Effect of restrictions placed by schools on HPV vaccine uptake, British Columbia

Background: In British Columbia (BC), public health nurses immunize school-age students through school-based programs. In the first two years of the human papillomavirus (HPV) immunization program for grade 6 and 9 girls, uptake was 20% lower than for other vaccines. We examined whether this was due to restrictions by schools. Purpose: To quantify the nature, extent and effects of schools' restrictions on the HPV program. Methods: Health regions completed a standardized survey asking about schools' restrictions to the delivery of grade 6 and 9 immunization programs in 2009/10. Results: 15 of BC's 16 (93.8%) health regions responded. One hundred schools (4.7% and 7.6% of grade 6 and 9 enrollment) had at least one restriction. The most common restriction (82 schools; 3.9% and 6.0% of grade 6 and 9 enrollment) was prohibiting mature minor consent. Most of these applied restrictions to all immunizations. Among the 17 schools targeting only HPV, the most common restriction (41%) was distributing information opposing immunization. Schools with restrictions for all immunization programs had significantly higher coverage rates for non-HPV vaccines and non-statistically significant lower HPV coverage rates (grade 6: 58.3% vs. 60.9%, p=0.123; grade 9: 56.5% vs. 58.2%, p=0.284). Schools with restrictions only to HPV had significantly lower HPV coverage rates (grade 6: 36.3% vs. 60.9%, p<0.001; grade 9: 43.1% vs. 58.2%, p<0.001), and significantly lower coverage rates for other grade 9, but not grade 6, immunizations. Conclusion: Restrictions placed by schools play only a minor role in low HPV uptake in BC.