Background From mid-2007 Australia funded a universal free vaccination program for all females between 12 and 26 years, but not for men or for women who were older than 26 years in 2007. Vaccine coverage rates of >80% were achieved for school-girls, though coverage was probably lower for young women in the community. To determine the population effect of the vaccine program we established a national surveillance network to measure trends in clinical presentations for genital warts.
Methods Eight sexual health services dispersed around Australia provided data on all new patients between 2004 and 2010, including new diagnoses of genital warts, demographics, sexual behaviour, and HPV vaccination status.
Results Among more than 130 000 new patients we identified over 10 000 new cases of genital warts. Before the vaccination program there was no change in the proportion of women or heterosexual men diagnosed with genital warts. In the first 30 months of the vaccination program we detected a 59% decline in the proportion of young resident women diagnosed with genital warts (p-trend <0.0001) and preliminary analysis indicates that this trend was ongoing in 2010. In contrast, we could not detect any significant decline in genital warts among non-resident young women, older women, or men who have sex with men. Interestingly, the proportion of younger men (<26 years in mid-2007) diagnosed with genital warts declined by 39% (p-trend <0.0001) while there was no significant decline among older heterosexual men. By 2009, 65% of resident women of free vaccine-eligible age, 15% of non-resident women of the same age, and 11% of older women reported having had a quadrivalent or an unknown HPV vaccine.
Conclusion The vaccination program has had a large population-level impact on the incidence of genital warts in young Australian women, with some flow-on benefit for young heterosexual men as a result of herd immunity.
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