Intended for healthcare professionals

Rapid response to:


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

Rapid Response:

An encouraging trial

An uptake of nearly 70% for two doses of vaccine in a pilot programme such as this is very encouraging.

This trial was performed before the national education programme had started, and therefore at a time when relatively few members of the public will have been aware of the vaccine or its benefits. It is to be hoped that when the national programme begins, following and accompanied by well -designed health promotion materials explaining the reason for the vaccination, an even higher uptake will be possible.

The authors correctly state that "The effectiveness of the national immunisation programme depends on good coverage." It is true, of course, that the effect on the overall cancer burden is dependent on the uptake of the vaccine. The more people who reduce their chances of getting cervical cancer by 70%, the smaller the number of cases we can expect. But it is also true that the benefit to the recipients of the vaccine is NOT dependent on anybody else getting the vaccine: those girls who are vaccinated will (as long as they haven't already been infected with the virus) be reducing their odds of getting cervical cancer by about 70%. Of course, if enough people are vaccinated, there will be a herd immunity effect; but that must be considered a bonus.

As another respondent has implied, three doses of vaccine are required to obtain maximum benefit; but on the other hand, there is evidence from "intention to treat" studies that two doses provide a good antibody response in most patients. Indeed, it is quite possible that the schedule might be changed to a two-dose schedule - although I hasten to point out that this is, at this point, speculation. Furthermore, since the vaccine manufacturers will presumably sell less vaccine if this is the case, accumulating the evidence necessary for making this change will probably need to be done via state-funded studies and/or evaluations of the vaccination programme.

Competing interests: I have received payment from vaccine manufacturers for participation in boards to discuss how to implement HPV vaccination, and for speaking at meetings, and funding to attend the European Society for Paediatric Infectious Disease conference.

Competing interests: No competing interests

02 May 2008
Peter M English
Public Health Physician
Surrey KT19 9XF