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School-level variation in coverage of co-administered dtpa and hpv dose 1 in three Australian states


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Vujovich-Dunn, C, Skinner, SR, Brotherton, J, Wand, H, Sisnowski, J, Lorch, R, Veitch, M, Sheppeard, V, Effler, P, Gidding, H, Venn, A ORCID: 0000-0001-7090-1398, 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 and 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 , doi: 10.3390/vaccines9101202.

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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.

Item Type: Article
Authors/Creators:Vujovich-Dunn, C and Skinner, SR and Brotherton, J and Wand, H and Sisnowski, J and Lorch, R and Veitch, M and Sheppeard, V and Effler, P and Gidding, H and Venn, A and Davies, C and Hocking, J and Whop, LJ and Leask, J and Canfell, K and Sanci, L and Smith, M and Kang, M and Temple-Smith, M and Kidd, M and Burns, S and Selvey, L and Meijer, D and Ennis, S and Thomson, CA and Lane, N and Kaldor, J and Guy, R
Keywords: adolescent vaccination, cancer prevention, differential uptake, evaluation and impact, implementation, school-based immunisation, vaccination, vaccine specific hesitancy
Journal or Publication Title: Vaccines
Publisher: MDPI AG
ISSN: 2076-393X
DOI / ID Number: 10.3390/vaccines9101202
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Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons 4.0 International (CC BY 4.0) license (

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