Cervical screening outcomes for HPV-vaccinated participants
With the introduction of the HPV vaccine in Australia in 2007, that is expected to prevent many of the HPV infections that would go on to develop into cervical cancer, ongoing monitoring of the effects of HPV vaccination on key performance indicators is required to allow the NCSP to respond to changes and to ensure the screening program remains effective, high-quality, and safe.
The AIHW has twice previously used data linkage between cervical screening data and HPV vaccination data to report on key outcomes related to the effects and effectiveness of HPV vaccination, but as Australia strives to be the first country to eliminate cervical cancer, continuing to monitor the effects and effectiveness of HPV vaccination is an ongoing requirement.
In recognition of this need, the AIHW has developed a mechanism of ongoing data linkage to routinely report performance indicators by HPV vaccination status, along with other performance indicators for the NCSP and the National Bowel Cancer Screening Program that require this data linkage.
This is the first report to include NCSP performance indicators by HPV vaccination status. In the first instance, two performance indicators are the focus on this section, with further performance indicators and data planned for inclusion in future reports.
Box HPV vaccination 1: HPV vaccination in Australia
In April 2007, Australia introduced HPV vaccination using the quadrivalent vaccine Gardasil (protecting against HPV types 6, 11, 16, 18), which included an ongoing program for girls aged 12–13 and a ‘catch-up’ program for girls and women aged 14–26 through to the end of 2009. This program was extended to boys from February 2013 with a catch up program for boys aged up to 15 years through to the end of 2014. Catch up for HPV vaccine doses missed as part of the school program was made available to all people aged up to 19 years through primary care from July 2017.
In 2018, Australia commenced using the nonavalent HPV vaccine, Gardasil9, replacing the quadrivalent vaccine, Gardasil, thereby protecting against an additional 5 types of HPV (types 6, 11, 16, 18, 31, 33, 45, 52 and 58). The program began in line with the school year and reduced the number of doses from 3 to 2 (spaced 6–12 months apart).
In 2023, Australia switched to a single-dose HPV vaccination program, on the basis of international evidence that a single dose provides equivalent protection, using Gardasil9 and extended catch up, using a single dose, to age 25 (inclusive).
Use of the nonavalent HPV vaccine provides improved protection against HPV and against the development of CIN, cervical cancer, and other HPV-related cancers. A study suggested that up to 93% of cervical cancers in Australia are associated with the HPV types covered by the new vaccine (Brotherton et al. 2017). In addition, by decreasing the number of recommended doses, first to two, and now to one, the increased ease of administration should facilitate catch up opportunities and hopefully increase vaccine coverage.
HPV vaccination status has been calculated as unvaccinated where there is no record of HPV vaccination, partially vaccinated where participants did not complete the required number and/or spacing of doses, and fully vaccinated where participants completed the required number of doses at the correct spacing to be considered clinically completely vaccinated.
As ongoing HPV vaccination of 12–13 year-olds has only been in effect since 2007, reporting of performance indicators by HPV vaccination status is restricted to younger age groups.