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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

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Clarification on effect of ethnicity would be welcome


The publication of the article by Brabin et al on uptake of human papillomavirus (HPV) vaccine by schoolgirls[1] is timely, as it precedes the introduction of the national HPV vaccine programme in the UK this autumn.

One of the most striking findings in this study was the apparent effect of ethnicity on compliance with vaccination. It was observed that "Vaccine uptake was significantly lower in schools with a higher proportion of girls from ethnic minority groups (P<_0.001 for="for" trend.="trend." this="this" statistically="statistically" significant="significant" finding="finding" was="was" referred="referred" to="to" in="in" the="the" accompanying="accompanying" editorial="editorial" which="which" also="also" highlighted="highlighted" possible="possible" effect="effect" of="of" religion="religion" on="on" uptake2="uptake2" as="as" two="two" schools="schools" declined="declined" participate="participate" study="study" religious="religious" grounds.="grounds." p="p"/> However, this apparent effect of ethnicity on vaccine uptake is not as clear-cut as it first seems. One can only infer from the article that schoolgirls from "ethnic minority groups" have a lower vaccine uptake, at least this is what Brabin and colleagues appear to imply.

Assuming that it is a valid inference, the effect of ethnicity and possibly religion on vaccine uptake are potentially important findings. They suggest that the successful implementation of the national HPV vaccine programme may vary across the UK, depending upon local variation in demography. Thus it was disappointing that the authors did not provide a more detailed exposition of their findings. One wonders whether the reduced uptake was uniform across all ethnic minorities or not. The last UK population Census contained no less than 16 ethnic groupings[3]. The collective term "ethnic minority" lacks precision; more detail would be welcome.

It is not clear whether the research questionnaire gathered data on ethnicity on an individual basis or not. Presumably this data was not gathered or it would have been presented. This is a pity if this was the case as this information would have been very helpful to the authorities which must introduce the vaccine, especially in cities like London for example, where in 2003, about 40% of the population was not classified as "White British"[4].

Clearly, if the Manchester experience in relation to ethnicity and HPV vaccine uptake is reproduced in cities like London, public health officials will have a mountain to climb.

With respect to religion, it would be very interesting to know the religious affiliation of the two schools which declined to take part in the study on religious grounds. Again, this information would be of use to those whose responsibility it is to implement this new vaccine.

I hope the authors are in a position to clarify the situation as regards ethnicity and reveal the religious affiliation of the two non- participating schools as that would certainly add to an already valuable piece of work.


1. Brabin L, Roberts SA, Stretch R et al Uptake of first two doses of human papillomavirus vaccine by adolescent schoolgirls in Manchester. prospective cohort study. BMJ 336:1056-1059

2. Waller J, Wardle J. HPV vaccination in the UK. BMJ 336:1028-1029

3. Bosveld K, Connolly H, Rendall MS. A guide to comparing 1991 and 2001 Census ethnic group data. Office of National Statistics 2006 available at: (accessed 09/05/08)

4. Large P, Ghosh K. Estimates of the population by ethnic group for the areas within England. Population Trends 2006;124:8-17

Competing interests: None declared

Competing interests: No competing interests

12 May 2008
Gee Yen Shin
Locum Consultant Virologist
Infection and Immunology Unit, 5th Floor, North Wing, St Thomas' Hospital, London SE1 7EH