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

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.

COVID Vaccines in Adolescents and Young Adults

“…Similarly, using schools as a venue for vaccine administration could enhance vaccine access and delivery. Generally, school-based vaccination programs are effective at achieving high coverage rates for immunizations and in many countries have high levels of support from parents/guardians [ 29 ].…”

Using World Cafés to engage an Australian culturally and linguistically diverse community around human papillomavirus vaccination

“…20 In spite of these national gains, local‐level data reveals variable vaccine coverage based on gender, socioeconomic status and geographical location. 20 , 21 , 22 , 23 However, as CALD data are not collected in vaccination registers, assessing if any CALD communities experience vaccination coverage inequities is difficult. To date, only two Australian studies have reported vaccination coverage for students with ‘a language background other than English’ with neither study finding an association.…”

“…To date, only two Australian studies have reported vaccination coverage for students with ‘a language background other than English’ with neither study finding an association. 21 , 23 However, these studies did not specify the language backgrounds included. With some immunization providers reporting much lower vaccination coverage of around 53.2% in schools or communities with higher CALD representation, 20 it is possible that as seen in Canada 24 and England, 25 associations between lower vaccination coverage and CALD status are being masked.…”

“…Since then, a significant reduction in HPV disease has been observed 17–20 and national coverage is now about 82.6% for females and 79.9% for males 20 . In spite of these national gains, local‐level data reveals variable vaccine coverage based on gender, socioeconomic status and geographical location 20–23 . However, as CALD data are not collected in vaccination registers, assessing if any CALD communities experience vaccination coverage inequities is difficult.…”

“…However, as CALD data are not collected in vaccination registers, assessing if any CALD communities experience vaccination coverage inequities is difficult. To date, only two Australian studies have reported vaccination coverage for students with ‘a language background other than English’ with neither study finding an association 21,23 . However, these studies did not specify the language backgrounds included.…”