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


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, School-level variation in coverage of co-administered dtpa and hpv dose 1 in three Australian states, Vaccines, 9, (10) Article 1202. ISSN 2076-393X (2021) [Refereed Article]

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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 (

DOI: doi:10.3390/vaccines9101202


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 Details

Item Type:Refereed Article
Keywords:adolescent vaccination, cancer prevention, differential uptake, evaluation and impact, implementation, school-based immunisation, vaccination, vaccine specific hesitancy
Research Division:Health Sciences
Research Group:Public health
Research Field:Preventative health care
Objective Division:Health
Objective Group:Clinical health
Objective Field:Prevention of human diseases and conditions
UTAS Author:Venn, A (Professor Alison Venn)
ID Code:150914
Year Published:2021
Deposited By:Menzies Institute for Medical Research
Deposited On:2022-07-05
Last Modified:2022-08-02
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