- Email: [email protected]
HPV related surveillance activities in Australia
Vaccine 28 (2010) 7453–7454
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Letter to the Editor HPV related surveillance activities in Australia Keywords: HPV vaccine Surveillance
Dear Editor, We read with interest the article by Bonanni et al. describing many of the post licensure surveillance studies related to quadrivalent human papillomavirus (HPV) vaccination underway worldwide [1]. The article briefly referred to Australia, where the world’s mostly widely targeted funded catch up HPV vaccination program has just been completed, but did not indicate the full breadth of activities; we would like to elaborate upon surveillance activities and existing infrastructure in Australia. The national program provided free quadrivalent HPV vaccine to all women aged 12–26 years between 2007 and 2009, and HPV vaccine is now routinely offered to girls in schools, in the first year of high school (age 12–13). We have recently described a framework for HPV related surveillance in Australia, with a number of the components operational, while others are in the planning phases [2]. Bonanni et al. noted that in Australia a sentinel surveillancebased method for monitoring genital warts is underway, which is already indicating a decline in incidence [3] and that surveillance for vaccine coverage occurs through the National HPV Vaccination Program Register. In addition to these two mechanisms, there are several other key areas of HPV related surveillance where activity is underway or planned by various stakeholders in Australia. These are (1) Vaccine safety monitoring, through Australia’s established national adverse events following immunisation passive surveillance system. Regular reports are available at http://www.tga.gov.au/alerts/medicines/gardasil.htm. (2) Genotype specific HPV surveillance in samples of women in the general population, from samples of CIN3 biopsy specimens (in the first instance in those under 30 years of age) and eventually in all cervical cancers. Pilot sentinel studies are underway for the first two elements. (3) Monitoring of cervical screening participation and incidence of screen detected cervical abnormalities, including CIN2+ histopathology diagnoses. Australia has state based cervical cytology registers, which also capture cervical histopathology, which provide population wide coverage of, and infrastructure support for, the national cervical screening program. Regular national monitoring reports are produced describing agreed
0264-410X/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.vaccine.2010.09.015
(4)
(5)
(6)
(7)
national indicators and these indicators are currently being revised to ensure they are able to capture relevant measures of HPV vaccination impacts on screening outcomes. Monitoring of cervical cancer incidence and mortality. Australia has established cancer registries and routinely monitors cervical cancer incidence and mortality. Data linkage between registries. Facilities for data linkage are well developed in Australia, so evaluation of vaccine effectiveness by linkage of both the cervical cytology registers and cervical cancer registers with the national HPV vaccination register is feasible and is planned once administrative and legislative arrangements are finalised. Monitoring of recurrent respiratory papillomatosis. Planning is underway to establish a national surveillance system under the auspices of the Australian Paediatric Surveillance Unit. Monitoring of knowledge, attitudes and beliefs about HPV and HPV vaccination. Australian researchers and national and state government health departments conduct regular health related surveys of the general Australian population. Monitoring of HPV relevant knowledge, attitudes and beliefs is of ongoing interest and relevance in these surveys [4–6].
We believe Australia’s comprehensive existing infrastructure in relation to cervical screening and cervical cancer, augmented by the national HPV vaccination register and the additional surveillance activities described above, will allow Australia to make a unique and substantial contribution to assessing the impact and effectiveness of population-based HPV vaccination over time. References [1] Bonanni P, Cohet C, Kjaer SK, Lathamb NB, Lambert P-H, Reisinger K, et al. A summary of the post-licensure surveillance initiatives for GARDASIL/SILGARD® . Vaccine 2010;28:4719–30. [2] Brotherton JML, Kaldor JM, Garland SM. Monitoring the control of human papillomavirus (HPV) infection and related diseases in Australia: towards a national HPV surveillance strategy. Sexual Health 2010;7(3):310–9. [3] Fairley CK, Hocking JS, Gurrin LC, Chen MY, Donovan B, Bradshaw CS. Rapid decline in presentations of genital warts after the implementation of a national quadrivalent human papillomavirus vaccination programme for young women. Sex Transm Infect 2009;85:499–502. [4] Agius PA, Pitts MK, Smith AM, Mitchell A. Human papillomavirus and cervical cancer: Gardasil((R)) vaccination status and knowledge amongst a nationally representative sample of Australian secondary school students. Vaccine 2010;28:4416–22. [5] Pitts MK, Heywood W, Ryall R, Smith AM, Shelley JM, Richters J, et al. Knowledge of human papillomavirus (HPV) and the HPV vaccine in a national sample of Australian men and women. Sexual Health 2010;7(3):299–303. [6] Marshall H, Ryan P, Roberton D, Baghurst P. A cross-sectional survey to assess community attitudes to introduction of Human Papillomavirus vaccine. Aust N Z J Public Health 2007;31:235–42.
7454
Letter to the Editor / Vaccine 28 (2010) 7453–7454
Julia Brotherton ∗ National HPV Vaccination Program Register, Victorian Cervical Cytology Registry, Victorian Cytology Service East Melbourne, PO Box 310, East Melbourne, VIC 8002, Australia John M. Kaldor National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Australia Peter McIntyre National Centre for Immunisation Research and Surveillance The Children’s Hospital at Westmead,
Discipline of Paediatrics and Child Health, School of Public Health, University of Sydney, Australia ∗ Corresponding
author at: Level 1, 250 Victoria Pde, East Melbourne, VIC 3002, Australia. Tel.: +61 03 8417 6819; fax: +61 03 8417 6836. E-mail address: [email protected] (J. Brotherton) 13 August 2010 Available online 20 September 2010
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Letter to the Editor HPV related surveillance activities in Australia Keywords: HPV vaccine Surveillance
Dear Editor, We read with interest the article by Bonanni et al. describing many of the post licensure surveillance studies related to quadrivalent human papillomavirus (HPV) vaccination underway worldwide [1]. The article briefly referred to Australia, where the world’s mostly widely targeted funded catch up HPV vaccination program has just been completed, but did not indicate the full breadth of activities; we would like to elaborate upon surveillance activities and existing infrastructure in Australia. The national program provided free quadrivalent HPV vaccine to all women aged 12–26 years between 2007 and 2009, and HPV vaccine is now routinely offered to girls in schools, in the first year of high school (age 12–13). We have recently described a framework for HPV related surveillance in Australia, with a number of the components operational, while others are in the planning phases [2]. Bonanni et al. noted that in Australia a sentinel surveillancebased method for monitoring genital warts is underway, which is already indicating a decline in incidence [3] and that surveillance for vaccine coverage occurs through the National HPV Vaccination Program Register. In addition to these two mechanisms, there are several other key areas of HPV related surveillance where activity is underway or planned by various stakeholders in Australia. These are (1) Vaccine safety monitoring, through Australia’s established national adverse events following immunisation passive surveillance system. Regular reports are available at http://www.tga.gov.au/alerts/medicines/gardasil.htm. (2) Genotype specific HPV surveillance in samples of women in the general population, from samples of CIN3 biopsy specimens (in the first instance in those under 30 years of age) and eventually in all cervical cancers. Pilot sentinel studies are underway for the first two elements. (3) Monitoring of cervical screening participation and incidence of screen detected cervical abnormalities, including CIN2+ histopathology diagnoses. Australia has state based cervical cytology registers, which also capture cervical histopathology, which provide population wide coverage of, and infrastructure support for, the national cervical screening program. Regular national monitoring reports are produced describing agreed
0264-410X/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.vaccine.2010.09.015
(4)
(5)
(6)
(7)
national indicators and these indicators are currently being revised to ensure they are able to capture relevant measures of HPV vaccination impacts on screening outcomes. Monitoring of cervical cancer incidence and mortality. Australia has established cancer registries and routinely monitors cervical cancer incidence and mortality. Data linkage between registries. Facilities for data linkage are well developed in Australia, so evaluation of vaccine effectiveness by linkage of both the cervical cytology registers and cervical cancer registers with the national HPV vaccination register is feasible and is planned once administrative and legislative arrangements are finalised. Monitoring of recurrent respiratory papillomatosis. Planning is underway to establish a national surveillance system under the auspices of the Australian Paediatric Surveillance Unit. Monitoring of knowledge, attitudes and beliefs about HPV and HPV vaccination. Australian researchers and national and state government health departments conduct regular health related surveys of the general Australian population. Monitoring of HPV relevant knowledge, attitudes and beliefs is of ongoing interest and relevance in these surveys [4–6].
We believe Australia’s comprehensive existing infrastructure in relation to cervical screening and cervical cancer, augmented by the national HPV vaccination register and the additional surveillance activities described above, will allow Australia to make a unique and substantial contribution to assessing the impact and effectiveness of population-based HPV vaccination over time. References [1] Bonanni P, Cohet C, Kjaer SK, Lathamb NB, Lambert P-H, Reisinger K, et al. A summary of the post-licensure surveillance initiatives for GARDASIL/SILGARD® . Vaccine 2010;28:4719–30. [2] Brotherton JML, Kaldor JM, Garland SM. Monitoring the control of human papillomavirus (HPV) infection and related diseases in Australia: towards a national HPV surveillance strategy. Sexual Health 2010;7(3):310–9. [3] Fairley CK, Hocking JS, Gurrin LC, Chen MY, Donovan B, Bradshaw CS. Rapid decline in presentations of genital warts after the implementation of a national quadrivalent human papillomavirus vaccination programme for young women. Sex Transm Infect 2009;85:499–502. [4] Agius PA, Pitts MK, Smith AM, Mitchell A. Human papillomavirus and cervical cancer: Gardasil((R)) vaccination status and knowledge amongst a nationally representative sample of Australian secondary school students. Vaccine 2010;28:4416–22. [5] Pitts MK, Heywood W, Ryall R, Smith AM, Shelley JM, Richters J, et al. Knowledge of human papillomavirus (HPV) and the HPV vaccine in a national sample of Australian men and women. Sexual Health 2010;7(3):299–303. [6] Marshall H, Ryan P, Roberton D, Baghurst P. A cross-sectional survey to assess community attitudes to introduction of Human Papillomavirus vaccine. Aust N Z J Public Health 2007;31:235–42.
7454
Letter to the Editor / Vaccine 28 (2010) 7453–7454
Julia Brotherton ∗ National HPV Vaccination Program Register, Victorian Cervical Cytology Registry, Victorian Cytology Service East Melbourne, PO Box 310, East Melbourne, VIC 8002, Australia John M. Kaldor National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Australia Peter McIntyre National Centre for Immunisation Research and Surveillance The Children’s Hospital at Westmead,
Discipline of Paediatrics and Child Health, School of Public Health, University of Sydney, Australia ∗ Corresponding
author at: Level 1, 250 Victoria Pde, East Melbourne, VIC 3002, Australia. Tel.: +61 03 8417 6819; fax: +61 03 8417 6836. E-mail address: [email protected] (J. Brotherton) 13 August 2010 Available online 20 September 2010