Challenges, lessons learned and results following the implementation of a human papilloma virus school vaccination program in South Australia

Abstract

Objective: To describe the process and challenges in the roll out of a large cervical cancer vaccination program to protect against human papilloma virus (HPV) infection. Methods: This article describes the process of planning and implementing a HPV vaccination program using the existing state‐wide framework that supports vaccine delivery to all 219 high schools in South Australia. The decision was made to offer three doses of HPV vaccine to 50,191 female students in Years 8‐12 during the 2007 school year. Results: By November 2007, despite many challenges, the school vaccination program had delivered 107,541 doses of HPV vaccine. Coverage of dose 1 was highest in Years 8 (83%) and 10 (70%), but was reduced for doses 2 and 3 in all year levels, with dose 3 coverage ranging from 55% (Year 11) to 77% (Year 8). Conclusions: The introduction of a large school‐based vaccination program at short notice posed new challenges for the co‐ordination and implementation. Not all schools supported the introduction of HPV vaccine, resulting in reduced access for some students. Negative media messages provided a strong platform for individuals who opposed vaccination. These factors may have contributed to the less‐than‐expected uptake of HPV vaccine. Implications: Historically, there has been high uptake of other vaccines given to adolescents. However, the introduction of HPV vaccine may have adversely affected the uptake of Hepatitis B vaccine, given concurrently in the school program. Further studies are needed to determine if this is likely to have a negative effect on the public perception of the value of vaccine programs in general.

Human papillomavirus vaccine delivery strategies that achieved high coverage in low- and middle-income countries

“…9,[23][24][25][26] However, this study clearly shows that a range of HPV vaccine delivery strategies can be successful in low-resource settings. The coverage levels achieved resemble those obtained with vaccination programmes in high-income countries: 65.1% uptake of the first dose in British Columbia, Canada; 27 68.5% uptake of two doses in Manchester, United Kingdom; 28 and 26.7% and 55.0% coverage with three doses in the United States 29 and southern Australia, 30 respectively. Although our study involved demonstration projects, admittedly not reflective of routine field conditions, HPV vaccination was conducted in large, geographically distinct areas using only the infrastructure already in place for the EPI.…”

Vaccination uptake by vaccine-hesitant parents attending a specialist immunization clinic in Australia

“…A similar observation was made following the introduction of HPV vaccine in South Australia, with significantly lower HBV uptake. 53 The potential for poor acceptance for one vaccine to affect uptake of a co-administered vaccine in our SIC is concerning and requires ongoing research.…”

Innovations in HPV Vaccination and Roles of Nurses in Cervical Cancer Prevention

“…Some countries within the Gardasil Access Program used schools and clinics and vaccination based on school-based, health facilitybased, and mixed strategies (Lander et al, 2012). Some of the national programs (TNSCCS, 2007;Ogilvie et al, 2010;Limia and Pachon, 2011;Binagwaho et al, 2012) and regional level programs (Brabin et al, 2008;Watson et al, 2009) indicated efficient vaccination to prevent cervical cancer through a national media campaign. In Turkey, the routine screening program for cervical cancer started with the "National Standards for Cervical Cancer Screening" published in 2007.…”