Review ArticleThe Australian Experience With the Human Papillomavirus Vaccine
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Review of published data and unpublished data presented at scientific forums relating to the introduction and subsequent measurable outcomes of the quadrivalent vaccine, which became part of the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)
- et al.
Early effect of the HPV vaccination programme on cervical abnormalities in Victoria, Australia: an ecological study
Lancet
(2011) - et al.
Adolescent and young adult HPV vaccination in Australia: achievements and challenges
Prev Med
(2011) - et al.
Quadrivalent human papillomavirus vaccination and trends in genital warts in Australia: analysis of national sentinel surveillance data
Lancet Infect Dis
(2011) - Australian Bureau of Statistics. Population by age, sex, Australian states and territories....
- Department of Health. NHMRC screening to prevent cervical cancer: guidelines for the management of asymptomatic women...
- et al.
Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008
Int J Cancer
(2010) - Department of Health and Ageing. Screening: National Cervical Screening Program Renewal. September 2013....
- Australian Institute of Health and Welfare. Cervical screening in Australia 2008–2009. Cancer Series No. 61. Cat. no....
- et al.
Impact of a population-based HPV vaccination program on cervical abnormalities: a data linkage study
BMC Med
(2013) - et al.
Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases
N Engl J Med
(2007)
Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions
N Engl J Med
Immunisation coverage annual report, 2008
Commun Dis Intell Q Rep
Measuring human papillomavirus (HPV) vaccination coverage and the role of the National HPV Vaccination Program Register, Australia
Sex Health
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
HPV vaccination catch up program—utilisation by young Australian women
Aust Fam Physician
Human papillomavirus (HPV) vaccination coverage in young Australian women is higher than previously estimated: independent estimates from a nationally representative mobile phone survey
Vaccine
Human papillomavirus vaccine coverage among female Australian adolescents: success of the school-based approach
Med J Aust
Syncope and seizures following human papillomavirus vaccination: a retrospective case series
Med J Aust
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 - AmericasCitation 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, VaccineCitation 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].
High-risk HPV genotype distribution in HPV co-test specimens: study of a predominantly Midwestern population
2018, Journal of the American Society of CytopathologyThe vaccines anti-HPV today in the treatment of the genital infections to HPV
2017, Annales de Dermatologie et de Venereologie