Intended for healthcare professionals


Uptake of first two doses of human papillomavirus vaccine by adolescent schoolgirls in Manchester: prospective cohort study

BMJ 2008; 336 doi: (Published 08 May 2008) Cite this as: BMJ 2008;336:1056
  1. Loretta Brabin, reader in women’s health1,
  2. Stephen A Roberts, senior lecturer in statistics2,
  3. Rebecca Stretch, research nurse1,
  4. David Baxter, consultant in communicable diseases3,
  5. Gloria Chambers, programme manager screening failsafe4,
  6. Henry Kitchener, professor of gynaecological oncology1,
  7. Rosemary McCann, consultant in communicable diseases5
  1. 1Academic Unit of Obstetrics and Gynaecology, St Mary’s Hospital, University of Manchester, Manchester M13 OJH
  2. 2Health Methodology Research Group, University of Manchester
  3. 3Public Health Department, Stockport Primary Care Trust, Stockport
  4. 4Public Health Department, Bury Primary Care Trust, Bury
  5. 5Greater Manchester Health Protection Unit, Eccles
  1. Correspondence to: L Brabin loretta.brabin{at}
  • Accepted 1 April 2008


Objective To assess the feasibility and acceptability of delivering a human papillomavirus (HPV) vaccine to adolescent girls.

Design Prospective cohort study.

Setting 36 secondary schools in two primary care trusts in Greater Manchester, United Kingdom.

Participants 2817 schoolgirls in year 8 (12 and 13 year olds).

Intervention Delivery of the bivalent vaccine at 0, 1, and 6 months over one school year.

Main outcome measures Vaccine uptake for doses 1 and 2 of a three dose schedule.

Results Vaccine uptake was 70.6% (1989/2817) for the first dose and 68.5% (1930/2817) for the second dose. Uptake was significantly lower in schools with a higher proportion of ethnic minority girls (P<0.001 for trend) or higher proportion of girls entitled to free school meals (P=0.029 for trend). The main reason for parents’ refusal of vaccination was insufficient information about the vaccine and its long term safety. Maintaining the vaccine schedule was challenging as 16.3% (dose 1) and 23.6% (dose 2) of girls missed their vaccination day and had to be offered alternative appointments. No serious adverse events were reported.

Conclusion Delivery of the first two doses of HPV vaccine to adolescent schoolgirls is encouraging, but the success of the vaccination programme depends on high coverage for the third dose.


  • We thank staff of the primary care trust and school for working against a tight timescale to bring this project to fruition and the education departments of the two councils for providing school census data.

  • Contributors: LB conceived the study and wrote the paper. She is guarantor. SAR designed the study and analysed the data. RS managed the study, collected the data, and contributed to the analysis; DB and GC implemented the vaccination programme. HK commented on the analysis and revisions to the paper. RMcC facilitated the research, chaired the steering committee, and commented on the paper.

  • Funding: This study was sponsored by the University of Manchester. Vaccine delivery was the responsibility of the primary care trusts. GlaxoSmithKline funded the research and implementation costs and provided the vaccine. The authors’ work was independent of the funders, who played no part in the conduct of the research or vaccine delivery. LB is funded by the Max Elstein Foundation.

  • Competing interests: LB and HK have received research funds, conference fees, and honorariums for speaking at meetings sponsored by GlaxoSmithKline.

  • Ethical approval: This study was approved by the north Manchester National Health Service research ethics committee.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

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