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Dana H. Greenwood Chief Nurse Consultant Immunization Division IN State Dept Health

You are the Key to HPV Cancer Prevention Understanding the Burden of HPV Disease, the Importance of the HPV Vaccine Recommendation, and Communicating about HPV Vaccination. Dana H. Greenwood Chief Nurse Consultant Immunization Division IN State Dept Health November 7, 2014.

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Dana H. Greenwood Chief Nurse Consultant Immunization Division IN State Dept Health

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  1. You are the Keyto HPV Cancer PreventionUnderstanding the Burden of HPV Disease, the Importance of the HPV Vaccine Recommendation, and Communicating about HPV Vaccination Dana H. Greenwood Chief Nurse Consultant Immunization Division IN State Dept Health November 7, 2014

  2. Disclosure • I have not financial disclosures or conflicts of interest

  3. Objectives 1. Describe the burden of HPV infection in the United States 2. Share best practices for talking with parents about the HPV vaccine

  4. HPV Rate Girls: 54.1% (series initiation) 34.6% (series completion) HPV Rate Boys: 18.2% (series initiation) 8.1% (series completion)

  5. Understanding the Burden HPV Infection & Disease

  6. HPV Types Differ in their Disease Associations Mucosal sites of infection Cutaneous sites of infection ~ 80 Types ~40 Types High risk (oncogenic)HPV 16, 18 Low risk (non-oncogenic)HPV 6, 11 Cervical Cancer Anogenital Cancers Oropharyngeal Cancer Cancer Precursors Low Grade Cervical Disease Genital Warts Laryngeal Papillomas Low Grade Cervical Disease “Common” Hand and Foot Warts

  7. HPV Infection • Most females and males will be infected with at least one type of HPV at some point in their lives • Estimated 79 million Americans currently infected • 14 million new infections/year in the US • HPV infection is most common in people in their teens and early 20s • Most people will never know that they have been infected Jemal A et al. J Natl Cancer Inst2013;105:175-201

  8. Cancers Attributed to HPV, U.S. CDC, United States Cancer Statistics (USCS), 2006-2010

  9. Average Number of New Cancers Probably Caused by HPV, by Sex, United States 2006-2010 Penisn=7008% Vaginan=6003% Vulva n=2,200 13% Anusn=2,60015% Anusn=1,40015% Oropharynxn=1,80010% Oropharynxn=7,20077% Cervixn=10,40059% Men (n = 9,300) Women (n = 17,600) CDC, United States Cancer Statistics (USCS), 2006-2010

  10. Evidence-Based HPV Prevention HPV Vaccine

  11. HPV Prophylactic Vaccines • Recombinant L1 capsid proteins that form “virus-like” particles (VLP) • Non-infectious and non-oncogenic • Produce higher levels of neutralizing antibody than natural infection HPV Virus-Like Particle

  12. HPV Vaccine

  13. ACIP Recommendation and AAP Guidelines for HPV Vaccine • Routine HPV vaccination recommended for both males and females ages 11-12 years • Also ages 13-21 years for males; 13-26 for females • Vaccine can be given starting at age 9 years of age for both males and females; vaccine can be given ages 22-26 years for males CDC. Quadrivalent Human Papillomavirus Vaccine: Recommendations of ACIP. MMWR 2007;56(RR02):1-24.

  14. HPV Vaccination Schedule • ACIP Recommended schedule is 0, 1-2*, 6 months • Following the recommended schedule is preferred • Minimum intervals • 4 weeks between doses 1 and 2 • 12 weeks between doses 2 and 3 • 24 weeks between doses 1 and 3 • Administer IM CDC. Quadrivalent Human Papillomavirus Vaccine: Recommendations of ACIP. MMWR 2014;63(RR05):1-30.

  15. HPV Vaccine Is Safe, Effective, and Provides Lasting Protection • HPV Vaccine is SAFE • Safety studies findings for HPV vaccine similar to safety reviews of MCV4 and Tdap vaccines • HPV Vaccine WORKS • Vast reductions in high grade cervical lesions decline in Australia • 80% of school aged girls vaccinated • Prevalence of vaccine types declines by more than half in US • With only 33% of teens fully vaccinated • HPV Vaccine LASTS • Studies suggest that vaccine protection is long-lasting; no evidence of waning immunity Garland et al, Prev Med 2011; Ali et al, BMJ 2013; Markowitz JID 2013; Nsouli-Maktabi MSMR 2013

  16. HPV Vaccine coverage

  17. Adolescent Vaccination CoverageUnited States, 2006-2013 MMWR 2014; 63(29);625-633.

  18. Missed Opportunities: IndianaFemales Only

  19. HPV Vaccine Series InitiationGirls 13-17 Years, by State, 2013

  20. Top 5 reasons for not vaccinating daughter, among parents with no intention to vaccinate in the next 12 months, NIS-Teen 2013 13% CDC. National and State Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2012 MMWR 2014; 63(29);625-633.

  21. Talking about HPV vaccine Framing the conversation

  22. The Conversations with Parents • Give a STRONGrecommendation • Start conversation early and focus on cancer prevention • Offer a personal story • Welcome questions from parents, especially about safety

  23. Framing the HPV Vaccine Conversation

  24. Bundle Them Up! • Successful recommendations group all of the adolescent vaccines • Recommend HPV vaccine the same wayand on the same dayyou recommend Tdap and meningococcal vaccines. • A strong recommendation from you is the main reason parents decide to vaccinate • Many parents responded that they trusted their child’s doctor and would get the vaccine for their child as long as they received a recommendation from the doctor Unpublished CDC data, 2013.

  25. Surely, this kid isn’t going to be having sex anytime soon, right? Guess again. • 47% of high school students have already engaged in sexual intercourse (vaginal-penile) • 6% of these students had sexual intercourse before age 13 years • 1/3 of 9th graders and 2/3 of 12th graders have engaged in sexual intercourse • 1 in 7 high school students (all grades) have had sexual intercourse with 4 or more partners Jemal A et al. J Natl Cancer Inst 2013;105:175-201 Kahn. MMWR. 2014; 63(4)

  26. Rationale for vaccinating early: Protection prior to exposure to HPV

  27. HPV VaccineDuration of Immunity • Studies suggest that vaccine protection is long-lasting; no evidence of waning immunity • Available evidence indicates protection for at least 8-10 years • Multiple cohort studies are in progress to monitor the duration of immunity Romanowski B. Long term protection against cervical infection with the human papillomavirus: review of currently available vaccines. Hum Vaccin. 2011 Feb;7(2):161-9.

  28. Resources for HPV vaccine conversations Communication Tools

  29. “You Are the Key” HPV portal for Providers cdc.gov/vaccines/YouAreTheKey

  30. Factsheets Resources for Patients • cdc.gov/vaccines/who/teens/products/print-materials.html

  31. Adolescent Immunization Schedule Resources for Patients cdc.gov/vaccines/schedules/easy-to-read/preteen-teen.html

  32. Vaccines for Preteens and Teens Website cdc.gov/vaccines/teens Resources for Patients

  33. Acknowledgments • A BIG thank you to the CDC’s adolescent vaccination team for contributing the slides for today’s presentation!

  34. And YOU are the key! HPV VACCINE IS CANCER PREVENTION #WeCanStopHPV

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