Human papillomavirus vaccination and genital warts in young Indigenous Australians: national sentinel surveillance data

Abstract

The known The Australian HPV vaccination program has led to significant declines in a number of HPV-related conditions, including diagnoses of genital warts in young women and heterosexual men at sexual health clinics.The new We found marked declines in the proportions of young Indigenous women and men attending sexual health clinics for the first time who were diagnosed with genital warts following introduction of the HPV vaccination program, similar to declines among non-Indigenous young women and men.The implications Sustained high HPV vaccine coverage rates and monitoring are needed to close the gap between Indigenous and non-Indigenous Australians in the rates of cervical and other HPV-related cancers in older women.T he Australian national human papillomavirus (HPV) vaccination program commenced in April 2007. Free vaccination was provided to 12e13-year-old girls in schools; this was supplemented by a 3-year catch-up program for 13e18-year-old girls in schools and for 18e26-year-old women through family doctors in July 2007.1 In 2013, boys were added to the program, providing free HPV vaccination to 12e13-year-old boys in schools and, for 2 years, a catch-up program for 14e15-year-old boys. Australia uses the quadrivalent HPV vaccine (Gardasil), protecting against HPV types 6 and 11, which cause ano-genital warts, and HPV types 16 and 18, which cause cancer. 2,3The Australian HPV vaccination program has had very promising results. High coverage rates among vaccine-eligible girls have been achieved, 73% receiving all three doses in 2010. 4 Significant reductions in the prevalence of HPV-related conditions have been seen; diagnoses of genital warts in young women and heterosexual men at sexual health clinics, 5,6 inpatient treatment of genital warts at private hospitals, 7 hospital admissions for genital warts, 8 the prevalence in young women of HPV types targeted by the quadrivalent vaccine, 9,10 and the incidence of high grade cervical abnormalities 11 have all declined.Measuring the impact of the HPV vaccination program in Aboriginal and/or Torres Strait Islander (Indigenous) people is important because cervical cancer rates among Indigenous women are twice as high as among non-Indigenous women. 12 Similar findings have been reported overseas; a meta-analysis of data from 35 studies found that indigenous women had elevated risks of invasive cervical cancer and related mortality (pooled risk ratios, 1.72 and 3.45 respectively).13 Indigenous Australians experience poorer outcomes than non-Indigenous people for a range of conditions, 14 including some sexually transmissible infections (STIs). [15][16][17] In response to these inequities, the Australian Government initiated the Closing the Gap program in 2008, 18 followed in 2014 by the Fourth NationalAboriginal and Torres Strait Islander Blood-borne Viruses and STI Strategy, 2014e2017, which includes the aim of achieving high rates of HPV vaccination. 19Despite their disproportionately high rates of cervical cancer, there is a lack of information on HPV vacc...

HPV vaccination coverage and course completion rates for Indigenous Australian adolescents, 2015

“…In each jurisdiction, estimated HPV vaccination coverage of Indigenous students was much higher than reported in many countries, including the United States, New Zealand and France . This high level of coverage is consistent with findings of large falls in the prevalence of HPV and the incidence of genital warts in Indigenous people . The vaccine achieves strong herd protection even at relatively low coverage, and the benefits of vaccination were substantially augmented in Australia by the large scale catch‐up program .…”

“…A comprehensive analysis found the cervical screening participation rate in Queensland to be consistently much lower for Indigenous than non‐Indigenous Australian women aged 20–69 years during 2000–2011; further, high grade cervical abnormalities were detected more frequently and clinical investigation of abnormalities was slower . Prior to the HPV vaccination program, the prevalence of HPV types 16 and 18 was similar among Indigenous and non‐Indigenous women, consistent with findings that post‐vaccination reductions in the incidence of genital warts and in the prevalence of HPV infections have been similar for Indigenous and non‐Indigenous women …”

The projected timeframe until cervical cancer elimination in Australia: a modelling study

“…It is important to note that our analysis provides predictions across the entire Australian population, and the findings are not generalisable to specific population subgroups, such as Aboriginal and Torres Strait Islander women, migrants, or disadvantaged subpopulations. Although the effects of HPV vaccination in Australia appear to have been similar in Indigenous and non-Indigenous Australians 15,38 and across areas of different socioeconomic groups, 39 participation in screening differs by Indigenous status and area-level socioeconomic status. 4,40 Indigenous women are 2·5 times more likely to be diagnosed with cervical cancer, and 3·8 times more likely to die of the disease than non-Indigenous women.…”

Vaccine Preventable Diseases and Vaccination Coverage in Aboriginal and Torres Strait Islander People, Australia, 2011–2015

“…In ambulatory patients, a study reported significant declines in presentations with genital warts among Aboriginal and Torres Strait Islander women aged 12-20 years and 21-30 years and males aged 12-20 years presenting to sexual health clinics between the two periods of 2004-2007 and 2008-2014 ( Figure 6 and 7). 38 Another study found large declines in hospitalisations 30,39,40 Cervical screening registers have not routinely received information about the Aboriginal and Torres Strait Islander status of women participating in screening. However, the decline seen in the Northern Territory, where 31% of the female population is Aboriginal and Torres Strait Islander, 41 is similar to that observed nationally ( Figures 8 and 9).…”