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BackgroundAustralia was one of the first countries to introduce a publicly funded national human papillomavirus (HPV) vaccination program that commenced in April 2007, using the quadrivalent HPV vaccine targeting 12- to 13-year-old girls on an ongoing basis. Two-year catch-up programs were offered to 14- to 17- year-old girls in schools and 18- to 26-year-old women in community-based settings. We present data from the school-based program on population-level vaccine effectiveness against cervical abnormalities in Victoria, Australia.MethodsData for women age-eligible for the HPV vaccination program were linked between the Victorian Cervical Cytology Registry and the National HPV Vaccination Program Register to create a cohort of screening women who were either vaccinated or unvaccinated. Entry into the cohort was 1 April 2007 or at first Pap test for women not already screening. Vaccine effectiveness (VE) and hazard ratios (HR) for cervical abnormalities by vaccination status between 1 April 2007 and 31 December 2011 were calculated using proportional hazards regression.ResultsThe study included 14,085 unvaccinated and 24,871 vaccinated women attending screening who were eligible for vaccination at school, 85.0% of whom had received three doses. Detection rates of histologically confirmed high-grade (HG) cervical abnormalities and high-grade cytology (HGC) were significantly lower for vaccinated women (any dose) (HG 4.8 per 1,000 person-years, HGC 11.9 per 1,000 person-years) compared with unvaccinated women (HG 6.4 per 1,000 person-years, HGC 15.3 per 1,000 person-years) HR 0.72 (95% CI 0.58 to 0.91) and HR 0.75 (95% CI 0.65 to 0.87), respectively. The HR for low-grade (LG) cytological abnormalities was 0.76 (95% CI 0.72 to 0.80). VE adjusted a priori for age at first screening, socioeconomic status and remoteness index, for women who were completely vaccinated, was greatest for CIN3+/AIS at 47.5% (95% CI 22.7 to 64.4) and 36.4% (95% CI 9.8 to 55.1) for women who received any dose of vaccine, and was negatively associated with age. For women who received only one or two doses of vaccine, HRs for HG histology were not significantly different from 1.0, although the number of outcomes was small.ConclusionA population-based HPV vaccination program in schools significantly reduced cervical abnormalities for vaccinated women within five years of implementation, with the greatest vaccine effectiveness observed for the youngest women.

Enquiries about the content of the report should be directed to the above address.The Medical Services Advisory Committee (MSAC) is an independent committee which has been established to provide advice to the Minister for Health and Ageing on the strength of evidence available on new and existing medical technologies and procedures in terms of their safety, effectiveness and costeffectiveness. This advice will help to inform government decisions about which medical services should attract funding under Medicare. MSAC's advice does not necessarily reflect the views of all individuals who participated in the MSAC evaluation. Publication approval number: Template Version updated Nov 08Application 1276 NCSP Renewal: Modelled evaluation i Table 38 Summary of the effect of poor compliance with 5-yearly call-andrecall (high proportion of early re-screening, CR2) compared with the equivalent strategy under assumptions of better compliance with 5-yearly screening (low proportion of early re-screening, most women re-attending on time (CR1)) for primary HPV testing strategies . Table 71 Health and cost outcomes in strategies where women never return for more cervical screening after being completely discharged after a normal HPV exit test (compared to the equivalent strategy where some women continue to return after an exit test at rates as observed under current practice) and assuming screening ends at 69 instead of 64 years for both sets of scenarios -unvaccinated cohort .. Table 72 Health and cost outcomes in strategies where women never return for more cervical screening after being completely discharged after a normal HPV exit test (compared to the equivalent strategy where some women continue to return after an exit test at rates as observed under current practice) and assuming screening ends at 69 instead of 64 years for both sets of scenarios -cohort offered vaccination at age 12 . The relative trade-off between the percent increase in the mortality and the percent increase in the colposcopies compared to current practice of cervical screening using image-read LBC ( The Renewal aims to ensure the continuing success of the NCSP and that all Australian women, HPV vaccinated and unvaccinated, have access to a cervical screening program based on current evidence and best practice. The Renewal process will ensure the renewed program remains safe and continues to improve health outcomes of Australian women. Contents List of Tables List of FiguresThe objectives of the Renewal are to:1. Assess the evidence for screening tests and pathways, the screening interval, age range and commencement for both vaccinated and non-vaccinated women;2. Determine a cost-effective screening pathway and program model;3. Investigate options for improved national data collection systems and registry functions to enable policy, planning, service delivery and quality management; and 4. Assess the feasibility and acceptability of the renewed program for women.The first two objectives outlined above are being undertaken th...

Objective To estimate human papillomavirus (HPV) vaccination coverage and course completion rates for Indigenous adolescents in four Australian states and territories. Participants, setting Adolescents who were 12 years old in 2015 and received the quadrivalent HPV vaccine (three doses: 0, 2, 6 months) as part of the National HPV Vaccination Program in 2015 or 2016 in New South Wales, Queensland, the Northern Territory, or the Australian Capital Territory. Main outcome measures Estimated HPV vaccination coverage by dose and by Indigenous status and sex, based on National HPV Vaccination Program Register data; vaccination course completion rates (proportion of dose 1 recipients who received dose 3) for 12‐year‐olds vaccinated during 2013–2016, by sex, jurisdiction, and Indigenous status. Results Dose 1 coverage exceeded 80% for all Indigenous status/jurisdiction/sex groups (range, 83.3–97.7%). Coverage was similar for Indigenous and non‐Indigenous girls in Queensland (87.3% v 87.0%), lower for Indigenous girls in the ACT (88.7% v 97.7%) and the NT (91.1% v 97.0%), and higher in NSW (95.9% v 89.9%); it was similar for Indigenous and non‐Indigenous boys in all jurisdictions except the NT (88.6% v 96.3%). Dose 3 coverage (range, 61.2–87.7%) was markedly lower for Indigenous than non‐Indigenous 12‐year‐olds in all jurisdictions, except for girls in NSW (82.6% v 83.6%). Conclusion HPV vaccine coverage is high, but course completion is generally lower for Indigenous adolescents. Strategies for improving completion rates for Indigenous Australians are needed to end the higher burden of cervical cancer among Indigenous than non‐Indigenous women.

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