School-Level Variation in Coverage of Co-Administered dTpa and HPV Dose 1 in Three Australian States
, Susan Rachel Skinner 2,3, Julia Brotherton 4,5, Handan Wand 1, Jana Sisnowski 1,6, Rebecca Lorch 1, Mark Veitch 7, Vicky Sheppeard 8,9, Paul Effler 10, Heather Gidding 11,12,13,14, Alison Venn 15, Cristyn Davies 2,3, Jane Hocking 5, Lisa J. Whop 6,16, Julie Leask 17, Karen Canfell 18, Lena Sanci 19, Megan Smith 9,18, Melissa Kang 20, Meredith Temple-Smith 19, Linda Selvey 23, add
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Round 1
Reviewer 1 Report
- School figures provided in Table 1 does not always add up. For e.g., “Remoteness classification” adds up to 1281, while Co-educational status” adds up to 1256, but results (line 233) says the figure as 1280. Please explain the discrepancies.
- Please verify if all other columns/rows add-up and if something is missing, use appropriate column/row such as “unverified” or “unavailable” or “miscellaneous”, as applicable.
- Use “vaccine coverage” after HPV in figure and table titles as applicable. Otherwise it gives a feeling as if HPV was tested and reported.
- Replace “enrollment s” in a couple of places with “enrollments”.
- If I understand figure 1 correctly, more schools (173) showed lower dTpa acceptance (< - 10%, a part of 32% lower dTap coverage) than those showed ‘hesitancy’ to HPV vaccine (132 with 10%+). Do authors have any reason why dTap acceptance is so low in these specific schools? Please comment/discuss.
- In table 2 please explain what is meant by “Ref”.
Author Response
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Author Response File: 
Author Response.docx
Reviewer 2 Report
I would like to commend the authors on highlighting the vaccination aspects in Australia.
As the authors stated, the few limitations in their are crucial in understanding the what & why questions, on a more granularity level.
I recommend the authors to mention certain aspects of the lines 375 - 377 as part of the conclusion in the abstract.
Throughout the manuscript, the authors have stated "more than 5% lower", which can lead to misinterpretation by the reader. - Please re-write
Line76: "... latter 2 also provide protection against genital warts. - is this in reference to what is mentioned in like 70 - "....90% of all cases of genital warts are caused by non-oncogenic HPV types 6 & 11." If so, please state the same, else clarify.
Line98: "....... other practical barriers." - please state a few barriers as examples
Lines 288-290: "...where HPV coverage was much lower than dTpa, the HPV coverage was much lower, than in schools where dTpa was lower," - please explain as I did not understand the author's description.
At several instances in the manuscript, the authors have stated low uptake/low initiation coverage to be a result of vaccine hesitancy. I do not agree to this statement as there may be correlation b/w the 2, but may not the only causation. - this will lead to a dangerous precedent for future such studies and can lead to misinterpretation.
Lastly, the manuscript is heavily focused on data, yet there are only 2 figures, mainly line graphs. I recommend the authors to incorporate all the valuable data captured and represented in the manuscript in various graphical forms - dot plots, scatter plots, alluvial plots, to name a few.
Author Response
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Author Response File: Author Response.docx
