School-level variation in coverage of co-administered dTpa and HPV dose 1 in three Australian states

Cassandra Vujovich-Dunn; Susan Rachel Skinner; Julia Brotherton; Handan Wand; Jana Sisnowski; Rebecca Lorch; Mark Veitch; Vicky Sheppeard; Paul Effler; Heather Gidding; Alison Venn; Cristyn Davies; Jane Hocking; Lisa J. Whop; Julie Leask; Karen Canfell; Lena Sanci; Megan Smith; Melissa Kang; Meredith Temple-Smith; Michael Kidd; Sharyn Burns; Linda Selvey; Dennis Meijer; Sonya Ennis; Chloe A. Thomson; Nikole Lane; John Kaldor; Rebecca Guy

doi:10.3390/vaccines9101202

School-level variation in coverage of co-administered dTpa and HPV dose 1 in three Australian states

Cassandra Vujovich-Dunn, Susan Rachel Skinner, Julia Brotherton, Handan Wand, Jana Sisnowski, Rebecca Lorch, Mark Veitch, Vicky Sheppeard, Paul Effler, Heather Gidding, Alison Venn, Cristyn Davies, Jane Hocking, Lisa J. Whop, Julie Leask, Karen Canfell, Lena Sanci, Megan Smith, Melissa Kang, Meredith Temple-SmithMichael Kidd, Sharyn Burns, Linda Selvey, Dennis Meijer, Sonya Ennis, Chloe A. Thomson, Nikole Lane, John Kaldor, Rebecca Guy

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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.

Original language	English
Article number	1202
Pages (from-to)	1-14
Number of pages	14
Journal	Vaccines
Volume	9
Issue number	10
DOIs	https://doi.org/10.3390/vaccines9101202
Publication status	Published - Oct 2021

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Vujovich-Dunn, C., Skinner, S. R., Brotherton, J., Wand, H., Sisnowski, J., Lorch, R., Veitch, M., Sheppeard, V., Effler, P., Gidding, H., Venn, A., Davies, C., Hocking, J., Whop, L. J., Leask, J., Canfell, K., Sanci, L., Smith, M., Kang, M., ... Guy, R. (2021). School-level variation in coverage of co-administered dTpa and HPV dose 1 in three Australian states. Vaccines, 9(10), 1-14. [1202]. https://doi.org/10.3390/vaccines9101202

@article{9d0eec5f5a114318b8ac81436f660836,

title = "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.",

keywords = "Adolescent vaccination, Cancer prevention, Differential uptake, Evaluation and impact, Implementation, School-based immunisation, Vaccination, Vaccine specific hesitancy",

author = "Cassandra Vujovich-Dunn and Skinner, {Susan Rachel} and Julia Brotherton and Handan Wand and Jana Sisnowski and Rebecca Lorch and Mark Veitch and Vicky Sheppeard and Paul Effler and Heather Gidding and Alison Venn and Cristyn Davies and Jane Hocking and Whop, {Lisa J.} and Julie Leask and Karen Canfell and Lena Sanci and Megan Smith and Melissa Kang and Meredith Temple-Smith and Michael Kidd and Sharyn Burns and Linda Selvey and Dennis Meijer and Sonya Ennis and Thomson, {Chloe A.} and Nikole Lane and John Kaldor and Rebecca Guy",

note = "Funding Information: Institutional Review Board Statement: Ethical approval was provided by the Human Research Ethics Committees of the University of New South Wales (HC17632), the Australian National University (2017/516), the University of Tasmania (1320/17), the Aboriginal Health and Medical Research Council of New South Wales (1320/17), the Aboriginal Health Council of Western Australia (818), and the Department of Health of Western Australia (RGS0000000456). Funding Information: Funding: The study was conducted as part of the HPV Partnership Project (NHMRC grant number APP1132344), which was formed between researchers, the National HPV Vaccination Program Register, and the health departments of three states, New South Wales, Tasmania, and Western Australia to understand why gaps persist in the HPV vaccination school-based program. JS was funded by an Australian Government Research Training Program Scholarship, LW was funded by the NHMRC Early Career Fellowship (#1142035), and MS was funded by NHRMC grant (APP1159491) Cancer Institute NSW. RG was funded by an NHMRC fellowship (GNT1124647) and is a co-investigator on a project which received funding from Seqirus [unrelated to this project]. KC reports she is co-PI of an investigator-initiated trial of cervical screening, “Compass”, run by the VCS Foundation Australia, which is a government-funded not-for-profit charity. The VCS Foundation has received equipment and a funding contribution from Roche Molecular Diagnostics. She is also co-PI on a major implementation program “Elimination of Cervical Cancer in the Western Pacific” which will receive support from the Minderoo Foundation and the Frazer Family Foundation and equipment donations from Cepheid Inc. However, neither KC nor her institution has received direct funding from industry for these or any other research project. Funding Information: Ethical approval was provided by the Human Research Ethics Committees of the University of New South Wales (HC17632), the Australian National University (2017/516), the University of Tasmania (1320/17), the Aboriginal Health and Medical Research Council of New South Wales (1320/17), the Aboriginal Health Council of Western Australia (818), and the Department of Health of Western Australia (RGS0000000456). Funding Information: The study was conducted as part of the HPV Partnership Project (NHMRC grant number APP1132344), which was formed between researchers, the National HPV Vaccination Program Regis-ter, and the health departments of three states, New South Wales, Tasmania, and Western Australia to understand why gaps persist in the HPV vaccination school-based program. JS was funded by an Australian Government Research Training Program Scholarship, LW was funded by the NHMRC Early Career Fellowship (#1142035), and MS was funded by NHRMC grant (APP1159491) Cancer Institute NSW. RG was funded by an NHMRC fellowship (GNT1124647) and is a co-investigator on a project which received funding from Seqirus [unrelated to this project]. KC reports she is co-PI of an investigator-initiated trial of cervical screening, ?Compass?, run by the VCS Foundation Australia, which is a government-funded not-for-profit charity. The VCS Foundation has received equipment and a funding contribution from Roche Molecular Diagnostics. She is also co-PI on a major implementation program ?Elimination of Cervical Cancer in the Western Pacific? which will receive support from the Minderoo Foundation and the Frazer Family Foundation and equipment donations from Cepheid Inc. However, neither KC nor her institution has received direct funding from industry for these or any other research project. Publisher Copyright: {\textcopyright} 2021 by the authorsLicensee MDPI, Basel, Switzerland. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = oct,

doi = "10.3390/vaccines9101202",

language = "English",

volume = "9",

pages = "1--14",

journal = "Vaccines",

issn = "2076-393X",

publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",

number = "10",

}

Vujovich-Dunn, C, Skinner, SR, Brotherton, J, Wand, H, Sisnowski, J, Lorch, R, Veitch, M, Sheppeard, V, Effler, P, Gidding, H, Venn, A, Davies, C, Hocking, J, Whop, LJ, Leask, J, Canfell, K, Sanci, L, Smith, M, Kang, M, Temple-Smith, M, Kidd, M, Burns, S, Selvey, L, Meijer, D, Ennis, S, Thomson, CA, Lane, N, Kaldor, J & Guy, R 2021, 'School-level variation in coverage of co-administered dTpa and HPV dose 1 in three Australian states', Vaccines, vol. 9, no. 10, 1202, pp. 1-14. https://doi.org/10.3390/vaccines9101202

TY - JOUR

T1 - School-level variation in coverage of co-administered dTpa and HPV dose 1 in three Australian states

AU - Vujovich-Dunn, Cassandra

AU - Skinner, Susan Rachel

AU - Brotherton, Julia

AU - Wand, Handan

AU - Sisnowski, Jana

AU - Lorch, Rebecca

AU - Veitch, Mark

AU - Sheppeard, Vicky

AU - Effler, Paul

AU - Gidding, Heather

AU - Venn, Alison

AU - Davies, Cristyn

AU - Hocking, Jane

AU - Whop, Lisa J.

AU - Leask, Julie

AU - Canfell, Karen

AU - Sanci, Lena

AU - Smith, Megan

AU - Kang, Melissa

AU - Temple-Smith, Meredith

AU - Kidd, Michael

AU - Burns, Sharyn

AU - Selvey, Linda

AU - Meijer, Dennis

AU - Ennis, Sonya

AU - Thomson, Chloe A.

AU - Lane, Nikole

AU - Kaldor, John

AU - Guy, Rebecca

N1 - Funding Information: Institutional Review Board Statement: Ethical approval was provided by the Human Research Ethics Committees of the University of New South Wales (HC17632), the Australian National University (2017/516), the University of Tasmania (1320/17), the Aboriginal Health and Medical Research Council of New South Wales (1320/17), the Aboriginal Health Council of Western Australia (818), and the Department of Health of Western Australia (RGS0000000456). Funding Information: Funding: The study was conducted as part of the HPV Partnership Project (NHMRC grant number APP1132344), which was formed between researchers, the National HPV Vaccination Program Register, and the health departments of three states, New South Wales, Tasmania, and Western Australia to understand why gaps persist in the HPV vaccination school-based program. JS was funded by an Australian Government Research Training Program Scholarship, LW was funded by the NHMRC Early Career Fellowship (#1142035), and MS was funded by NHRMC grant (APP1159491) Cancer Institute NSW. RG was funded by an NHMRC fellowship (GNT1124647) and is a co-investigator on a project which received funding from Seqirus [unrelated to this project]. KC reports she is co-PI of an investigator-initiated trial of cervical screening, “Compass”, run by the VCS Foundation Australia, which is a government-funded not-for-profit charity. The VCS Foundation has received equipment and a funding contribution from Roche Molecular Diagnostics. She is also co-PI on a major implementation program “Elimination of Cervical Cancer in the Western Pacific” which will receive support from the Minderoo Foundation and the Frazer Family Foundation and equipment donations from Cepheid Inc. However, neither KC nor her institution has received direct funding from industry for these or any other research project. Funding Information: Ethical approval was provided by the Human Research Ethics Committees of the University of New South Wales (HC17632), the Australian National University (2017/516), the University of Tasmania (1320/17), the Aboriginal Health and Medical Research Council of New South Wales (1320/17), the Aboriginal Health Council of Western Australia (818), and the Department of Health of Western Australia (RGS0000000456). Funding Information: The study was conducted as part of the HPV Partnership Project (NHMRC grant number APP1132344), which was formed between researchers, the National HPV Vaccination Program Regis-ter, and the health departments of three states, New South Wales, Tasmania, and Western Australia to understand why gaps persist in the HPV vaccination school-based program. JS was funded by an Australian Government Research Training Program Scholarship, LW was funded by the NHMRC Early Career Fellowship (#1142035), and MS was funded by NHRMC grant (APP1159491) Cancer Institute NSW. RG was funded by an NHMRC fellowship (GNT1124647) and is a co-investigator on a project which received funding from Seqirus [unrelated to this project]. KC reports she is co-PI of an investigator-initiated trial of cervical screening, ?Compass?, run by the VCS Foundation Australia, which is a government-funded not-for-profit charity. The VCS Foundation has received equipment and a funding contribution from Roche Molecular Diagnostics. She is also co-PI on a major implementation program ?Elimination of Cervical Cancer in the Western Pacific? which will receive support from the Minderoo Foundation and the Frazer Family Foundation and equipment donations from Cepheid Inc. However, neither KC nor her institution has received direct funding from industry for these or any other research project. Publisher Copyright: © 2021 by the authorsLicensee MDPI, Basel, Switzerland. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/10

Y1 - 2021/10

N2 - 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.

AB - 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.

KW - Adolescent vaccination

KW - Cancer prevention

KW - Differential uptake

KW - Evaluation and impact

KW - Implementation

KW - School-based immunisation

KW - Vaccination

KW - Vaccine specific hesitancy

UR - http://www.scopus.com/inward/record.url?scp=85117920891&partnerID=8YFLogxK

U2 - 10.3390/vaccines9101202

DO - 10.3390/vaccines9101202

M3 - Article

AN - SCOPUS:85117920891

VL - 9

SP - 1

EP - 14

JO - Vaccines

JF - Vaccines

SN - 2076-393X

IS - 10

M1 - 1202

ER -

School-level variation in coverage of co-administered dTpa and HPV dose 1 in three Australian states

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