Study casts school nurses as champions of high vaccination rates but some groups do not get adequate protection.

Adapted from a news release issued by Sanofi Pasteur MSD

New research shows that delivery of the national human papillomavirus (HPV) immunisation programme differs vastly across the UK, revealing local health inequalities with regard to cervical cancer risk. Some areas are achieving a high vaccination rate due to the excellent work of school nurses to target all key audiences, but coverage in other areas is less comprehensive.

The research, published in the journal PLOS ONE, explores the reasons why some young women haven’t received the routine HPV vaccination, challenging previously held conceptions about the importance of ethnicity and religion in uptake rates.

Routine HPV immunisation of girls aged 12-13 years started in September 2008 in the UK, with the aim of preventing cervical cancer.  School nurses have successfully delivered the school-based vaccination programme, achieving a coverage rate for the three vaccine doses of around 80 per cent across the UK. However, the new research has highlighted that although in most areas school nurses or dedicated HPV immunisation teams organise and deliver the HPV immunisation programme effectively, a wide variation exists in uptake.

The study was authored by Dr Tammy Boyce and Professor Alison Holmes from the National Centre for Infection Prevention and Management in the  Department of Medicine at Imperial College London.  “There’s no question that the UK national HPV immunisation programme is one of the most successful in the world, but this research has highlighted thousands of young women who have either not been offered the vaccine, or where  more could have been done to increase uptake,” Dr Boyce said. “What’s more, there is a group of young women in certain social classes or who do not regularly attend school that could be vulnerable in terms of HPV risk.

“More efforts could be made to vaccinate these vulnerable young women who have not yet received the vaccine. We mustn’t let overall vaccination rates mask the stark inequalities that do exist, and instead take action to identify and reach those that drop off the school system and are most in need of protection.”

According to school nurses, young women’s social class and educational status were the most important factors in whether vaccination would be missed, rather than religious beliefs or ethnicity which previous research identified.  The authors highlighted the need for health professionals and their managers to closely monitor HPV vaccine uptake in order to understand and eradicate inequalities in the programme.

HPV-related genital cancers and genital warts are increasingly seen as a major public health concern, with a cost to the NHS exceeding £186 million. Following a recommendation by the Joint Committee on Vaccination and Immunisation (JCVI) in 2007, routine HPV immunisation of girls aged 12-13 years started in September 2008 with an accelerated catch-up vaccination of girls aged 13-18 years.

In November 2011 the Department of Health announced a switch from the bivalent vaccine (containing two HPV types) to the quadrivalent vaccine Gardasil® (or four-type HPV vaccine), effective from September 2012.  In 2010-11, over 10 per cent of eligible girls did not start their course of HPV vaccination and a focus is now on ensuring that uptake is as widespread as possible throughout the UK.

Reference:

Boyce T, Holmes A (2012) Addressing Health Inequalities in the Delivery of the Human Papillomavirus Vaccination Programme: Examining the Role of the School Nurse. PLoS ONE 7(9): e43416. doi:10.1371/journal.pone.0043416