1. Human Papillomavirus (HPV)
Increasing Vaccination Rates for Human Papillomavirus
BY: April bickham

2. What is HPV?

4. What is HPV? QUICK FACTS! Why NOT get vaccinated? ONLY
6.9 % males (2012)
16.6 % females (2008)
were vaccinated
QUICK FACTS!
Most commonly sexually transmitted infection in USA.
SO COMMON THAT ALMOST ALL SEXUALLY ACTIVE MEN AND WOMEN GET IT AT SOME POINT IN THEIR LIVES!
Cancer takes years to develop after being infected w/ HPV
Types of HPV that cause warts are different than those that cause cancer
>11,000 women in U.S. get cervical cancer each year.
HPV most common cause for cervical cancer
Why NOT get vaccinated?
No reason!
Reduce cancer risk/ rate
Cancer can be prevented with vaccination!
Early vaccination= allows body to build immune response B4 sexual activity
In most cases, HPV goes away on its own. However, it can cause genital warts and cancer.
~12,000 women per year get cervical cancer- 4,000 die from it- HPV VACCINE can PREVENT this!!!!
In the U.S., HPV infections cause over 17,000 cancers in women, and over 9,000 cancers in men each year.
females y.o. (16.6%, 2008) and males same age (6.9%, 2012)

5. Survey Data: Adolescents 13 through 17 Years of Age HPV Vaccine
For girls ages 13-17, coverage with at least one dose of HPV vaccine increased by 3.3 percentage points from 2013 to 2014 (56.7% in 2013 vs. 60.0% in 2014).
Coverage with each HPV vaccine dose was higher among Hispanic girls than among white girls; coverage with one and two doses of HPV vaccine was higher among black girls than among white girls.
Coverage with each HPV vaccine dose was higher among girls living below the poverty level compared with those living at or above the poverty level.
For boys ages 13-17, coverage with at least one dose of HPV vaccine increased by 8.1 percentage points from 2013 to 2014 (33.6% in 2013 vs 41.7% in 2014).
Coverage with each HPV vaccine dose was higher among Hispanic boys than among white boys; and coverage with one dose of HPV vaccine was higher among black boys than among white boys.
Coverage with each HPV vaccine dose was higher among boys living below the poverty level compared with those living at or above the poverty level.
There was wide variation in HPV vaccination coverage at the state level.
For girls, state-level coverage with at least one dose of HPV vaccine ranged from 38.3% in Kansas to 76.0% in Rhode Island.
For boys, state-level coverage with at least one dose of HPV vaccine coverage ranged from 23.2% in Indiana to 69.0% in Rhode Island.
Community Health Clinics better at advocating vaccination than regular clinics?

6. 2 1 4

7. Healthy People 2020
Goal:
TARGET: 80% vaccination rate for the 3-dose vaccine
in 2020

8. Myths: BUSTED! Myth Truth
Early protection/ vaccination = better protection, build immune response- kids are going to eventually grow up and have sex, we want them to be immune before then…vaccine wont cause ^ interest in sex.. Emphasize vaccine’s ability to prevent cancer, not that it’s an STD.
Not true, it has been studied carefully, no serious safety concerns linked
Most common STD, give them stats!
Getting child vaccinated at an early age = increased interest in sexual activity/ will make my child think they are safe from all STDs
People have died from that vaccine!
It’s not a required vaccine, so it must not be important…
Need to educate child about the facts, what is the purpose?...to prevent cancer!!!

9. HPV Vaccine “Gardasil-9”
New: FDA-approved December 2014
Could prevent 90% of all cervical cancers if every uninfected person gets vaccinated
Protects against most common cancer-causing HPV strains: 16, 18
HPV Vaccine “Gardasil-9”
3-dose series
Over 6 months
2nd and 3rd dose given 1-2 months & 6 months after 1st dose
Routine: y.o OR Can be given: ages 9- 26
FINISH ENTIRE SERIES FOR BEST PROTECTION
Not recommended for pregnant women, but no reason to expect problems if get vaccine before discovering pregnancy
Don’t give w/current moderate or severe illness
Strain: 6, 11, 16, 18, 31, 33, 45, 52 and 58
Efficacy for preventing precancerous lesions for both vaccines is greater than 92% in women who have not been previously infected
Clinical trials show that HPV vaccines are effective for at least five to six years (the duration to date, based on follow-up data from the major trials), but they are likely to be effective for much longer.

10. Other HPV vaccines Cervarix Gardasil-4 Protects only against 2 strains
16, 18
FDA-approval: 2006
Protects against 4 of strains of HPV
2 of which cause 70% of all cervical cancer cases (16 ,18)
2 others that cause 90% of all genital warts (6, 11)

12. Why the gap in % between girls & boys?
HPV vaccine approved for boys at later date: Oct 2009

13. Provider-Patient/ Parent Dialogue
Educate
Emphasize Personal Belief
Dispel myths &
Address Barriers
What is HPV?
What are the consequences of not getting vaccinated?
HPV can prevent cervical, vaginal and anal cancers as well as genital warts
Studies in US & other countries have shown a decrease in HPV infection
Is HPV common?
- Almost everyone gets it!
EMPHASIZE HOW YOU ,AS A HEALTH CARE PROVIDER, BELIEVE IN THE HPV VACCINE. IT HELPS PARENTS FEEL CONFIDENT IN THEIR DECISION AND THEY FEEL LIKE THEY CAN TRUST YOU
Tell them that the American Academy of Pediatrics, cancer doctors and the CDC believe that the vaccine is essential to prevent cancer.
Reassure them that the vaccine has been carefully studied by experts and that it’s shown to be very effective and safe.
The only side effects = slight pain and redness.
No long term side effects have been seen.
Since 2006, 57 million doses given in the US
No serious safety concerns have been identified

14. Tips: HPV & Approaching Parents
Stress CANCER PREVENTION : “HPV vaccine prevents cancer, and I want your child to be protected from cancer. Therefore, I think your child should get their first dose today.”
Why start the vaccine at years old? : “We want your child to be protected long before they become sexually active. Just like the measles vaccine, we want them to get vaccinated long before exposure.”
But vaccinating my child will make them think they have permission to have sex : “Research has shown that getting the vaccine does not lead to kids having sex at a younger age”
The chances of my child getting HPV are low because they aren’t the type of child to get an STD : “HPV is so common that almost everyone will become infected at some point in their lives; Even if they wait to have sex until they’re married, their partner could have been exposed and transfer it to them.”
Emphasize personal belief: “My son/ daughter received the HPV vaccine as well as my nieces, nephews…etc.”
Remind parents that it’s a 3-dose series : Important so that they remember to come back at 2 and 6 months after 1st dose = have the best protection against HPV
Centers for Disease Control & Prevention. (2015). Tips and time-savers for talking with parents about HPV vaccine. Retrieved from

15. 11-12 year olds Any youth < or = 26 yo Remember:
Simple answers about cancer prevention and personal testimonials work best.
Recommend HPV vaccine at every opportunity, including well and sick visits.
11-12 year olds
Any youth < or = 26 yo
Ask if they’ve had the vaccine
Do they know what the vaccine can prevent?
Dispel Myths
Ensure that vaccine is safe
Educate
Lightbulb should go off in your head as HCP year old = time to bring up HPV vaccine, better to get them vaccinated before exposed to sex

16. You should know about the Gardasil horror stories.
Once you have seen what parents may or may not have seen, you may be able to impart your knowledge in a better way and present the HPV vaccine in a more acceptable way than you would have if you had never seen….

17. Unanswered Q’s booster necessary?
ARE 3-DOSE VACCINES NECESSARY, OR IS PROTECTION REACHED WITH FEWER DOSES?
Is the current dosing schedule best regimen?

18. References http://www.rho.org/about-cervical-cancer.htm
more-HPV-types
htm
provedProducts/UCM pdf
objectives/topic/immunization-and-infectious-diseases/objectives