1. + Head to Toe and Places in Between April 21, 2016 Lance Chilton, MD Winona Stoltzfus, MD

2. + Places in Between HPV TdaP

3. + Places in Between, with Dr. Stoltzfus Men ACWY Men B

4. + Let’s talk about the Adolescent Platform

5. + Adolescent Platform = 11-12 years Lots going on in middle school! Talk about sex, drugs, rock and roll (and family relationships, hunger, suicide risk…) Waning immunity to tetanus, diphtheria and pertussis Precede exposure to HPV Best immune response to HPV vaccine Higher risk of meningococcal disease (late adolescence) WHY?

6. + TdaP = tetanus, diphtheria and (acellular) pertussis

7. + We’re doing pretty well with TdaP, but… HPV3-M

8. + So, let’s talk about HPV vaccine If there were a vaccine against cancer, wouldn’t you want it for your child?

9. + No one (well, almost no one) doubts that HPV causes cancer And not just in females!

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11. + Make an Effective Recommendation Same way: Effective recommendations group all of the adolescent vaccines Recommend HPV vaccination the same way you recommend Tdap & meningococcal vaccines. Same day: Recommend HPV vaccine today Recommend HPV vaccination the same day you recommend Tdap & meningococcal vaccines. Don’t apologize!

12. + What do parents want to know? My child is at risk if she/he doesn’t get the vaccine. The vaccine is safe. The vaccine is effective. The vaccine is affordable.

13. + The Meningococcal Maze

14. + Meningococcal Disease Rare but devastating infection Vaccines targeted for age groups at higher risk

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16. + Types of Meningococcal Vaccines or Alphabet Soup Vaccines Conjugate Quadrivalent (ACWY) Menactra, Menveo C, Y and Hib MenHibrix Polysaccharide Menomune Serogroup B Trumenba, Bexsero

17. + Who Needs Protection? Meningococcal vaccination recommended for all preteens and teens Quadrivalent Meningococcal Conjugate Vaccine All 11 to 12 year olds should be vaccinated with a single dose of a quadrivalent with a booster dose at age 16 Serogroup B meningococcal vaccine Teens and young adults (16 through 23 year olds) may also be vaccinated with a (Bexsero® or Trumenba®), Preferably at 16 -18 years old Two or three doses are needed depending on the brand People ages 10-18 years old at increased risk of meningococcal disease need serogroup B vaccine

18. + Lance Winona Role Play

19. Ms. Aurelia Sánchez 38 y.o. mother of Sara, age 7 Saúl, age 9 Linda, age 11 Generally healthy Highly intelligent, well- educated Committed to protecting her children Dr. Nadir Irawaddi 47 y.o. physician Married, father of Bijay, age 15 Neema, age 18 Highly intelligent, well- educated Committed to prevention of disease A little play