1. Massachusetts HPV Vaccination Initiative Update MDPH 2014 1 HPV Summitt November 7, 2014 Susan M. Lett, MD, MPH Medical Director, Immunization Program Massachusetts Department of Public Health

2. Disclosure Slide I, Susan Lett, have been asked to disclose any significant relationships with commercial entities that are either providing financial support for this program or whose products or services are mentioned during my presentations. I have no relationships to I may talk about off-label recommendations for HPV vaccine in a manner not approved by the U.S. Food and Drug Administration But in accordance with the recommendations of CDC’s Advisory Committee on Immunization Practices (ACIP)

3. MDPH 2014 MA HPV Initiative Activities 1.Development of statewide joint initiative with partners and stakeholders 2.Educating healthcare providers about burden of HPV disease, HPV vaccine schedule, evidence-based strategies 3.Implementation of media campaign targeting parents 4.Training and supporting a subset of providers to pilot the MIIS (MA Immunization Registry) to use immunization coverage reports and to use reminder/recall MDPH one of 11 states initially funded by CDC. MDPH 2014 3

4. Statewide Joint HPV Vaccine Initiative Partners and stakeholders from 29 external organizations – More than 100 members on group email – Wide variety of organizations: professional associations, non-profits, hospitals, universities – Build on work done in 1 st HPV Summit in 2013 Strong partnership with MCAAP & MA League of Community Health Centers – AAP grant to MCAAP for HPV vaccination activities New MA Coalition for HPV/ Cervical Cancer Awareness New federal funding just awarded to several national organizations Activity 1. MDPH 2014 4

5. HPV page on MA Chapter of the AAP website and 4 webinars Grand rounds, seminars including residents & students Other in-person events such as conferences and annual meetings Electronic distribution of information: newsletters, websites, journals, blogs, etc. 2 nd Annual HPV/Cervical Cancer Summit at Dana Farber Cancer Institute on November 7th HPV Educational Activities Total of 50 events reaching more than 2,700 individuals!! Activity 2. MDPH 2014 5

6. 6 Evidence-Based Strategies to Improve HPV Vaccine Rates Strong, clear, routine recommendation for HPV vaccine at 11-12 years Assess and vaccinate at every visit Use reminder/recall systems Assessment and feedback Standing Orders Immunization Champion Overdue: HPV-2 Tdap Activity 2. http://www.thecommunityguide.org/about/methods.html MDPH 2014

7. Flyer available at: https://mcaap.org/immunization-hpv/https://mcaap.org/immunization-hpv/ URGENT CALL TO PREVENT CANCER TAKE THE HPV VACCINE CHALLENGE MDPH 2014 7 Start your vaccine discussions with all 11-12 year-olds and their parents by saying: “ Your child needs 3 vaccines today – HPV, Tdap and meningococcal.”

8. Dr. Rebecca Perkins’ MMS Physician Focus October 2014 MDPH 2014 Audience both general public and providers Half hour cable TV segment Broadcast on public access stations in 275 communities in MA Also distributed nationally 8 MMS Link: http://www.hcam.tv/physician-focushpv National ACOG Link: http://www.immunizationforwomen.org/resources /education MMS Link: http://www.hcam.tv/physician-focushpv National ACOG Link: http://www.immunizationforwomen.org/resources /education

9. ACOG Immunization for Women Website HPV Tool Kit: http://www.immunizationforwomen.org/immunization_facts/ vaccine-preventable_diseases/hpv Article in Aug. 2014 Pediatrics. Missed Opportunities for HPV Vaccination In Adolescent Girls: A Qualitative Study. Perkins, Clark, Apt, Sumner, Wall-Haas, Rosenquist and Pierre-Joseph.

10. 10 HPV Media Campaign Campaign ran during June 2014 Primary target: parents of adolescents with focus on Hispanic & African American audiences Primary g oal: increase awareness of importance of HPV vaccine to prevent cancer Mechanisms – TV & radio 30 second ads – reached >2.4 M people – Tweeting complemented the ads Activity 3.

11. Close the Door to Cancer: AN Animated PSA that illustrates the numbers associated with HPV related infections and cancers. Why HPV Vaccine is Important: We have three separate PSA’s one from a survivor, one from an English speaking pediatrician, and one from a Spanish speaking physician. Each of these PSAs talks about why HPV vaccine is so important. Each runs about 30 seconds. MA used this PSA. Video PSAs

12. HPV Media Campaign, cont. Social Media: Twitter #vaccineagainstcancer MDPH has an estimated over 18,000 twitter followers Most popular tweet was: Total number of impressions (defined as number of times users saw the tweet) was 28,673 – much greater than we anticipated!! If there were a #vaccine against #cancer wouldn’t you get it for your child? There is its #HPV vaccine: http://ow/ly/xxsBw http://ow/ly/xxsBw If there were a #vaccine against #cancer wouldn’t you get it for your child? There is its #HPV vaccine: http://ow/ly/xxsBw http://ow/ly/xxsBw Activity 3. MDPH 2014 12

13. MA Parent Teacher Association – Health Committee Have embraced HPV vaccination education for parents Presentations given and materials distributed at various state and regional chapter meetings Several youth activities – HPV session held with Kids United by Service (KUBS): high school student leaders bring info back to their peers – First MA Youth Summit on 11/8: leadership & advocacy training to prepare youth leaders to mobilize their peers around specific issues in their school & community. Activity 3.

14. Using the MA Immunization Information System (MIIS) Pilot of 10 CHCs and 10 pediatric practices will receive technical assistance and training to: – Run practice-based adolescent vaccination coverage reports – Generate reminder/recall materials for adolescents due and overdue for adolescent vaccines – “Using the MIIS to Improve HPV Rates in Your Practice” Webinar 10/9/14 and Workshop at MIAP 10/24/14 – Assessments began in October Activity 4. MDPH 2014 14

15. Where Are We Now and What Lies Ahead? MDPH 2014 15 NIS Data CDC HPV Quarterly Reports CDC Funding of New Initiatives New MA Coalition for HPV/ Cervical Cancer Awareness

16. Adolescent Vaccination Coverage United States, 2006-2013 MMWR 2014; 63(29);625-633. MDPH 2014 16

17. Adolescent Vaccination Coverage, Massachusetts, 2008 – 2013 NIS Data, CDC *Data for 3 HPV in males only available in 2013 MDPH 2014 In MA, 176,000 teens have not received ANY doses of HPV vaccine: About 4 in 10 girls and 5 in 10 boys. 17

18. HPV Missed Opportunities in Massachusetts, 2013 NIS Teen 100% of girls who were unvaccinated against HPV had a missed opportunity (MO). 100% of girls could have started the series if MO’s were eliminated. CDC. HPV Quarterly Report 10-14

19. CDC Federal Funding of 6 New Projects Academic Pediatric Association – Promote partnerships, provide training of providers and for faculty for primary care pediatric residents – https://www.academicpeds.org/ https://www.academicpeds.org/ American Academy of Pediatrics – Outreach, education and training for pediatric offices, includes QA activities, interface with immunization registries and outreach to state AAP chapters – http://www2.aap.org/immunization/http://www2.aap.org/immunization/ American Cancer Society – Increase rates at safety net clinics and CHCs by identifying best interventions and outreach to state health departments and other state agencies – www.cancer.org www.cancer.org American Cancer Society – Roundtable Project – Will convene a network of organizations involved with cancer prevention, immunization, healthcare delivery, public health and other stakeholders. Pilot projects will focus on overcoming barriers in priority areas – www.cancer.org www.cancer.org MDPH 2014 19

20. National Area Health Education Centers (AHEC) Network – Will develop and provide training to clinicians across disciplines nationwide, work with state health departments, inventory resources and develop what is needed – http://www.nationalahec.org/ http://www.nationalahec.org/ National Association of City and County Health Officers (NACCHO) – Build capacity for local health departments to implement HPV recommendations – http://www.naccho.org/ http://www.naccho.org/ 20 CDC Federal Funding, cont. 11 more states/projects just received funding for HPV initiatives for a total of 22.

21. MA Coalition for HPV/Cervical Cancer Awareness Comprised of advocates, health care professionals, agencies, and stakeholders Ensure MA continues to be a leader in HPV vaccine uptake to decrease HPV-related cancers 21 15-40 Connection American Cancer Society-New England Division BC/BS of Massachusetts Boston Public Health Commission Brigham and Women’s Hospital Cape Cod Healthcare Dana-Farber Cancer Institute MA Caucus of Women Legislators MA Department of Public Health MA Commission on the Status of Women MA Chapter - American Academy of Pediatrics MA League of Community Health Centers Coalition website has been donated by Team Maureen. Learn more or join at: TeamMaureen.org Pediatrics West Salem State University Sociedad Latina Team Maureen UMass Memorial Children’s Medical Center Yellow Umbrella Organization Current Members

22. MDPH 2014 CDC “You Are the Key” Website http://www.cdc.gov/vaccines/who/tee ns/for-hcp/hpv-resources.html http://www.cdc.gov/vaccines/who/tee ns/for-hcp/hpv-resources.html 22 Reviews HPV materials from reliable websites and has quick links to key materials: http://mcaap.org/immunization- hpv/ MA Chapter of the AAP “HPV Vaccine Initiative” Website

23. Immunization Program Main Number For questions about immunization recommendations, disease reporting, etc. Phone: 617-983-6800 Fax: 617-983-6840 Website: www.mass.gov/dph/immwww.mass.gov/dph/imm MIIS Help Desk Phone: 617-983-4335 Fax: 617-983-4301 Email: miishelpdesk@state.ma.usmiishelpdesk@state.ma.us Websites: www.contactmiis.info | www.mass.gov/dph/miiswww.contactmiis.infowww.mass.gov/dph/miis MDPH Vaccine Unit Phone: 617-983-6828 Fax: 617-983-6924 Email: dph-vaccine-management@state.ma.usdph-vaccine-management@state.ma.us Website: www.mass.gov/dph/imm (click on Vaccine Management)www.mass.gov/dph/imm MDPH Immunization Program Contact Information 23

24. 24 THANKS FOR ALL YOU DO!!!