Elsevier

Clinical Therapeutics

Volume 36, Issue 1, 1 January 2014, Pages 17-23
Clinical Therapeutics

Review Article
The Australian Experience With the Human Papillomavirus Vaccine

https://doi.org/10.1016/j.clinthera.2013.12.005Get rights and content

Abstract

Objective

The goal of this study was to review the current human papillomavirus (HPV) vaccine program and its outcomes to date in Australia.

Methods

This was a review of the published data relating to the introduction and subsequent measurable outcomes of the quadrivalent vaccine, which became part of the Australian national HPV immunization program in 2007. Australia commenced an ongoing, schoolbased, government-funded, HPV vaccination program using the quadrivalent vaccine from April 2007 for adolescent female subjects aged 12 to 13 years, together with a catch-up program for female subjects 13 to 26 years of age from July 2007 to December 31, 2009.

Results

The Australian community (lay and clinical) have embraced the program, resulting in high coverage with >70% for 3 doses in the 12- to 13-year-old ongoing target population. Vaccine effectiveness (outcomes of vaccination in a real-world setting) is already being seen. This effectiveness has been noted in significant reductions in HPV vaccine–related infections in vaccine eligible age female subjects (77% fall in prevalence), rapid reduction of >90% in genital warts (first marker of disease reduction, as well as herd immunity), and reduction in high-grade cervical lesions in this age group. These remarkable changes so soon after implementation of the vaccine in the country occurred faster, and to a greater extent, than anyone could have predicted.

Conclusions

These findings from Australia should encourage other countries to follow suit, with the ultimate aim of translating treatment into reductions in HPV-related neoplasia globally. The greatest success from such an approach will only be realized when prophylactic vaccines are rolled out effectively, with high coverage and at affordable costs, to those areas of the world with the highest burden of disease. To achieve this outcome requires government endorsement and commitment; education of the community at large; realization of the safety, efficacy, and immunogenicity of the available prophylactic vaccines in reducing HPV-related infections and disease, especially neoplasia; and governments procuring vaccines at affordable prices through the various options now available (eg, support from the GAVI Alliance to eligible countries, tiered pricing, negotiation with pharmaceutical manufacturers). We have the tools to reach this goal, and it is time these tools were implemented.

Introduction

Australia is a large country with a relatively small population (~22 million people), most of whom are concentrated around the coastal regions.1 Australia has led the way in preventing cervical cancer, both from a primary as well as a secondary point of view. With respect to secondary screening, Australia moved from an opportunistic to an organized cervical cytology approach in 1991, in a program called the National Cervical Screening Program (NCSP).2 The NCSP is a comprehensive system that promotes routine screening with conventional cytology, every 2 years for women 18 years of age or 2 years after sexual debut (whichever is later) to the age of 69 years. This program has seen a large drop in the incidence of cervical cancer of more than one half, from 13.2 per 100,000 in the early 1980s to 6.9 per 100,000 most recently. Moreover, the mortality for this time period has dropped from 4 to 1.9 per 100,000. Accordingly, as a result of the NCSP program, cervical cancer is now the 13th most common cancer in women in Australia, compared with other countries, particularly those that are resource-poor and where cervical cancer can be the first or second most common cancer in women.3 The NCSP is currently being reviewed (known as the National Cervical Screening Program Renewal) in light of the success of the cervical cancer vaccine program, and largely as the vaccine reduces vaccine human papillomavirus (HPV) type–related cervical lesions, the positive predictive value of cytology will decline.4 We await the outcome of these deliberations, although it is predicted that Australia will follow other recommendations worldwide of commencing screening later, adopting wider screening intervals, and possibly using more sensitive assays. In the meantime, however, it is noteworthy that with a screening program of every 2 years (with a resultant 70%5 3 yearly uptake rate in the target population) from 18 years of age overlaps the vaccination age and has allowed the successful measure of the impact of the vaccine in the decline of vaccine-related HPV type high-grade disease or cervical intraepithelial neoplasia (CIN) in the catch-up population.6, 7

The goal of the present study was to review the current HPV vaccine program and its outcomes to date in Australia.

Section snippets

Methods

Review of published data and unpublished data presented at scientific forums relating to the introduction and subsequent measurable outcomes of the quadrivalent vaccine, which became part of the Australian national immunization program in 2007.

HPV Vaccination: Primary Prevention Program for Cervical Cancer

In 2007, after the successful Phase III clinical trials of the quadrivalent HPV vaccine,8, 9 Australia adopted a primary approach to cervical cancer prevention by introducing, through the National Immunisation Program (NIP), the HPV vaccine, otherwise known as the cervical cancer vaccine.10 This is an ongoing program in which the quadrivalent vaccine is offered free of charge to girls aged 12 to 13 years, primarily through

Conclusions

We are at the beginning of a potentially great journey (with high coverage and government, clinician, and lay public endorsement) of a vaccine program that ultimately should result in reduction in HPV-related neoplasia. To achieve this end, we must sustain high coverage of vaccination, with ongoing surveillance using linkages between various registries to measure disease outcomes. Now that a neutral-gender approach has been adopted, there is an even greater opportunity to reduce the pool of

Conflicts of Interest

The author has received advisory board fees and grant support from CSL Behring and GlaxoSmithKline and lecture fees from Merck, GlaxoSmithKline, and Sanofi Pasteur; in addition, she has received funding through her institution to conduct HPV vaccine studies for Merck and GlaxoSmithKline. She is a member of the Merck Global Advisory Board as well as the Merck Scientific Advisory Committee for HPV.

Acknowledgment

Dr. Garland reviewed literature that has been published and on behalf of my colleagues in Australia.

References (38)

  • Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions

    N Engl J Med

    (2007)
  • B.P. Hull et al.

    Immunisation coverage annual report, 2008

    Commun Dis Intell Q Rep

    (2010)
  • D.M. Gertig et al.

    Measuring human papillomavirus (HPV) vaccination coverage and the role of the National HPV Vaccination Program Register, Australia

    Sex Health

    (2011)
  • Australian Government Department of Health and Ageing. Immunise Australia program: human papillomavirus (HPV)...
  • J. Brotherton et al.

    Catching up with the catch-up: interim HPV coverage data for Australian women aged 18-26 years from the National HPV Vaccination Program Register

    Commun Dis Intell Q Rep

    (2011)
  • E. Weisberg et al.

    HPV vaccination catch up program—utilisation by young Australian women

    Aust Fam Physician

    (2009)
  • J.M. Brotherton et al.

    Human papillomavirus (HPV) vaccination coverage in young Australian women is higher than previously estimated: independent estimates from a nationally representative mobile phone survey

    Vaccine

    (2013 Dec 5)
  • J.M. Brotherton et al.

    Human papillomavirus vaccine coverage among female Australian adolescents: success of the school-based approach

    Med J Aust

    (2013)
  • N.W. Crawford et al.

    Syncope and seizures following human papillomavirus vaccination: a retrospective case series

    Med J Aust

    (2011)
  • Cited by (65)

    • The impact of publicly funded immunization programs on human papillomavirus vaccination in boys and girls: An observational study

      2022, The Lancet Regional Health - Americas
      Citation Excerpt :

      Routine childhood immunization programs are amongst the most lifesaving and cost-effective public health interventions available.1,2 Vaccinations can mitigate oropharyngeal and genital cancers with potentially high morbidity and mortality caused by human papillomavirus (HPV).3–6 Reductions in the uptake of immunization due to delayed, missed, or incomplete vaccination can lead to increases in vaccine preventable diseases.7–10

    • The uptake of adolescent vaccinations through the School Immunisation Program in specialist schools in Victoria, Australia

      2019, Vaccine
      Citation Excerpt :

      Although there is very little published research analysing dTpa uptake in adolescence, there is much published about HPV. It is well recognised globally that a government-funded school immunisation program yields the highest uptake of HPV immunisation [24–26]. Australia has become a world leader in the provision and completion of HPV vaccination, initiating the program in 2007 for girls and in 2013 for boys [24].

    View all citing articles on Scopus
    View full text