Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1698927718128.pdf (United Kingdom)
Annual HPV vaccine coverage in England in 2009/2010 Routine programme for year 8 females (12- to 13-years-old) Catch-up campaign for year 10 females (14- to 15-years-old) Catch-up campaign for year 11 females (15- to 16-years-old) Catch-up campaign for year 12 females (16- to17-years-old) Catch-up campaign for year 13 females (17- to 18-years-old) This collection has received approval from the Review of Central Returns Steering Committee (ROCR) – ROCR/OR/0228/001MAND The dataset is published under Dataset Change Notice (DSCN) 18/2008 see www.connectingforhealth.nhs.uk/dscn/dscn-2008/data-set-change-1 Version Last Updated Status Authors 1.0 22 December 2010 Final Report commissioned by the Department of Health and written by Alan Sheridan and Joanne White.
Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 DH INFORMATION READER BOX Policy HR / Workforce Management Planning / Clinical nce Performa Document Purpose Gateway Reference Title Estates Commissioning IM & T Finance Social Care / Partnership Working For Information 15439 Annual HPV vaccine coverage in England in 2009/2010 Author Publication Date Target Audience A. Sheridan (HPA) and J.
White (HPA) 27 Jan 2011 PCT CEs, SHA CEs, Directors of PH Circulation List PCT Immunisation Coordinators, HPU Consultants in Communicable Disease ControlN/ Description A summary of HPV vaccination coverage across England at PCT, SHA and national level for the second year of the programme.

This includes additional data from Devolved Authorities and comparisons with available international equivalent programmes.
Cross Ref Annual HPV vaccine uptake in England: 2008/09 Superseded Docs Action Required N/A N/A Timing Contact Details For Recipient's Use N/A Alan Sheridan HPV@hpa.org.uk 0 0 0 0 0 Page 2 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 1 Contents 1 Contents....................................................................................................................... 3 2 Executive summary..................................................................................................... 4 3 Introduction ................................................................................................................. 6 4 Methods ....................................................................................................................... 7 Data ............................................................................................................................... 7 Data sources ........................................................................................................................... 7 Data quality.............................................................................................................................. 8 Definitions................................................................................................................................ 8 Annual survey denominator..................................................................................................... 8 Annual survey
8 Annual survey numerators.......................................................................................................9 Coverage ................................................................................................................................. 9 User feedback ......................................................................................................................... 9 5 Analysis and commentary ........................................................................................ 10 Routine cohort 2009/10................................................................................................ 10 Setting for HPV vaccination delivery ..................................................................................... 11 Comparison of 2008/09 and 2009/10 routine cohort vaccine coverage ................................ 11 PCT coverage........................................................................................................................ 12 Catch-up cohorts 2009/10............................................................................................ 13 Setting for HPV vaccination delivery ..................................................................................... 13 Comparison of year 13 (aged 17 to 18 years) catch-up cohorts in 2008/09 and 2009/10..... 15 Annual UK HPV vaccine coverage 2009/10................................................................. 17 International HPV vaccine coverage
 ............................................................................ 17 6 References ................................................................................................................. 18 7 Acknowledgements................................................................................................... 19 8 Data table ................................................................................................................... 20 9 Appendices ................................................................................................................ 29 Appendix 1 ImmForm website...................................................................................... 29 Appendix 2 PCT ImmForm data entry form.................................................................. 31 Appendix 3 Denominator data quality .......................................................................... 34 Page 3 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 2 Executive summary Human papillomavirus (HPV) vaccine was introduced into the United Kingdom (UK) immunisation programme from September 2008 for females up to the age of 18 years.
To assess the coverage of HPV vaccine in England, aggregated primary care trust (PCT) level data were collected using the Department of Health (DH) ImmForm website.

Data were collected on the number of females vaccinated by the 152 PCTs (including PCT-based care trusts).

ImmForm is designed and managed by DH and the Health Protection Agency (HPA) coordinates and manages the collection and reporting of national data on behalf of DH.
This second annual report on HPV vaccine coverage in England presents data for the academic year 2009/10 (Table 1) and provides a comparison with vaccine coverage achieved during the first year of the programme (academic year 2008/09), and with published data from selected international HPV vaccine programmes.
Key points: • During the first two years of the HPV programme over 60% of all females born between 1 September 1990 and 31 August 1997 completed the three-dose course of HPV vaccination (Table 1), with the highest coverage achieved in the youngest cohorts.

• The high level of coverage achieved in 2008/09 for the routine cohort has been maintained in 2009/10 with 76.4% of 12- to 13-year-old females completing the three-dose course.
• More than 3 million doses of vaccine were given through the routine and catch-up programmes during 2009/10.

• HPV vaccination status is increasingly being routinely entered onto child health information systems (CHIS) for vaccinations delivered through schools enabling automated extraction of coverage data in some PCTs.
Page 4 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Table 1 HPV vaccine coverage in routine and catch-up cohorts in England: 2008/09 and 2009/10 academic years.
Cohorts Vaccine coverage % Cohort (dates of birth) Age in academic year 2009/10 (years) Number in cohort At least 1 dose At least 2 doses 3 doses 2009/10 final estimates Routine cohort 7 (1 Sep 1996 to 31 Aug 1997) Catch-up cohort 6 (1 Sep 1994 to 31 Aug 1995) Catch-up cohort 5 (1 Sep 1993 to 31 Aug 1994) Catch-up cohort 4 (1 Sep 1992 to 31 Aug 1993) Catch-up cohort 3 (1 Sep 1991 to 31 Aug 1992) 12-13 304073 84.3 82.3 14-15 305232 77.5 75.2 15-16 309727 77.6 75.0 16-17 319340 58.1 53.1 17-18 323826 55.6 50.3 Updated final 2008/09 estimates 2008/09 Routine cohort 1 (1 Sep 1995 to 31 Aug 1996) 2008/09 Catch-up cohort 2 (1 Sep 1990 to 31 Aug 1991) All cohorts 2008/09 - 2009/10 (1 Sep 1990 to 31 Aug 1997) 13-14 304035 89.8 87.7 18-19 328004 66.1 59.3 2008/09 and 2009/10 combined 76.4 68.5 68.6 41.7 38.9 84.1 47.4 12-19 2194237 72.4 68.6 60.4 Page 5 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 3 Introduction The aim of the HPV vaccination programme is to reduce the incidence of cervical cancer in women.
The objective of the HPV vaccination programme is to provide three doses of HPV vaccine to females before they reach an age when the risk of HPV infection increases and they are at subsequent risk of cervical cancer.1 The programme was implemented following advice from the Joint Committee on Vaccination and Immunisation (JCVI).
The JCVI recommended that the HPV vaccine should be offered routinely to females aged 12 to 13 years.2 The committee also recommended a time-limited catch up vaccination of girls aged 13 to 17 years.2 Initially, catch-up campaigns targeting all girls aged from 14 up to 18 years were planned for the academic years 2009/10 and 2010/11.
However, in January 2009 these plans were brought forward and PCTs were informed that they could start vaccinating any of the catch-up cohorts as part of an accelerated catch-up campaign from 1 April 2009, completing within the academic year 2009/10.3 Five PCTs chose not to, or were unable to, accelerate the campaign.

The HPV vaccine used in the UK immunisation programme is Cervarix®, which protects against HPV types 16 and 18.

HPV is one of the most common sexually transmitted infections.
It is the main cause of cervical cancer and is responsible for nearly 3000 cases every year in the UK, with HPV types 16 and 18 causing over 70% of cases.4 Immunising females before they become infected will reduce cases of cervical cancer and could eventually prevent up to 400 deaths every year in the UK.5 A more recent mathematical modelling study of the potential impact of the English vaccination programme projected an eventual reduction in invasive cervical cancer of 63% in women aged 20 to 29 years.6 In England, a routine immunisation programme targeting 12- to13-year-old females (school year 8) and a catch-up programme for females aged 17 to 18 years (school year 13) were undertaken during the academic year 2008/09.
The majority of PCTs started a phased catch-up programme for females in school years 10 to 13 (born 1 September 1991 to 31 August 1995) during the 2009/10 academic year.

Five PCTs will continue to complete part of the catch-up programme during the 2010/2011 academic year.

Data were collected over an academic year because the majority of PCTs, 150 of 152, chose to offer the vaccine in school for females in years 8, 10 and 11.
For females in years 12 and 13, PCTs chose to offer the vaccine in GP practices and community health clinics or a mix of GPs, schools and clinics.

This second annual report on HPV vaccine coverage in England presents data for the academic year 2009/10, and provides a comparison with HPV vaccine coverage achieved during the first year of the programme, academic year 2008/09, and with published data from selected international HPV vaccine programmes.
The report also summarises the methods used for data collection, validation and analysis.

Page 6 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 4 Methods Data Data sources The HPV vaccine coverage collection was facilitated by the ImmForm website.

The ImmForm system provides a manual on-line data submission function for PCTs, together with relevant survey information and guidance.

It is designed and managed by DH.


The HPA coordinates and manages the collection, validation, reporting and analysis of national data on behalf of DH.

A more detailed explanation of the website and the collection form can be found in Appendices 1 and 2.

Data on HPV immunisations given in schools were collected by school nurses or administrative support staff and passed to the PCT HPV data-provider for collation and data entry.
Data on females vaccinated in GP surgeries were collated by PCTs from information submitted by fax, email or telephone.

Additionally, some PCTs made use of the optional GP data entry tool on the ImmForm website, which allows GP practices to submit data in the same format as the PCT monthly data submission.
PCTs are encouraged to enter vaccination data on to a child health information system (CHIS) prior to submitting data to the ImmForm website and this has become standard practice for an increasing number of PCTs over the course of the first two years of the programme.
PCTs have also been urged to ensure that each female’s vaccination status is recorded on her GP records and Open Exeter ensuring a link is established with future cervical screening.7-9 Data on HPV vaccine coverage were entered manually by a nominated PCT HPV data-provider on to the ImmForm website.
During 2009/10, PCTs submitted monthly cumulative data for females who had received at least one, at least two, or all three doses of vaccine in the routine cohort (school year 8, 12- to 13-year-olds) and the catch-up cohorts (years 10 to 13, 14- to 18-year-olds).
The cohort denominators for each cohort for each PCT were estimated and fixed for the monthly collections, based on 2008/09 PCT school-roll data for each school year received from the Department for Education (formally the Department for Children, Schools and Families), modified as appropriate, if requested by a PCT.

Additionally, PCTs provided an update on the vaccination of two cohorts from the 2008/09 campaign, now school year 9, 13- to 14-year-olds and out of school 18- to 19-year-olds.
PCTs completed the annual survey on the ImmForm website at the end of the 2009/10 academic year.

PCTs were required to provide an actual denominator, where possible.

Appropriate algorithms were developed for either a schools- or GP- based programme according to the guidance on completing the annual return provided on the DH website.10 The annual survey also required PCTs to provide a breakdown of the number of vaccinations given in different settings (i.e.

school/GP practice/clinic etc.).


These data were also based on manual records collated centrally by PCT HPV data- providers.

The monthly surveys were considered as provisional, estimated data.

The annual survey is considered as the final data and provides the data for this report.

Page 7 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Data quality All 152 PCTs in England submitted annual returns.
Any PCT that had locally provided annual denominators that varied from the original estimated monthly denominators by +/- 5% was contacted via email and asked to verify their data as part of data validation and quality assurance.

The results of this process are provided in Appendix 3.
Definitions 2009/10 cohorts During the second year of the HPV vaccination campaign, five cohorts were targeted for vaccination: (i) The routine cohort (school year 8): females aged 12-13 years, born between 1 September 1996 and 31 August 1997.

(ii) Four catch-up cohorts (school years 10-13): females aged 14-18 years, born between 1 September 1991 and 31 August 1995.
Annual survey denominator Depending on the type of programme the PCT ran, annual denominators for each cohort could be derived from one of three methods: Schools-based programme denominator: the school roll for the PCT as of 31 August 2010 was used.
This was defined as all females in the appropriate school year attending school in the PCT (including those from the PCT’s ‘responsible population’ and other PCTs), PLUS females in the PCT’s ‘responsible population’ not otherwise offered the vaccine, such as those not on any school roll or those attending a school in another PCT without a schools based programme.
Non-schools-based programme denominator: all females in the appropriate birth cohort as of 31 August 2010 from the PCT’s ‘responsible population’ only, EXCLUDING those on the school roll of neighbouring PCTs with schools-based programmes.
Schools/non-schools mixed approach denominator: all females in the appropriate birth cohort as of 31 August 2010 from the PCT’s ‘responsible population’ only, PLUS females not registered in the PCT that attend schools targeted for vaccination and EXCLUDING those on the school roll of neighbouring PCTs with similar schools based programmes.
A more detailed description of how the annual denominator was determined is available via the DH immunisation website11 Page 8 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 The PCT ‘responsible population’ for the HPV data collection is defined as: • all females in the appropriate age cohort registered with a GP practice whose practice forms part of the PCT, regardless of where they are resident, plus • any females in the appropriate age cohort not registered with a GP, who are resident within the PCT’s statutory geographical boundary.
For the purposes of the data collection, the term ‘schools’ includes all schools managed by a local authority, voluntary or private agents, grant maintained schools, sixth form colleges, pupil referral units, young offender units and residential units.
An up-to-date list of Educational Establishments in England and Wales, maintained by the Department for Education can be found at www.edubase.gov.uk Annual survey numerators Three numerators were collected for the number of females who received at least one, at least two, or all three doses, respectively within the period of 1 September 2008 to 31 August 2010.

These were used to calculate vaccine coverage by dose, using the appropriate denominator as defined above.
To minimise the numbers of missed or double counted females, providing a more accurate estimate of HPV coverage, the numerators were corrected (where possible) by PCTs to record the number of vaccinations given to females included in the denominator irrespective of who delivered the vaccinations.

A detailed description of how annual numerators were determined is available via the DH immunisation website.11 The numerators for the setting in which vaccinations were given (e.g.
school, GP practice, community clinic, or other settings) were a simple count of doses administered per location, irrespective of whether dose 1, dose 2 or dose 3.

Coverage In the 2008/09 report, the term ‘uptake’ was used to describe the proportion of the eligible population who are vaccinated.

In this year’s report, the term ‘uptake’ has been replaced with ‘coverage’ as this is more widely used in reporting the proportion of a target population known to have received the appropriate vaccine(s).
User feedback The DH and the HPA welcome feedback on this publication.

This can be done either via the ImmForm website login (use the feedback facility, selecting HPV surveys) or alternatively email hpv@hpa.org.uk for comments on the data collection process, immform@dh.gsi.gov.uk for comments on the website or other technical issues or dhmail@dh.gsi.gov.uk for comments regarding policy.
Page 9 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 5 Analysis and commentary Annual data returns were received from all 152 PCTs.

For each PCT, the reported annual denominators were compared with the fixed monthly denominator estimates and ONS population estimates for mid-2008.

Differences greater than +/– 5% were queried with the PCT data-provider and any anomalies corrected.
The data tables (pages 19-27) show the reported annual denominators and vaccine coverage of the first, second and third dose of HPV vaccine for females in England by SHA and PCT for the routine and catch-up cohorts.

The range of vaccine coverage by dose is given at the national and SHA levels.

Routine cohort 2009/10 In England, 76.4% of females aged 12-13 years who were eligible to routinely receive HPV vaccine in the academic year 2009/10 completed the three dose course (PCT range 15.4%*ito 95.6%).
82.3% received at least two doses and 84.3% received at least one dose (Table 1).

Coverage varied by SHA across England ranging from 84% for third dose coverage (North West) to 65% (South East Coast).

First dose SHA coverage ranged from 89.4% to 73.9%; second dose from 87.9% to 71.3% (Figure 1).
Figure 1 HPV vaccine coverage for 12- to 13-year-old females in England by dose and SHA in 2009/10 % e g a r e v o C 100 90 80 70 60 50 40 30 20 10 0 1 dose 2 doses All 3 doses North East SHA North West SHA Yorkshire & The Humber SHA East Midlands SHA West Midlands SHA NHS East of England London SHA South East Coast SHA South Central SHA South West SHA Strategic health authority * Rotherham PCT (15.4%) chose to offer HPV vaccine to year 10 and 11 before vaccinating year 8, consequently they were unable to complete vaccinating this cohort before the end of the academic year.
Page 10 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Setting for HPV vaccination delivery Data were also provided on the setting in which vaccinations were given (e.g.

school, GP practice, community clinic, or other settings).

One hundred and fifty of the 152 PCTs followed JCVI advice to vaccinate the routine cohort using a schools-based programme.

For the routine cohort, 94.4% of vaccinations given to 12- to 13-year- olds were delivered in schools.
Most of the 3.9% of 12- to 13-year-olds vaccinated in GP practices were from two PCTs (Derbyshire County and Cornwall and the Isles of Scilly) that chose to offer HPV vaccine through GP practices rather than in schools.

A further 1.4% of 12- to 13-year-olds were vaccinated in health clinics, and further 0.3% were vaccinated in ‘other’ settings.
Comparison of 2008/09 and 2009/10 routine cohort vaccine coverage Vaccine coverage for the 2009/10 routine cohort was 3.6% lower than that achieved in 2008/09.12 Factors that may have had an impact on the vaccine coverage achieved for the 2009/10 academic year include: • the scale of the programme - during 2009/10 PCTs were asked to accelerate the catch-up programme and vaccinate five school year cohorts rather than two, as in the previous year.
Consequently, over 3,000,000 doses of vaccine were administered over the 2009/10 academic year compared with 1,360,000 doses given in 2008/09.

• H1N1 pandemic vaccination programme - PCTs had to introduce a pandemic influenza vaccination programme at the same time as running the first and second dose HPV vaccination sessions in schools and GP practices at the beginning of the 2009/10 academic year; this may have had logistical and resourcing implications for the HPV vaccination programmes.
• adverse media publicity - at the end of September 2009 there was media coverage of the death of a Coventry school-girl soon after receiving an HPV vaccine.

Although this death was subsequently found to be entirely unrelated to the vaccine, many PCTs reported anecdotally that adverse publicity was a major reason given by parents for non-consent around the time of the publicity.
• data quality - for the first year of the programme many PCTs were unable to provide an adjusted denominator for their annual return as only manual data systems were available, possibly resulting in over-estimates of vaccine coverage for some PCTs.

Data quality has improved for 2009/10 as more PCTs were able to provide an adjusted denominator for their annual return using child health information systems (see page 6 and Appendix 3).
A comparison of provisional monthly coverage data collected over the course of the first two years of the programme shows a slower increase in coverage of the first and second doses in 2009/10 in the winter months, although from April 2010 onwards coverage was closer to that achieved in 2008/09 (Figure 2).
Page 11 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Figure 2 Comparison of HPV vaccine coverage for routine cohorts in 2008/09 and 2009/10 (provisional monthly data) % e g a r e v o C 100 90 80 70 60 50 40 30 20 10 0 Dose 1 09/10 Dose 2 09/10 Dose 3 09/10 Dose 1 08/09 Dose 2 08/09 Dose 3 08/09 S epte m b er O cto b er N o ve m b er D ece m b er Ja n u ary F e bru ary M arc h A pril M ay J u n e J uly A u g u st Month PCT coverage As previously mentioned, a number of factors may have contributed to the slightly lower national vaccine coverage for three doses achieved in 2009/10 compared with the previous year.12 Although fewer than in 2008/09, many PCTs recorded high coverage in the routine cohort: 12 (7.9%) reported 90% coverage or greater, 56 (36.8%) reported 80 to 89%, and 44 (28.9%) reported 70 to79%.
Forty PCTs (26.3%) reported coverage below 70% (Figure 3).
Figure 3 PCT coverage for third dose in the routine cohort (12- to 13-year-olds) in 2008/09 and 2009/10 90 and over 12 31 % e g n a R e g a r e v o C 80-89 70-79 60-69 50-59 Under 50 3 6 5 4 60 56 39 44 14 30 2008/09 2009/10 0 10 20 30 40 50 60 70 Number of PCTs Page 12 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Catch-up cohorts 2009/10 The accelerated catch-up programme targeted all females aged between 14 and 18 years of age.
PCTs were given the option to start vaccinating any of the catch-up cohorts from 1 April 2009 and complete within the academic year 2009/10.3 Five PCTs chose not to implement the entire accelerated catch-up programme during 2009/10; three PCTs offered HPV vaccine to 16- to 18-year-olds only and two PCTs offered the vaccine to 15 to 18 year olds only.
All five PCTs will run catch-up campaigns to complete vaccinations during the 2010/11 academic year and therefore vaccine coverage achieved for these catch-up cohorts is expected to increase during the coming year.

Updated coverage data will be collected in the annual survey in September 2011 and will be reported on and published in the third annual report.
All 152 PCTs submitted annual data on the catch-up cohorts 3 and 4, 149 PCTs submitted data on catch-up cohort 5 and 147 PCTs submitted data on catch-up cohort 6.

In the two younger cohorts (cohorts 5 and 6), coverage of three doses was very similar at just under 70% and for cohorts 4 and 3 third dose coverage was 41.7% and 38.9% respectively (Table 2).
Table 2 HPV vaccine coverage: final estimates for catch-up cohorts in England in 2009/10 Cohorts Vaccine c overage % Cohort (dates of birth) Catch - u p cohort 6 ( 1 Sep 199 4 to 31 Aug 199 5) Catch - u p cohort 5 ( 1 Sep 199 3 to 31 Aug 199 4) Catch - up cohort 4 ( 1 Sep 199 2 to 31 Aug 199 3) Catch - up c ohort 3 ( 1 Sep 199 1 to 31 Aug 199 2) Age (years) Number in cohort At least 1 dose At least 2 dose s 3 doses 14-15 305232 77.5 75.2 68.5 15-16 309727 77.6 75.0 68.6 16-17 319340 58.1 53.1 41.7 17-18 323826 55.6 50.3 38.9 All c atch - u p c ohorts 2009/10 ( 1 S ep 199 1 to 31 Aug 199 5) 14-18 1258125 67.0 63.2 54.1 Setting for HPV vaccination delivery A PCT’s HPV programme was classified as either a school or GP-based programme when at least 60% of vaccinations were in that setting; those PCTs where less than 60% were vaccinated in one setting were classified as having a mixed programme.
Over 90% of females in years 10 and 11 (14- to 16-year-olds) received their vaccinations in schools/colleges (Table 3).

A more mixed approach was taken by PCTs for the years 12 and 13 (16- to 18-year-olds) with these older cohorts predominantly receiving vaccine in general practice as many of these individuals were not in full-time education.
Page 13 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Table 3 HPV vaccine delivery settings for the catch-up cohorts in England in 2009/10 Total number of doses administered by location type In schools / colleges In GP-practices In health centres / community clinics In other No.

% No.

% No.

% No.
% Cohorts Cohort Age (years) Catch-up cohort 6 Catch-up cohort 5 Catch-up cohort 4 Catch-up cohort 3 14-15 611601 90.9 47478 7.1 12035 1.8 1896 0.3 15-16 615579 90.1 52012 7.6 12833 1.9 2534 0.4 16-17 201443 41.2 252021 51.5 31742 6.5 4198 0.9 17-18 162461 34.6 267679 57.0 35350 7.5 4119 0.9 Figures 4 and 5 show the PCT programme (school, GP or mixed delivery model) and HPV vaccination coverage by PCTs as defined by third dose coverage, for the 16- to 17-year-old and 17- to 18-year-old catch-up cohorts respectively.
Figure 4 PCT third dose HPV vaccine coverage achieved by PCT programme- delivery model: 16- to 17-year-olds in 2009/10 6 e g a r e v o c e n i c c a v e s o d d r i h T 0 60%+ 50-59% 40-49% 2 2 30-39% 1 20-29% <20% 4 4 4 4 3 3 19 20 17 15 15 16 17 Mixed GPs Schools 0 Number of PCTs Page 14 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Figure 5 PCT third dose HPV vaccine coverage achieved by PCT programme- delivery model: 17- to 18-year-olds in 2009/10 e g a r e v o c i e n c c a v e s o d d r i h T 60%+ 50-59% 40-49% 30-39% 20-29% <20% 1 0 0 0 0 4 4 4 3 5 5 10 10 8 17 21 11 15 15 26 Mixed GPs Schools 10 15 20 25 30 Number of PCTs Comparison of year 13 (aged 17 to 18 years) catch-up cohorts in 2008/09 and 2009/10 The proportion of year 13 females (aged 17 to 18 years) completing the three-dose HPV vaccination course in 2009/10 was 7.8% higher than that achieved in 2008/09, despite 5.7% fewer females receiving the first dose.12 Several factors may have contributed to the differences in vaccine coverage for 17- to 18-year-old females during the second year of the programme: • the 2008/09 catch-up programme for year 13 was announced in July 2008 (later than the routine programme announcement).
PCTs and GPs were better prepared at the start of the second year in September 2009 and more PCTs were able to deliver part of this programme through schools and colleges • some of the factors that contributed to lower vaccine coverage in the routine cohort (see earlier) may have also contributed to the slowdown in vaccine coverage of the first and second dose for the year 13 cohort from March 2010.
In particular, the H1N1 pandemic vaccination programme which was delivered through GP practices may have had an impact third dose coverage was less affected as this was scheduled later in the school year and therefore remained consistently higher than in the previous year.

• A comparison of provisional monthly coverage data collected over the course of the first two years of the programme shows the increased coverage of the third dose of HPV for year 13 in 2009/10 compared with 2008/09 (Figure 6).
Page 15 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Figure 6 Comparison of HPV vaccine coverage for year 13 (aged 17 to 18 years) catch-up cohorts in 2008/09 and 2009/10 (provisional monthly data) Dose 1 09/10 Dose 2 09/10 Dose 3 09/10 Dose 1 08/09 Dose 2 08/09 Dose 3 08/09 % e g a r e v o C 100 90 80 70 60 50 40 30 20 10 0 S e pte m b er O cto b er N o ve m b er D ece m b er Ja n u ary F e bru ary M arch A pril M ay J u n e J uly A u g u st Month Updated vaccine coverage for 2008/09 routine and catch-up cohorts Some females who were due to receive HPV during 2008/09 actually received vaccine during 2009/10 in mop-up sessions.
To quantify this, PCTs also provided updated annual coverage data on the two 2008/09 cohorts; these were the routine year 8 cohort (born 1 September 1995 to 31 August 1996) and the year 13 catch-up cohort (born 1 September 1990 to 31 August 1991).

During 2009/10 third dose coverage increased by 4.1% to 84.2% for the routine cohort (Figure 7) and by 15.6% to 47.4% for the catch-up cohort (Figure 8).
Figure 7 Improvement in vaccine coverage during 2009/10 for the 2008/09 routine cohort (born 1 September 1995 to 31 August 1996) % e g a r e v o C 100 90 80 70 60 50 40 30 20 10 0 2008/09 2009/10 Dose 1 Dose 2 Dose 3 Page 16 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Figure 8 Improvement in vaccine coverage during 2009/10 for the 2008/09 catch-up cohort (born 1 September 1990 to 31 August 1991) 2008/09 2009/10 % e g a r e v o C 100 90 80 70 60 50 40 30 20 10 0 Dose 1 Dose 2 Dose 3 Annual UK HPV vaccine coverage 2009/10 Annual HPV vaccine coverage data for the routine cohort of females aged 12-13 years are available from equivalent reporting systems in all countries in the UK as shown in Table 4.13-15 Published data for 2008/09 are shown in brackets.12 Table 4 Annual UK HPV vaccine coverage for females aged 12-13 years (year 8) by country in 2009/10 (2008/09) 2009/10 HPV vaccine coverage % (2008/09) Country England Scotland Wales N .
I .

UK At least 1 dos e At least 2 doses 84.3 (88.1) 92.6 (93.7) 84.5 (87.9) 86.5 (89.6) 85.0 (88.4) 82.3 (86.0) 91.1 (92.7) 82.6 (87.0) 85.3 (85.9) 83.1 (86.6) 3 doses (80.1) 476.

86.9 (89.4) 77.3 (78.8) 83.4 (83.9) 77.5 (80.9) International HPV vaccine coverage Coverage of HPV vaccine for the routine England and UK programmes compares favourably with estimates recorded in other European countries that have introduced HPV vaccination and have a monitoring system implemented.
Only Portugal reports coverage similar to that achieved the UK for 2009 (81%).16 In British Columbia, Canada, third dose coverage for 11- to 12-year-olds for 2009/10 is 62%.17 Data for the catch-up programme as presented in this report, shows that England has one of the most successful European programmes to date.16 It also exceeds estimates of coverage in 2009 for similar age groups in the US where HPV vaccine coverage with one or more doses of HPV among female adolescents aged 13 to 17 Page 17 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 years was 44.3%, and with three or more doses was 26.7%18 and for British Columbian 14- to 15-year-olds where coverage in 2009/10 was around 62%.17 6 References 1.
Department of Health (2009) The ‘Green Book’ chapter on Human papillomavirus (HPV).

www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/document s/digitalasset/dh_087787.pdf.

Accessed: Dec. 2010.

2.

JCVI (2008) Statement on HPV vaccination .

www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@ab/document s/digitalasset/dh_094739.pdf.

Accessed: Dec. 2010.

3.

Salisbury D (2009) Acceleration of the HPV vaccination catch-up campaign .
www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/document s/digitalasset/dh_094026.pdf.

Accessed: Dec. 2010.

4.

Department of Health (2008) The human papillomavirus vaccine.

The virus, the diseases and the new HPV vaccine.

www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/document s/digitalasset/dh_114262.pdf.

Accessed: Dec. 2010.

5.

Jit M, Choi YH and Edmunds WJ (2008) Economic evaluation of human papillomavirus vaccination in the United Kingdom.

BMJ 337 a769.

6.
BMJ 337 a769.

6.

Cuzick J, Castanon A and Sasieni P (2010) Predicted impact of vaccination against human papillomavirus 16/18 on cancer incidence and cervical abnormalities in women aged 20-29 in the UK.

Br J Cancer 102(5): 933-9.

7.

Department of Health (2008) Introduction of human papillomavirus vaccine into the national immunisation programme.
www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Professionallett ers/Chiefmedicalofficerletters/DH_084542?IdcService=GET_FILE&dID=164669 &Rendition=Web.

Accessed: Dec. 2008.

8.

Department of Health (2008) Statutory directions for the routine HPV vaccination programme.

www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalass et/dh_087340.pdf.

Accessed: Dec. 2010.

9.

Department of Health (2009) HPV vaccination record keeping and reporting.

Vaccine Update 161.

10.


Department of Health (2010) Human papillomavirus (HPV) vaccine uptake annual survey 2009/10: PCT user guide for determining annual denominators and HPV vaccine uptake on the ImmForm website .

www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/docu ments/digitalasset/dh_118055.pdf.

Accessed: Dec. 2010.

Page 18 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 11.
Department of Health (2009) Measuring HPV vaccine uptake: determining the annual denominator.

www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalass et/dh_117147.pdf.

Accessed: Dec. 2010.

12.

Sheridan A and White J (2010) Annual HPV vaccine uptake in England: 2008/09 .

www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/docu ments/digitalasset/dh_111676.pdf.

Accessed: Dec. 2010.

13.


Data for Northern Ireland supplied by Dr Neil Irvine Consultant in Health Protection, Public Health Agency, Northern Ireland.

14.

Data for Scotland supplied by Information Services Division of Health Protection Scotland Interim data can be found at: www.isdscotland.org/isd/5921.html.

15.
15.

Data for Wales supplied by Public Health Wales quarterly immunisation data for third quarter of 2009/10 can be found at : www2.nphs.wales.nhs.uk:8080/VaccinationsImmunisationProgsDocs.nsf/3c046 69c9e1eaa880257062003b246b/3e538c1741ff083d802577dc00500080/$FILE/ Cov10q3%20(report96).pdf.

16.

Dorleans F, Giambi C, Dematte L et al.

(2010) The current state of introduction of human papillomavirus vaccination into national immunisation schedules in Europe: first results of the VENICE2 2010 survey.
Euro Surveill 15(47): 2-5.

17.

British Columbia CDC (2010) Grade 6 students with up-to-date immunizations, British Columbia.

www.bccdc.ca/NR/rdonlyres/BDD8BBD7-2C78-4369-B5B1- 69D4B039BC3D/0/EPI_Report_PublicGrade6Results_20101103.pdf.

Accessed: Dec. 2010.

18.

Stokley S, Dorell C and Yankey D (2010) National, state, and local area vaccination coverage among adolescents aged 13-17 years --- United States, 2009.

MMWR Morb Mortal Wkly Rep 59(32): 1018-23.

19.


HPA (2009) HPA survey of primary care trusts teenage vaccination programmes (2008) and Health Protection Agency survey of primary care trust teenage vaccination programmes December (2009).

www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/VaccineCoverageAnd COVER/.

Accessed: Dec. 2010.

7 Acknowledgements • Staff who participated in and supported the HPV vaccination programme and the vaccine uptake collection.
• DH colleagues for their contribution in producing this report, especially Dr Stephen Robinson (Senior Scientist) and Dr Tom Barlow (Principal Scientist) Immunisation Branch; Peter Gates, Project Manager, Immunisation Web Group Programme - IT lead for ImmForm, members of the ImmForm Development and Test Team, and the ImmForm Support Team and Chris Owen, Immunisation Branch for editorial input Page 19 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 8 Data table Table 5: Annual data, as submitted by PCTs, for first, second and third dose vaccine uptake by 31 August 2010 Cohort 7 (routine vaccination - 12- to 13-year-olds – school year 8) Cohort 3 (catch-up – 17- to 18- year-olds – school year 13) Cohort 4 (catch-up – 16- to 17- year-olds – school year 12) Cohort 5 (catch-up – 15- to -16- year-olds – school year 11) Cohort 6 (catch-up – 14- to 15- year-olds – school year 10) Organisation name Total no.
in cohort 7 Doses given since 1 Sept 2009 Dose 1&2 % All 3 doses % % Dose 1 Total no.

in cohort 3 Doses given since 1 April 2009 Dose 1&2 % All 3 doses % % Dose 1 Total no.

in cohort 4 Doses given since 1 April 2009 Dose 1&2 % All 3 doses % % Dose 1 Total no.

in cohort 5 Doses given since 1 April 2009 Dose 1&2 % All 3 doses % % Dose 1 Total no.
in cohort 6 Doses given since 1 April 2009 Dose 1&2 % All 3 doses % Dose 1 % England National vaccine uptake range North East SHA SHA vaccine uptake range NEWCASTLE PCT NORTH TYNESIDE PCT HARTLEPOOL PCT STOCKTON-ON-TEES tPCT DARLINGTON PCT GATESHEAD PCT SOUTH TYNESIDE PCT SUNDERLAND TEACHING PCT MIDDLESBROUGH PCT COUNTY DURHAM PCT REDCAR & CLEVELAND PCT NORTHUMBERLAND 304073 84.3 36.0- 100.0 15063 87.2 74.5- 96.4 93.6 86.3 96.4 86.4 74.5 93.1 84.6 84.6 85.9 84.0 84.9 91.8 1432 1155 585 1139 709 1091 864 1700 760 2840 921 1867 82.3 34.2- 96.3 85.1 69.3- 94.2 91.1 85.6 94.2 86.1 69.3 93.0 82.6 83.4 81.7 82.0 80.1 89.4 76.4 15.4- 95.6 81.2 66.6- 91.1 87.6 82.9 90.8 81.9 66.6 91.1 74.2 81.4 75.8 79.5 73.9 83.2 323826 55.6 0.9- 99.0 64.9 49.3- 84.0 55.8 51.6 62.4 68.6 61.6 49.3 56.1 72.2 65.8 84.0 63.0 61.1 15852 1555 1149 450 960 643 1478 1034 1623 970 3024 995 1971 50.3 0.9- 95.2 55.2 41.3- 64.4 52.4 49.3 61.3 55.9 59.4 41.3 49.5 64.4 55.9 58.4 57.5 56.7 38.9 319340 58.1 0.1- 74.8 46.0 15878 34.9- 55.7 50.7 1555 40.3 1149 36.2 655 45.6 1090 47.7 643 34.9 1249 38.5 996 55.7 1573 43.3 970 48.0 3024 44.4 995 51.0 1979 0.8- 98.9 71.3 53.8- 97.8 71.1 62.5 62.7 53.8 72.9 54.2 59.7 79.3 97.8 87.8 60.6 65.6 53.3 0.4- 89.3 63.7 49.5- 73.8 70.1 60.1 49.5 51.7 70.0 50.1 57.6 65.9 72.6 73.8 56.4 63.5 41.7 309727 77.6 0.3- 76.8 46.4 15618 29.8- 64.6 64.6 1850 50.1 1098 29.8 611 38.7 1195 38.4 541 35.5 1224 40.0 990 49.7 1557 42.0 879 44.8 2800 37.9 974 58.5 1899 0.0- 97.3 80.0 57.9- 94.9 63.4 84.5 90.0 83.3 93.9 61.8 57.9 81.2
 84.1 94.9 79.3 82.9 75.0 0.0- 96.0 74.2 54.8- 89.6 63.4 84.1 86.3 78.7 89.6 55.6 54.8 69.5 81.3 80.8 74.6 80.8 68.6 305232 77.5 0.0- 95.4 62.2 15393 32.2- 80.7 61.7 1850 77.0 1098 80.7 619 74.1 1199 32.2 541 38.5 1219 33.8 883 53.1 1478 71.7 832 64.3 2800 66.7 969 77.1 1905 0.0- 99.1 81.2 61.6- 92.2 70.3 88.0 92.2 87.2 87.1 61.6 75.3 81.4 87.5 86.0 80.3 84.8 75.2 0.0- 98.1 77.3 52.1- 91.0 67.8 86.2 91.0 86.1 82.6 52.1 66.7 74.6 83.7 82.4 77.4 82.8 68.5 0.0- 94.8 65.1 34.0- 85.5 65.8 80.3 85.5 74.4 34.0 39.2 42.6 53.7 74.8 67.8 65.0 79.4 Page 20 of 35 Table 5 (Continued) Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Cohort 7 (routine vaccination - 12- to 13-year-olds – school year 8) Cohort 3 (catch-up – 17- to 18- year-olds – school year 13) Cohort 4 (catch-up – 16- to 17- year-olds – school year 12) Cohort 5 (catch-up – 15- to -16- year-olds – school year 11) Cohort 6 (catch-up – 14- to 15- year-olds – school year 10) Organisation name Total no.
in cohort 7 Doses given since 1 Sept 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.

in cohort 3 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.

in cohort 4 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.

in cohort 5 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.
in cohort 6 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % North West SHA 41888 88.3 86.7 84.0 46995 51.3 45.4 32.5 45281 53.7 48.0 33.4 42500 84.6 82.2 78.3 41660 77.3 75.7 72.7 SHA vaccine uptake range BLACKBURN WITH DARWEN SALFORD PCT STOCKPORT PCT ASHTON, LEIGH & WIGAN † BLACKPOOL PCT BOLTON PCT WARRINGTON PCT KNOWSLEY PCT OLDHAM PCT BURY PCT TAMESIDE AND GLOSSOP CUMBRIA PCT NORTH LANCASHIRE PCT CENTRAL LANCASHIRE PCT EAST LANCASHIRE PCT SEFTON PCT WIRRAL PCT LIVERPOOL PCT HALTON & ST. HELENS PCT WEST CHESHIRE PCT 81.1- 95.8 79.9- 94.4 76.7- 91.5 21.0- 79.0 18.7- 79.0 5.1- 65.4 22.0- 94.9 17.9- 89.3 5.5- 76.8 46.8- 97.3 40.8- 96.0 26.1- 91.8 1.0- 95.1 0.7- 93.8 0.2- 1099
96.8
Page 21 of 35 Table 5 (Continued) Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Cohort 7 (routine vaccination - 12- to 13-year-olds – school year 8) Cohort 3 (catch-up – 17- to 18- year-olds – school year 13) Cohort 4 (catch-up – 16- to 17- year-olds – school year 12) Cohort 5 (catch-up – 15- to -16- year-olds – school year 11) Cohort 6 (catch-up – 14- to 15- year-olds – school year 10) Organisation name Total no.
in cohort 7 Doses given since 1 Sept 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.

in cohort 3 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.

in cohort 4 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.

in cohort 5 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.
in cohort 6 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % CENTRAL & EASTERN CHESHIRE HEYWOOD, MDLT'N & ROCHDALE TRAFFORD PCT MANCHESTER PCT † Yorkshire & The Humber SHA 30875 89.4 87.9 81.2 33475 63.0 55.4 43.3 32741 64.9 58.5 47.5 32107 80.7 78.1 72.6 31315 82.9 80.7 74.1 SHA Vaccine uptake range NORTH LINCOLNSHIRE PCT ROTHERHAM PCT CALDERDALE PCT BARNSLEY PCT LEEDS PCT KIRKLEES PCT WAKEFIELD DISTRICT PCT SHEFFIELD PCT DONCASTER PCT NORTH YORKSHIRE & YORK EAST RIDING OF YORKSHIRE HULL PCT BRADFORD & AIREDALE PCT N.E.
LINCOLNSHIRE TRUST 82.3- 93.5 79.9- 92.5 15.4- 92.5 47.8- 75.8 42.8- 71.8 23.9- 60.6 42.3- 85.4 42.3- 81.3 20.0- 67.2 56.8- 96.8 54.7- 95.4 49.8- 95.4 55.3- 99.1 54.1- 98.1 9.0- 77.6
85.6 81.2 85.2 82.6 9.0 85.5 83.0 87.2 83.4 77.6 78.3 69.5 94.8 50.1 83.3 74.1 81.2 79.7 Page 22 of 35 Table 5 (Continued) Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Cohort 7 (routine vaccination - 12- to 13-year-olds – school year 8) Cohort 3 (catch-up – 17- to 18- year-olds – school year 13) Cohort 4 (catch-up – 16- to 17- year-olds – school year 12) Cohort 5 (catch-up – 15- to -16- year-olds – school year 11) Cohort 6 (catch-up – 14- to 15- year-olds – school year 10) Organisation name Total no.
in cohort 7 Doses given since 1 Sept 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.

in cohort 3 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.

in cohort 4 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.

in cohort 5 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.
in cohort 6 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % East Midlands SHA 25956 87.1 85.7 77.4 28249 58.3 54.4 42.2 27533 62.1 58.4 48.3 26786 85.2 82.2 73.6 25955 85.2 83.7 76.7 SHA vaccine uptake range 83.2- 100.0 79.3- 90.5 63.3- 90.3 12.1- 78.4 10.2- 72.9 7.2- 57.9 29.6- 81.4 25.3- 76.8 15.6- 64.8 75.6- 89.3 74.1- 87.5 65.2- 85.1 79.4- 92.0 77.9- 91.0 63.0- 88.5 NOTTINGHAM CITY PCT 1467 86.6 BASSETLAW PCT 698 100.0 DERBYSHIRE COUNTY PCT DERBY CITY PCT NOTTINGHAMSHIRE COUNTY LINCOLNSHIRE PCT LEICESTERSHIRE & RUTLND LEICESTER CITY PCT NORTHAMPTONSHIRE PCT West Midlands SHA 33246 83.1 81.0 73.9 35831 57.8 52.6 37.6 34867 58.4 53.1
 39.6 33886 76.6 73.9 65.3 33539 78.3 75.5 67.3 SHA vaccine uptake range 63.4- 95.3 60.8- 90.8 53.3- 85.3 37.6- 98.2 31.0- 95.2 5.8- 67.0 14.8- 92.9 12.7- 83.0 7.1- 74.0 57.1- 94.2 53.3- 86.8 41.2- 81.3 60.4- 95.6 55.3- 88.7 42.4- 80.3 HEREFORDSHIRE PCT SOUTH BIRMINGHAM PCT SHROPSHIRE COUNTY PCT WALSALL TEACHING PCT COVENTRY TEACHING PCT TELFORD AND WREKIN PCT WOLVERHAMPTON CITY PCT 1014 2747 1758 1792 1913 1027 1452 75.3 81.9 84.8 85.7 87.3 90.8 95.3 74.3 79.3 83.8 83.8 83.4 87.6 90.8 67.1 73.8 81.5 73.1
Page 23 of 35 Table 5 (Continued) Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Cohort 7 (routine vaccination - 12- to 13-year-olds – school year 8) Cohort 3 (catch-up – 17- to 18- year-olds – school year 13) Cohort 4 (catch-up – 16- to 17- year-olds – school year 12) Cohort 5 (catch-up – 15- to -16- year-olds – school year 11) Cohort 6 (catch-up – 14- to 15- year-olds – school year 10) Organisation name Total no.
in cohort 7 Doses given since 1 Sept 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.

in cohort 3 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.

in cohort 4 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.

in cohort 5 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.
in cohort 6 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % HEART OF BIRMINGHAM PCT DUDLEY PCT SANDWELL PCT BIRMINGHAM EAST & NORTH NORTH STAFFORDSHIRE PCT STOKE ON TRENT PCT SOUTH STAFFORDSHIRE PCT WORCESTERSHIRE PCT WARWICKSHIRE PCT SOLIHULL CARE TRUST NHS East of England 34127 86.7 85.0 81.6 35283 60.0 55.2 46.8 35701 68.0 64.1 55.2 35017 71.5 69.8 65.4 34800 70.6 68.8 66.0 SHA vaccine uptake range LUTON PCT †† SOUTH EAST ESSEX PCT BEDFORDSHIRE PCT E & N HERTFORDSHIRE PCT WEST HERTFORDSHIRE PCT PETERBOROUGH PCT
 CAMBRIDGESHIRE PCT †† NORFOLK PCT 72.3- 97.8 71.9- 96.3 66.9- 95.6 35.0- 71.6 34.4- 66.3 29.8- 63.5 51.9- 81.4 48.5- 75.7 38.5- 71.8 0.0- 91.6 0.0- 90.1 0.0- 83.2 0.0- 93.8 0.0- 91.3 0.0- 50.8
Page 24 of 35 Table 5 (Continued) Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Cohort 7 (routine vaccination - 12- to 13-year-olds – school year 8) Cohort 3 (catch-up – 17- to 18- year-olds – school year 13) Cohort 4 (catch-up – 16- to 17- year-olds – school year 12) Cohort 5 (catch-up – 15- to -16- year-olds – school year 11) Cohort 6 (catch-up – 14- to 15- year-olds – school year 10) Organisation name Total no.
in cohort 7 Doses given since 1 Sept 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.

in cohort 3 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.

in cohort 4 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.

in cohort 5 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % Total no.
in cohort 6 Doses given since 1 April 2009 Dose 1 % Dose 1&2 % All 3 doses % GT YARMOUTH & WAVENEY SUFFOLK PCT WEST ESSEX PCT NORTH EAST ESSEX PCT MID ESSEX PCT SOUTH WEST ESSEX PCT London SHA 41679 73.9 71.3 66.6 43963 39.6 35.3 26.6 43911 40.2 35.6 26.8 42310 62.7 60.0 54.7 41850 64.8 62.2 56.6 SHA vaccine uptake range 36.0- 95.6 34.2- 89.1 29.9- 81.6 0.9- 99.0 0.9- 81.0 0.1- 67.7 0.8- 98.9 0.4- 81.8 0.3- 64.9 0.0- 95.1 0.0- 95.1 0.0- 95.1 0.0- 97.5 0.0- 94.1 0.0- 80.6 HAVERING PCT KINGSTON PCT BROMLEY PCT GREENWICH TEACHING PCT BARNET PCT HILLINGDON PCT ENFIELD PCT BARKING AND DAGENHAM CITY & HACKNEY TEACHING TOWER HAMLETS PCT NEWHAM PCT 62.6
59.8
Page 25 of 35 Table 5 (Continued) Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Cohort 7 (routine vaccination - 12- to 13-year-olds – school year 8) Cohort 3 (catch-up – 17- to 18- year-olds – school year 13) Cohort 4 (catch-up – 16- to 17- year-olds – school year 12) Cohort 5 (catch-up – 15- to -16- year-olds – school year 11) Cohort 6 (catch-up – 14- to 15- year-olds – school year 10) Organisation name Total no.
in cohort 7 Doses given since 1 Sept 2009 Dose 1 Dose 1&2 All 3 doses Total no.

in cohort 3 Doses given since 1 April 2009 Dose 1 Dose 1&2 All 3 doses Total no.

in cohort 4 Doses given since 1 April 2009 Dose 1 Dose 1&2 All 3 doses Total no.

in cohort 5 Doses given since 1 April 2009 Dose 1 Dose 1&2 All 3 doses Total no.
in cohort 6 Doses given since 1 April 2009 Dose 1 Dose 1&2 All 3 doses % % % % % % % % % % % % % % % HARINGEY TEACHING PCT †† 1205 HAMMERSMITH & FULHAM EALING PCT HOUNSLOW PCT BRENT TEACHING PCT HARROW PCT CAMDEN PCT ISLINGTON PCT CROYDON PCT KENSINGTON AND CHELSEA WESTMINSTER PCT LAMBETH PCT SOUTHWARK PCT LEWISHAM PCT WANDSWORTH PCT RICHMOND & TWICKENHAM SUTTON AND MERTON PCT REDBRIDGE PCT WALTHAM FOREST PCT BEXLEY CARE TRUST 21.3
1513
Page 26 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Table 5 (Continued) Organisation name Cohort 7 (routine vaccination - 12- to 13-year-olds – school year 8) Doses given since 1 Sept 2009 Dose 1&2 % Total no.
in cohort 7 Dose 1 % All 3 doses % Cohort 3 (catch-up – 17- to 18- year-olds – school year 13) Cohort 4 (catch-up – 16- to 17- year-olds – school year 12) Cohort 5 (catch-up – 15- to -16- year-olds – school year 11) Cohort 6 (catch-up – 14- to 15- year-olds – school year 10) Total no.

in cohort 3 Doses given since 1 April 2009 Dose 1&2 % All 3 doses % Dose 1 % Total no.

in cohort 4 Doses given since 1 April 2009 Dose 1&2 % All 3 doses % Dose 1 % Total no.
in cohort 5 Doses given since 1 April 2009 Dose 1&2 % All 3 doses % Dose 1 % Total no.
in cohort 6 Doses given since 1 April 2009 Dose 1&2 % All 3 doses % Dose 1 % South East Coast SHA 26392 80.9 79.0 65.0 27597 50.0 46.3 33.7 27206 48.0 44.1 30.6 25802 77.1 74.8 66.2 25685 77.5 75.4 59.9 SHA vaccine uptake range MEDWAY PCT BRIGHTON AND HOVE CITY SURREY PCT WEST SUSSEX PCT E SUSSEX DOWNS & WEALD HASTINGS & ROTHER PCT WEST KENT PCT EASTERN & COASTAL KENT 74.1- 94.0 72.4- 92.7 41.5- 90.0 34.4- 61.8 34.0- 56.3 10.4- 45.9 19.4- 64.7 19.4- 59.2 10.1- 46.1 71.3- 86.2 66.9- 84.7 50.5- 81.1 70.0- 84.0 62.1- 82.2 39.8- South Central SHA 24040 88.0 84.6 80.4 25467 60.3 56.1 44.9 25122 61.8 58.3 47.7 24313 84.5 82.5 78.5 24194 85.5 82.2 75.2 77.0 62.3 77.9 45.6 48.7 39.8 55.9 76.9 SHA vaccine uptake range 85.0- 90.9 81.5- 89.7 73.8- 88.3 36.0- 74.9 34.9-
 71.1 25.8- 56.7 31.7- 81.7 30.0- 78.1 23.3- 63.8 81.4- 88.2 79.8- 86.6 73.4- 84.1 81.1- 91.1 77.9- 89.6 70.4- 87.8 MILTON KEYNES PCT PORTSMOUTH CITY PCT SOUTHAMPTON CITY PCT HAMPSHIRE PCT BUCKINGHAMSHIRE PCT OXFORDSHIRE PCT BERKSHIRE WEST PCT BERKSHIRE EAST PCT ISLE OF WIGHT PCT 46.1
Page 27 of 35 Table 5 (Continued) Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Cohort 7 (routine vaccination - 12- to 13-year-olds – school year 8) Cohort 3 (catch-up – 17- to 18- year-olds – school year 13) Cohort 4 (catch-up – 16- to 17- year-olds – school year 12) Cohort 5 (catch-up – 15- to -16- year-olds – school year 11) Cohort 6 (catch-up – 14- to 15- year-olds – school year 10) Organisation name Doses given since 1 Sept 2009 Dose 1 Dose 1&2 All 3 doses Doses given since 1 April 2009 Dose 1 Dose 1&2 All 3 doses Doses given since 1 April 2009 Dose 1 Dose 1&2 All 3 doses Total no.
in cohort 5 Total no.

in cohort 4 Total no.

in cohort 3 Total no.

in cohort 7 Doses given since 1 April 2009 Dose 1 Dose 1&2 All 3 doses Total no.
in cohort 6 Doses given since 1 April 2009 Dose 1 Dose 1&2 All 3 doses % % % % % % % % % % % % % % % South West SHA 30807 82.5 80.6 75.2 31114 63.0 57.6 47.1 31100 66.4 62.1 52.2 31388 80.3 77.5 70.7 30841 81.7 79.2 73.1 72.7- 91.3 70.5- 90.8 56.9- 89.6 35.1- 96.4 29.7- 89.2 15.1- 74.8 33.5- 90.3 28.9- 85.1 14.2- 76.2 67.6- 90.9 63.9- 90.7 55.0- 89.1 69.8- 93.5 66.8- 92.9 57.3- 92.1 SHA vaccine uptake range SOUTH GLOUCESTERSHIRE PLYMOUTH TEACHING PCT BATH & N. E. SOMERSET PCT SWINDON PCT NORTH SOMERSET PCT GLOUCESTERSHIRE PCT BRISTOL PCT WILTSHIRE PCT SOMERSET PCT DORSET PCT BOURNEMOUTH & POOLE CORNWALL & ISLES OF SCILLY DEVON PCT TORBAY CARE TRUST 60.1 †† PCT did not accelerate catch-up campaign; did not offer vaccine to cohorts 5 and 6 † PCT partially accelerated catch-up campaign: did not offer vaccine to cohort 47.9
Page 28 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 9 Appendices Appendix 1 ImmForm website The HPV vaccine-uptake collection was facilitated by the ImmForm website.
The ImmForm system provides a manual on-line data submission function for PCTs, together with relevant survey information and guidance, designed and managed by DH.

The HPA coordinates and manages the collection, reporting and analysis of national data on behalf of DH.

The website can be accessed at www.immform.dh.gov.uk.

Further information about the ImmForm website can be found at www.dh.gov.uk/en/Publichealth/Immunisation/immform/index.htm.
All returns from PCTs were web-based (manual entry on-line) and no paper returns were accepted.

An on-line version of the data entry survey page was made available to GPs to allow them to complete and send it to their PCT data-provider for manual submission via the ImmForm website.

A letter sent to all PCT HPV data-providers before the start of the monitoring period outlined the collection and dataset requirements.
In addition, PCTs and GPs were sent a user guide on the HPV survey, with a ‘questions and answers’ section and a step-by-step guide on how to log-on, enter data and change their password.

The user guide was updated and re-issued for the 2010/11 campaign and can be found at: www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh _120004.pdf.

The website was open to GPs and PCTs at the start of each month, in line with the schedule shown in Table 6.
PCTs and GPs had ten working days to provide cumulative data on their vaccine uptake.

Data entered for each collection month was cumulative.

GPs and PCTs could view their data at any time but only had read/write access when the survey was open for data submission.

PCTs could see which practices had entered (or failed to enter) data by running a non-responder report at any time before the data entry window closed for each monthly collection, enabling follow-up of any outstanding data.
In addition, PCTs could extract data into Excel for analysis, view uptake rates and compare its own performance anonymously with other PCTs/SHAs, validate the data on point of entry and correct any errors before making a final submission.
Page 29 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Table 6 Dates for data collection for PCTs and GP practices End collection Start collection Thursday 01 October 2009 Monday 02 November 2009 Tuesday 01 December 2009 Monthly survey Month September 2009 October 2009 November 2009 December 2009 Monday 04 January 2010 Monday 01 February 2010 January 2010 Monday 01 March 2010 February 2010 Thursday 01 April 2010 March 2010 Tuesday 04 May 2010 April 2010 Tuesday 01 June 2010 May 2010 Thursday 01 July 2010 June 2010 Monday 02 August 2010 July 2010 Wednesday 01 September 2010 Tuesday 14 September 2010 August 2010 Wednesday 14 October 2009 Friday 13 November 2009 Monday 14 December 2009 Friday 15 January 2010 Friday 12 February 2010 Friday 12 March 2010 Friday 16 April 2010 Monday 17 May 2010 Monday 14 June 2010 Wednesday 14 July 2010 Friday 13 August 2010 Annual survey Year 1/9/2009 to 31/8/2010 Start collection End collection Wednesday 01 September 2010 Tuesday 28 September 2010 Page 30 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Appendix 2 PCT ImmForm data entry form Page 31 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Page 32 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Page 33 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Appendix 3 Denominator data quality Seventy-six PCTs were asked to indicate which of the following statements
 explained the variance in its denominator(s) and take any appropriate action: a) The denominator/s have been provided by your child health system and should be considered more accurate than the original estimate b) The incorrect algorithm was used (please recalculate using appropriate algorithm for school based, GP-based or mixed approach to vaccine delivery) c) Partial data provided; this may be as a result of a provider/commissioning split (please provide full data from both arms of the PCT) d) Human or system error (please resubmit after recalculating) e) Other (please give explanation).
PCTs were then grouped by their response to the email, the variance between its own denominator and the original estimate, and the delivery model used by the PCT.

For predominantly schools-based programmes (years 8, 10 and 11), PCTs fell into one of the following groups: • • • • the PCT was unable to provide an adjusted denominator and used the original estimate as its child health system was unable to provide accurate data.
(41- 44%) the PCT was able to provide an adjusted denominator from their child health system and this remained within 5% of the original estimate (30-40%) the PCT was able to provide an adjusted denominator from its child health system although this was more than 5% in variance with the original estimate (18-22%) the PCT denominator was in variance with the original estimate as it had used the incorrect algorithm, this was corrected and an amended denominator was calculated (2%).
Page 34 of 35 Human papillomavirus (HPV) vaccine coverage monitoring programme 2009/2010 Where a GP or GP/school mixed approach was used (school year 12 and 13), PCTs fell into one of the following groups: • • • • • the PCT was unable to provide an adjusted denominator and used the original estimate as their child health information system was unable to provide accurate data (46%) the PCT was able to provide an adjusted denominator from its child health information system and this remained within 5% of the original estimate (23-26%) the PCT was able to provide an adjusted denominator from its child health information system although this was more than 5% in variance with the original estimate (22-23%) the PCT denominator was in variance with the original estimate as it had used the incorrect algorithm, this was corrected and an amended denominator was calculated (1.5%) the PCT did not have complete data as the school programme was run by the provider arm and the GP programme by the commissioner arm.
Complete data were later supplied and the denominator amended (6.5%).

This analysis supports the findings of previous PCT surveys19 that many child health information systems now hold data for school-aged children but there are still a number that do not hold data beyond 16 years of age.

It also identified problems with reporting where separate programmes are run by the two arms of the PCT, i.e.

provider and commissioning.

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