Almost 1 in 3 teenage girls in some Australian areas haven't had the HPV vaccine. Why?

August 27, 2015

Image: iStock.

The National HPV Vaccination Program has been shown to reduce rates of cervical abnormalities and genital warts in young women, yet in some parts of Australia more than one in four of teenage girls haven’t completed it, despite it being free for students.

According to a report from the National Health Performance Authority, roughly 38,400 of the 137,460 Australian girls who turned 15 in 2013 were not fully immunised against the human papillomavirus. That equates to around 28 per cent.

Regions with the lowest coverage included the Blue Mountains, south-east Tasmania and rural South Australia, with the lowest coverage rate being just 56 per cent. Notably high coverage areas included Mackay, Warrnambool and inner south Melbourne.

The school-based National HPV Vaccination Program, which involves three injections beginning at age 12 to 13, was launched in 2007 to protect adolescent girls against HPV and its associated diseases, including cervical cancer. In 2013, this program was extended to include boys.

The HPV vaccine involves three injections.

HPV is a common viral infection of the reproductive tract that is a leading cause of cervical cancer and has also been linked to cancer of the anus, vagina, vulva and penis.

According to Dr Brian Morton, Chair of the AMA Council of General Practice, there are a number of possible explanations for low coverage rates, and it's not necessarily a case of outright objection from parents.

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For instance, from an administration point of view the process of parental approval required — as the children are underage when the first vaccine is administered — isn't fail-proof.

"You've got a letter for the parent's agreement or approval, that's got to get back to the school for the permission to actually be given it on the day. There are a couple of issues there, in either the letter not getting to the parents to sign, and secondly the delivery back to the school," Dr Morton says. (Post continues after gallery.)

What you need to know about HPV. (Info via health.gov.au)

It affects men and women.Image via iStock.

It's passed via skin to skin contact.Image via iStock.

It can be prevented by vaccination.Image via iStock.

Different kinds of HPV can affect different parts of the body, and some types are more harmful than others.Image via iStock.

HPV doesn't usually cause symptoms.Image via iStock.

The three-dose process could also be a contributing factor, as there's a higher chance of failure. "We actually see that in the childhood vaccinations - after the first, second and third, you start to get a drop in the 12 and 18 months... because of either parents being busy or forgetting about it or inadequate recall and reminders. There are those sorts of issues," Dr Morton says.

In some cases it could also be symptomatic of a lack of education, or misconceptions about why the vaccine is required.

"The implication people might take is that it's sexual promiscuity or promoting early sexual intercourse, or 'It's not necessary because my child wouldn't do that'. It probably requires a high level of myth-busting and understanding by parents as to why it should be done," Dr Morton explains.

"I think also we need to recognise that one solution doesn't solve the problem for everyone in the community. Some kids have a terrible fear of injections ... we see kids coming in to our practice because they didn't want to do [the HPV vaccine] at school because they were too scared or saw a school friend faint due to it. That adds to the fear." (Post continues after gallery.)

Popular forms of birth control

Contraceptive pillThe Pillis the most popular form of birth control. There are two types: the combined pill, containing two hormones, and theprogestogen-only, or mini, pill, which only contains one female hormone. The combined pill works by preventing the ovary from releasing an egg each month. The mini pill changes the mucus at the entrance of the uterus, which stops sperm from entering. Both are 99.7% effective; however, they don't offer protection from STDs.

Intrauterine deviceIUDs are small, T-shaped devices that are inserted into the uterus by a doctor in order to prevent pregnancy. There are two types of IUD: copper, which affects the movement and survival of sperm in the womb while changing the lining of the womb;and hormonal, which releases progestogen (a synthetic version of the naturally-occurring hormone progesterone) into the uterus. Although IUDs have a success rate of more than 99%, only around 2% of Australian women currently use one.

CondomsThe male condom is a barrier contraception that prevents both pregnancy and the transmission of STDs. They work by collecting semen so it doesn't enter theman's partner's body. Condoms are 95 to 99% effective at preventing pregnancy.

The female condomThe female condom is a pre-lubricated sheath, which loosely fits inside of the vagina. The condom has a removable ring, which helps to insert the sheath and keep the condom in place. A larger ring remains on the outside to cover the opening of the vagina. They are designed to fit all women and can only to be used once. Due to misuse of the product it is only 79 per cent effective.

DiaphragmLike the male condom, the diaphragm is a barrier method of contraception. It's a shallow silicone dome that's inserted into the vagina andcovers the cervix, which is the entrance to the uterus. It's held in place by the pelvic muscles, and works by preventing sperm from entering the uterus. After sex, diaphragms need to remain in placefor another six hours, in which time the sperm inside the vagina die. This method is 88 to 94% effective at preventing pregnancy, although this rate increases with experience.

Birth control implantThis is a 4cm-longimplant that is inserted into a woman's upper arm, just under the skin, by a doctor. It releases a hormone called etonogestrel, which prevents ovulation and thickens the mucus in the cervix, which can stop sperm from entering. Contraceptive implants - usually sold as Implanon - are removed under anaesthetic every three years, and are close to 100% effective.

Vaginal ringVaginal rings are soft plastic rings that contain the same two hormones as the combined pill - oestrogen and progestogen. The ring is inserted into the vagina, where the hormones are absorbed into the body and then prevent the ovaries from releasing eggs. Once inside the ring can't be felt, and it needs replacing every three weeks (with one week's break in between). When used correctly, this method is more than 99% effective.

Depo ProveraDepo is a long lasting hormonal injection. The synthetic form of progesterone is administered every 12 to 14 weeks to woman, preventing pregnancy within this ongoing time period. The injection, which is given in the buttock or muscle of the upper arm, prevents ovulation and thickens the mucus in the cervix, helping to block sperm. The injections are 99 per cent effective but do not protect against STDs. Male contraceptive injections are currently being trialled

The morning after pillEmergency contraception (popularly referred to as the morning after pill) is used to prevent a pregnancy following unprotected sex. Other reasons include missing a contraceptive pill or a condom breaking. It is common in Australia to use the progestogen-only method. This entails a dosage of EC pills containing progestogen or the synthetic version. A doctor can prescribe the pill or they can be bought over the counter at a pharmacy without a prescription. Emergency contraceptionis 85 per cent effective in reducing the risk of pregnancy.

SterilisationSterilisation is a permanent form of contraception. For women there are two types of sterilisation: tubal ligation, in which clips are placed on the fallopian tubes, or tubal occlusion in which a device is inserted into the tubes. These methods work by preventing the sperm from reaching the egg. Tubal litigation is 99.5 per cent effective. The Vasectomy (for men) works by cutting and blocking the tubes called the vas deferens, preventing sperm from leaving the testicles. The chances of impregnation with a vasectomy are 1 in 1000.

Dr Morton says it's vital to educate parents about alternative arrangements they can make if their child misses one of the injections at school due to illness or administration. According to the HPV Vaccine website, the school's immunisation provider will usually contact parents if their child has missed a dose. In some cases catch-up injections will be available at school or a special catch-up clinic, but they can also be administered by a GP.

He adds that he Government's plans to extend the vaccination register to cover all ages, not just early childhood, will help to improve success rates. "For GPs to be notified and follow up on those who have missed it would be another thing. The government needs to invest in these programs."

Although the benefits of the HPV vaccination received wide coverage when it was first invented and launched, Dr Morton says this knowledge has perhaps dropped from collective memory.

"We need to remind people about the benefits of it; it's a constant reminder because the health literacy levels in the community are not very high," he adds.

Have you, or your children, had the HPV vaccine? Are you surprised by these new findings?