Published 26 Jun, 2024

HPV is one of 4 main oncogenic infectious pathogens, of which HPV types 16 and 18 are estimated to account for 72% of all HPV-attributable cancers. HPV is responsible for an estimated 690,000 cases of cancer diagnosed worldwide every year.HPV is the primary cause of cervical cancer and also oropharyngeal, vulval, penile, and anal cancers, and of genital warts.1-4 While women are more commonly affected by HPV cancers, almost one in three men worldwide are infected with at least one genital HPV type.5

HPV vaccination, along with cervical screening, is a cost-effective means of reducing cervical cancer incidence and need for associated treatment.6 It would already be having a significant impact in reducing the burden of HPV-related cancers in Australia.7

    Charts
    • Notes
      • The National Centre for Immunisation Surveillance (NCIRS) will release the 2018 HPV Vaccination data (with adolescent data to be presented in a future report) after transition to the Australian Immunisation Register.
      • From 2018, Gardasil 9 - which provides protection against the HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58 – was administered, with two doses considered to be sufficient if given at age 14 years or younger.
      • Data sourced from the National HPV Vaccination Program Register website: http://www.hpvregister.org.au/
      • Includes females and males turning 15 years old in each reporting year.
      • The data refer to doses administered and reported to the HPV Register, excluding those for individuals who did not wish their details to be recorded on the Register.
      Table caption
      Proportion of the population aged 15 years who have received the first/second/third dose of the HPV vaccine, 2007 to 2020
    • Notes
      • Data are sourced from the National HPV Vaccination Program Register website: http://www.hpvregister.org.au/
      • Remoteness was classified according to the Australian Statistical Geography Standard (ASGS) Remoteness Areas, July 2011.
      • See 'About the data' for more information on changes to the National HPV Vaccination Program over time.
      Table caption
      Proportion of the population aged 12-13 years who have received the HPV vaccine, by dose number and remoteness, 2014
    • Notes
      • Data are sourced from the National HPV Vaccination Program Register website: http://www.hpvregister.org.au/
      • See 'About the data for more information on changes to the National HPV Vaccination Program over time.
      Table caption
      Proportion of the population aged 12-13 years who had received the HPV vaccine, by dose number and socioeconomic status, 2014

    Australia has adopted the World Health Organization (WHO) global goal of equitably eliminating cervical cancer as a public health problem by 2030 by achieving 90:70:90 targets with Human Papillomavirus (HPV) vaccination, cervical screening, and treatment, respectively.8 Aligned with the WHO aim of having 90% of girls fully vaccinated with HPV vaccine by 15 years of age by 2030 in each country, Australia has extended this HPV vaccination target to include both males and females by 2035.9

    Since mid-2007, the National HPV Vaccination Program implemented under Australia’s National Immunisation Program has offered HPV vaccination free of charge to young females, with an additional catch-up extension for ages 12–26 years occurring to the end of 2009. From 2009, the National Program offered HPV vaccination routinely to females in the first year of high school (usually at 12–13 years of age) through the Secondary School Immunisation Program. From 2013, males were also offered HPV vaccination in their first year of high school (age 12–13 years), with an additional catch-up extension for males aged 14–15 years in 2013 and 2014.10-12

    The current vaccine used in the Australian National Immunisation Program (NIP) is Gardasil9, 9vHPV, which protects against 9 HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58. Previously, from 2007, it was the quadrivalent HPV vaccine (Gardasil, 4vHPV) which can prevent infection and disease from 4 HPV types 6, 11, 16 and 18.10-12 Cervavix, the bivalent HPV vaccine (2vHPV), which protects against HPV types 16 and 18, is also available on the private market.

    It is recommended that adolescents and young adults receive 9vHPV vaccination from nine years of age. The optimal age for HPV vaccination is considered to be around 12–13 years, in advance of HPV exposure through sexual activity. However, those who have not received HPV vaccine by 14 years of age can still receive the vaccine up to 25 years of age.9-10

    From February 2023, Gardasil 9 has been administered as a single-dose rather than the previous two-dose course since 2018. The recommended HPV vaccination schedule for adolescents and young adults aged 9–25 years is now 1 dose.12 From January 2018, a 2-dose course of the 9vHPV, Gardasil 9, has replaced the previous 4vHPV Gardasil course.13 

    The jurisdiction-based (states & territories) National Human Papillomavirus Vaccination Program Register (HPV Register) ceased operation from December 31st 2018. All HPV vaccinations are now recorded by the Australian Immunisation Register (AIR) at the National Centre for Immunisation Research and Surveillance (NCIRS). Data from the AIR are used to monitor HPV population coverage at 15 years of age.14-15

    In 2023, 85.9% of Australian girls had received at least one dose of HPV vaccine by 15 years of age and 83.4% of boys had received at least one dose.14 In 2022, 85.3% of Australian girls had received at least one dose of HPV vaccine by 15 years of age and 83.1% of boys had received at least one dose.15

    Remoteness and socioeconomic disadvantage

    In 2022, girls living in Major cities and Inner regional had a higher HPV vaccination coverage rate than those in Very Remote areas (85.4% and 85.7% compared with 80.2%, respectively).15-16

    In 2022, girls living in the least socioeconomically disadvantaged areas had a higher HPV vaccination coverage rate (87.7%) than those living in the most disadvantaged areas (82.7%).15-16 This pattern was the same in boys. Boys living in Major cities and Inner regional had a higher HPV vaccination coverage rate than those in Very Remote areas (83.1% and 83.8% compared with 80.1%, respectively). Boys in the least socioeconomically disadvantaged areas had a higher HPV vaccination coverage rate (86.0%) than those living in the most disadvantaged areas (79.4%).15-16

    From the 2022 report, the vaccination coverage rate was reported for adolescents receiving at least one dose of HPV vaccine before the 15th birthday, whereas in previous reports in 2021 and 2020, coverage rates were reported for dose 1 and course completion. Course completion was defined as receipt of 2 doses if dose 2 was given ≥5 months after dose 1 or receipt of 3 doses if dose 2 was given <5 months after dose 1.18-20 Since February 1923, young people (except those who are immunocompromised) who had received a single dose before 26 years of age have been considered fully vaccinated and not to need further doses.12,15

    Up to 2017, reports on national 3 dose vaccination coverage were archived.17-18 In 2022, HPV vaccination coverage by 15 years of age was calculated using the cohort method. In the cohorts of Medicare-registered adolescents turning 15 years of age during 2022 or 2021 (i.e., cohorts born in 2007 or 2006, respectively), the proportion who had received at least one dose of HPV vaccine after their 9th birthday (as HPV vaccine is registered from 9 years of age) and before their 15th birthday was calculated.15

    In the 2020 and 2021 reports,19-20 HPV vaccination coverage was calculated in 2020 and 2019 as the proportion of girls and boys receiving dose 1 and having course completion defined as receipt of 2 doses (if dose 2 given ≥5 months after dose 1) or receipt of 3 doses (if dose 2 given <5 months after dose 1).

    During 2007-17, vaccination coverage was calculated as doses administered and reported to the HPV Register for the Estimated Resident Population (ERP) (note: expressed as a percentage)provided by the Australian Bureau of Statistics (ABS) for the year. Both numerator and denominator data were regularly updated using latest Registry data and ABS estimates. Age is specified as age at date of ERP estimate (30th June) for the specified year.17-18       

     

    Data caveat

    The 2020 NCIRS Annual Immunisation Report noted the impact on immunisation activity of the COVID-19 pandemic, particularly on adolescent HPV vaccination. This context should be considered when reviewing the 2020 data.

    As the HPV coverage rates were reported differently due to changes in the HPV vaccination program, caution should be taken when interpreting corresponding statistical changes. 

    In 2007-2017, HPV Vaccination doses administered through general practice and in other community settings may be incompletely notified to the HPV Register. The extent of under notification is thought to differ by jurisdiction, with the Northern Territory and Queensland having the most complete notification.17-19

     

    Data source:

     

    Australia Government. Department of Health and Aged Care. 2012 – 2017 Archived HPV Immunisation Data. Available at https://www.health.gov.au/resources/collections/historical-data-from-the-national-hpv-vaccination-program-register 

    Australia Government. Department of Health and Aged Care. National HPV 3 dose vaccination coverage for all adolescents turning 15 years of age from year of program commencement. 2007-2017. Available at https://www.health.gov.au/resources/publications/national-hpv-3-dose-vaccination-coverage-for-all-adolescents-turning-15-years-of-age-from-year-of-program-commencement?language=en

    National Centre for Immunisation Research and Surveillance Australia. Annual Immunisation Coverage Reports. 2020 onwards. Available at https://ncirs.org.au/reports?field_archive_value=2018&field_publication_category_target_id=48&combine=

    Australian Government. Department of Health and Aged Care. Human Papillomavirus (HPV) immunisation data. 2020 onwards. Available at https://www.health.gov.au/topics/immunisation/immunisation-data/human-papillomavirus-hpv-immunisation-data

    Data:

    Australia Government. Department of Health and Aged Care. 2012 – 2017 Archived HPV Immunisation Data. Available at https://www.health.gov.au/resources/collections/historical-data-from-the-national-hpv-vaccination-program-register 

    Australia Government. Department of Health and Aged Care. National HPV 3 dose vaccination coverage for all adolescents turning 15 years of age from year of program commencement. 2007-2017. Available at https://www.health.gov.au/resources/publications/national-hpv-3-dose-vaccination-coverage-for-all-adolescents-turning-15-years-of-age-from-year-of-program-commencement?language=en

    National Centre for Immunisation Research and Surveillance Australia. Annual Immunisation Coverage Reports. 2020 onwards. Available at https://ncirs.org.au/reports?field_archive_value=2018&field_publication_category_target_id=48&combine=

    Australian Government. Department of Health and Aged Care. Human Papillomavirus (HPV) immunisation data. 2020 onwards. Available at https://www.health.gov.au/topics/immunisation/immunisation-data/human-papillomavirus-hpv-immunisation-data

    Policy:

     

    Australian Government. Department of Health and Aged Care. National Strategy for the Elimination of Cervical Cancer in Australia. https://www.health.gov.au/sites/default/files/2023-11/national-strategy-for-the-elimination-of-cervical-cancer-in-australia.pdf

    Australian Immunisation Handbook. Human papillomavirus (HPV). https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/human-papillomavirus-hpv

    National Centre for Immunisation Research and Surveillance. HPV vaccines for Australians: https://www.ncirs.org.au/sites/default/files/2018-12/HPV%20Factsheet_2018%20Aug%20Update_final%20for%20web.pdf

     

    References:

    1. de Martel C, Georges D, Bray F, et al. Global burden of cancer attributable to infections in 2018: a worldwide incidence analysis. Lancet Glob Health. 2020 Feb;8(2): e180-e190. 
    2. Brotherton JM. How much cervical cancer in Australia is vaccine preventable? A meta-analysis. Vaccine. 2008 Jan 10;26(2):250-6.
    3. Hartwig, S., Syrjänen, S., Dominiak-Felden, G et al. Estimation of the epidemiological burden of human papillomavirus-related cancers and non-malignant diseases in men in Europe: a review. BMC Cancer 12, 30 (2012).
    4. Grulich AE, Jin F, Conway EL, et al. Cancers attributable to human papillomavirus infection. Sex Health. 2010;7(3):244-52. 10.1071/SH10020.
    5. Bruni L, Albero G, Rowley J, et al. Global and regional estimates of genital human papillomavirus prevalence among men: a systematic review and meta-analysis. Lancet Glob Health. 2023 Sep;11(9):e1345-e1362
    6. Kulasingam S, Connelly L, Conway E, et al. A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical Cancer Screening Program. Sex Health. 2007 Sep;4(3):165-75.
    7. Patel C, Brotherton JM, Pillsbury A, et al. The impact of 10 years of human papillomavirus (HPV) vaccination in Australia: what additional disease burden will a nonavalent vaccine prevent? Euro Surveill. 2018 Oct;23(41):1700737.
    8. WHO. Cervical Cancer Elimination Initiative. Accessed May 2024; https://www.who.int/initiatives/cervical-cancer-elimination-initiative#cms
    9. Australian Government. Department of Health and Aged Care. National Strategy for the Elimination of Cervical Cancer in Australia. Accessed May 2024; https://www.health.gov.au/sites/default/files/2023-11/national-strategy-for-the-elimination-of-cervical-cancer-in-australia.pdf
    10. Australian Immunisation Handbook. Human papillomavirus (HPV). Accessed May 2024; https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/human-papillomavirus-hpv
    11. National Centre for Immunisation Research and Surveillance. HPV vaccines for Australians. Accessed May 2024;  https://ncirs.org.au/sites/default/files/2023-02/HPV-Factsheet_February-2023.pdf
    12. Australian Government. Department of Health and Aged Care. HPV vaccine – Fact sheet outlining changes under the National Immunisation Program in 2023. Accessed May 2024; https://www.health.gov.au/resources/publications/hpv-vaccine-fact-sheet-outlining-changes-under-the-national-immunisation-program-in-2023?language=en
    13. National Centre for Immunisation Research and Surveillance. HPV vaccines for Australians. Accessed May 2024;  https://www.ncirs.org.au/sites/default/files/2018-12/HPV%20Factsheet_2018%20Aug%20Update_final%20for%20web.pdf
    14. Australian Government. Department of Health and Aged Care. Human papillomavirus (HPV) immunisation data. Accessed May 2024; https://www.health.gov.au/topics/immunisation/immunisation-data/human-papillomavirus-hpv-immunisation-data
    15. National Centre for Immunisation Research and Surveillance Australia. Annual Immunisation Coverage Reports 2022. Accessed May 2024; https://ncirs.org.au/sites/default/files/2024-01/NCIRS%20Annual%20immunisation%20coverage%20report%202022.pdf
    16. Machalek D, Smith M, Brotherton J. et al. Cervical Cancer Elimination Progress Report: Australia’s progress towards the elimination of cervical cancer as a public health problem. HPV Vaccine Coverage by Age 15 Years. Accessed May 2024;  https://report.cervicalcancercontrol.org.au/vaccine-coverage-indicators/
    17. Australia Government. Department of Health and Aged Care. National HPV 3 dose vaccination coverage for all adolescents turning 15 years of age from year of program commencement. Accessed May 2024; https://www.health.gov.au/resources/publications/national-hpv-3-dose-vaccination-coverage-for-all-adolescents-turning-15-years-of-age-from-year-of-program-commencement?language=en
    18. Australia Government. Department of Health and Aged Care. 2012 – 2017 Archived HPV Immunisation Data; Accessed May 2024; https://www.health.gov.au/resources/collections/historical-data-from-the-national-hpv-vaccination-program-register 
    19. National Centre for Immunisation Research and Surveillance Australia. Annual Immunisation Coverage Reports 2021. Accessed May 2024; https://ncirs.org.au/sites/default/files/2022-12/NCIRS%20Annual%20Immunisation%20Coverage%20Report%202021_FINAL.pdf
    20. National Centre for Immunisation Research and Surveillance Australia. Annual Immunisation Coverage Reports 2020. Accessed May 2024; https://ncirs.org.au/sites/default/files/2022-07/NCIRS%20Annual%20Immunisation%20Coverage%20Report%202020.pdf

    Summary

    HPV vaccination coverage

    In 2023, 85.9% of girls and 83.4% of boys in Australia had received at least one dose of HPV vaccine. 

    Uptake (ie coverage) of HPV vaccinations in females has increased

    The uptake in females of a complete vaccination course by 15 years of age increased from 72% in 2012 to 80.5% in 2020.

    Uptake of HPV vaccinations in males has increased

    The uptake in males of a complete vaccination course by 15 years of age increased from 62% in 2014 to 78% in 2020.

    HPV vaccination coverage varies by Remoteness and socioeconomic disadvantage.

    In 2022, girls and boys living in areas of the least disadvantage had higher vaccine coverage rate than those living in disadvantaged areas (87.7% and 86.0% compared to 82.7% and 79.4%, respectively). In 2022, girls and boys living in very remote areas had the lowest vaccine coverage rates (80.2% and 80.1%, respectively).