfell¹⁸, Lena Sanci¹⁹, Megan Smith^{9

18}, Melissa Kang²⁰, Meredith Temple-Smith¹⁹, Michael Kidd²¹, Sharyn Burns²², Linda Selvey²³, Dennis Meijer²⁴, Sonya Ennis²⁴, Chloe A Thomson¹⁰, Nikole Lane⁷, John Kaldor¹, Rebecca Guy¹

Affiliations

¹ The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia.
² Children's Hospital Westmead, Sydney Children's Hospitals Network, Sydney 2145, Australia.
³ Faculty of Medicine and Health, University of Sydney, Specialty of Child and Adolescent Health, Sydney 2006, Australia.
⁴ Population Health, VCS Foundation Ltd., East Melbourne, Melbourne 3053, Australia.
⁵ Melbourne School of Population and Global Health, University of Melbourne, Carlton, Melbourne 3010, Australia.
⁶ National Centre for Epidemiology & Population Health, Australian National University, Canberra 0200, Australia.
⁷ Department of Health and Human Services, Tasmanian Government, Hobart 7001, Australia.
⁸ Communicable Diseases Branch, Health Protection NSW, St Leonards, Sydney 2065, Australia.
⁹ School of Public Health, University of Sydney, Camperdown, Sydney 2006, Australia.
¹⁰ Department of Health, Communicable Disease Control Directorate, East Perth 6000, Australia.
¹¹ School of Population Health, University of New Souh Wales, Sydney 2052, Australia.
¹² Norther Clinical School of Sydney, University of Sydney, Camperdown, Sydney 2006, Australia.
¹³ Women and Babies Research, Kollin Intstitye, Northern Sydney Local Health District, St Leaonards, Sydney 2064, Australia.
¹⁴ National Centre for Immunisation Research and Surveillance, Westmead, Sydney 2145, Australia.
¹⁵ Menzies Institute for Medical Research, University of Tasmania, Tasmanian 7000, Australia.
¹⁶ Menzies School of Health Research, Charles Darwin University, Brisbane 4000, Australia.
¹⁷ Faculty of Medicine and Health, Sydney Nursing School, University of Sydney, Camperdown, Sydney 2006, Australia.
¹⁸ Cancer Research Division, Cancer Council, Brisbane 2011, Australia.
¹⁹ Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Melbourne 3010, Australia.
²⁰ Westmead Clinical School, University of Sydney, Sydney 2006, Australia.
²¹ Southgate Institute for Health, Flinders University, Adelaide 5042, Australia.
²² School of Population Health, Curtin University, Perth 6102, Australia.
²³ School of Public Health, University of Queensland, Brisbane 4072, Australia.
²⁴ Immunisation Unit, Health Protection NSW, St Leonards, Sydney 2065, Australia.

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.

Keywords: adolescent vaccination; cancer prevention; differential uptake; evaluation and impact; implementation; school-based immunisation; vaccination; vaccine specific hesitancy.

Grants and funding

APP1132344/National Health and Medical Research Council