Mandatory Childhood/Adolescent Immunizations (HPV)

1. Mandatory Childhood/Adolescent Immunizations (HPV) Elizabeth JunemannSarah knoll

2. CDC’s HPV (short) Video

3. Introduction • HPV infects approximately 20 million people in the United States with 6.2 million new cases each year. There is no cure for HPV, only treatment for related health problems. There are more than 30 strains of HPV that affect at least half of sexually active people in their lifetime. Most strains of HPV do not produce any symptoms and disappear on their own. Cervical cancer is the second leading cancer killer of women worldwide. In the United States, nearly 10,000 women are diagnosed with cervical cancer each year and 3,700 women die. Legislature, 2009

4. Relevance to Nursing • Nurses must be both knowledgeable about the infection itself and unbiased when providing information about the HPV vaccine. Providing concrete, clear information about the virus itself is necessary in helping patients and families make the decision to vaccinate or not. Bennett, 2008, pg. 275

5. Assessment of Healthcare Environment: Research The Advisory Committee on Immunization Practices (ACIP) has identified the following guidelines based off research and expertise: • “For females, ACIP recommends that Gardasil or Cervarix vaccination be given routinely at ages 11 or 12, although the series may be started for girls as early as 9 years of age” • “For males, ACIP recommends routine vaccination with Gardasil at ages 11 or 12 to prevent HPV infection” • "Although Gardasil and Cervarix have been found to be generally safe when given to people who are already infected with HPV, the vaccines do not treat infection and they provide maximum benefit if a person receives them before he or she is sexually active.” National Cancer Institute at the National Institute of Health, 2011

6. Assessment of Healthcare Environment: Policies/Ethics • State specific legislation determines whether or not a vaccine is mandated as a school requirement. National Conference of State Legislators, (2014). • Ethical questions arise regarding mandatory vaccination for a sexually transmitted virus. • “Controversy is grounded in moral, religious, political, economic, and sociocultural arguments including whether concerns that the vaccine increases sexual risk taking, sends mixed messages about abstaining from sexual intercourse, usurps parental authority, and increases the potential for development of new health disparities are offset by the value of administering a cost-effective, age-appropriate public health measure targeting a life-threatening problem” Vamos, McDermott, &Delay, (2008).

7. Assessment of Healthcare Environment: Financial/Resource

8. Assessment of Healthcare Environment: Nursing Practice • Nurses can play a vital role in HPV prevention through: • Educating themselves and the public on the spread of HPV • Understanding risk factors • Learning about risks/benefits of vaccination • Knowing where to guide people for vaccination • Helping the public to make educated and well informed decisions based off evidence based research (The Center for Young Women’s Health, 2012)

9. Root Cause Analysis • Contributing Factors to the Spread of HVP: • Unprotected Sex • Lack of Sex Education • Lack of knowledge regarding available vaccinations • Why this occurs: • Peer pressure • Increasing rates of sexual activity amongst teens and young adults • Misconceptions, misinterpretations, or misunderstanding of how sexually transmitted diseases are contracted or passed on. (Potter, DeVita, Vranesich,, & Boulton, 2014, pg, 1527)

10. Implications and Consequences With 6.2 million new cases identified each year, human papillomavirus is the most common sexually transmitted infection in the USA. A recent study found that HPV prevalence peaked in women ages 20–24; in this group, 44.8% of women were found to be infected. (Bendik, Mayo & Parker, 2011, pg. 461).

11. Implications and Consequences The vaccine is limited by being protective against only two of the 15 carcinogenic HPV types, the timely use of these vaccines has the potential to significantly reduce the burden of cervical cancer. The Centers for Disease Control (CDC) recommends that routine vaccination start with girls ages 11–12. Girls aging 13–26 that missed early-stage vaccination should be vaccinated preferably before beginning sexual activity. (Bendik, Mayo & Parker, 2011, pg. 461)

12. Recommendations: Quality HPV vaccine is recommended for girls ages 13 through 26 years and for boys ages 13 through 21 years, who have not yet been vaccinated. Two vaccines: Cervarixand Gardasil are available to prevent the HPV types that cause most cervical cancers and anal cancers.

13. Recommendations: Safety According to the CDC, HPV vaccines were studied in tens of thousands of people around the world. More than 57 million doses have been distributed to date, and there have been no serious safety concerns. Vaccine safety continues to be monitored by CDC and the Food and Drug Administration (FDA). These studies continue to show that HPV vaccines are safe. The most common side effects reported are mild, they include pain at the injection site, fever, dizziness, and nausea. (CDC, 2014)

14. Conclusion • Vaccinations continue to be a very controversial topic in healthcare. This is a very personal, individualized decision that parents make for their children. Numbers of confirmed HPV cases continue to rise every day in this nation. The HPV vaccination is approved and recommended by the FDA and CDC as a defense mechanism for our youth.

15. References Bendik, M., Mayo, R., & Parker, V. (2011). Knowledge, Perceptions, and Motivations Related to HPV Vaccination Among College Women. Journal Of Cancer Education, 26(3), 459-464. doi:10.1007/s13187-011-0200-8 Bennett, M. (2008). Ethics and the HPV vaccine: considerations for school nurses. Journal Of School Nursing (Sage Publications Inc.), 24(5), 275-283. CDC. (2014). Center for Disease Control. Retrieved from HPV Vaccine Safety: http://www.cdc.gov/vaccinesafety/Vaccines/HPV/index.html CDC. (2012). Center for Disease Control. Retrieved from Human Papillomavirus (HPV): http://www.cdc.gov/std/hpv/stdfact-hpv-vaccine-young-women.htm Javitt, G., Berkowitz, D., & Gostin, L. (2008). Assessing Mandatory HPV Vaccines: Who Should Call the Shots? Journal of Law, Medicine, & Ethics, 36(2). Kaiser Family Foundation. (2014). The HPV vaccine: Access and use in the U.S. Retrieved from: http://kff.org/womens-health-policy/fact-sheet/the-hpv-vaccine-access-and-use-in/ Legislature, N. C. (2009). HPV Vaccine Policies. Retrieved from NCSL website: http://www.ncsl.org/research/health/hpv-vaccine-state-legislation-and-statutes.aspx

16. References National Cancer Institute at the National Institute of Health (2011). Human Papillomavirus (HPV) vaccines. Retrieved from: http://www.cancer.gov/cancertopics/factsheet/prevention/HPV-vaccine#r10 National Conference of State Legislators. (2014). HPV vaccine policies. Retrieved from: http://www.ncsl.org/research/health/hpv-vaccine-state-legislation-and-statutes.aspx#2013-2014 chart Potter, R. C., DeVita, S. F., Vranesich, P. A., & Boulton, M. L. (2014). Adolescent Immunization Coverage and Implementation of New School Requirements in Michigan, 2010. American Journal Of Public Health, 104(8), 1526-1533. doi:10.2105/AJPH.2014.301910 The Center for Young Women’s Health. (2012). HPV vaccine. Retrieved from: http://youngwomenshealth.org/clinicians/hpv-vaccine-nurses/ Vamos, C.A., McDermott, R.J., Daley, E.M. (2008). The HPV vaccine: Framing the arguments for and against mandatory vaccination of all middle school girls. The Journal of School Health 78(6), 302-309. doi: 10.1111/j.1746-1561.2008.00306