Texas Department of State Health Services

2. Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the US There are about 40 types of HPV + 20 million people are infected in the US + 6.2 million new infections annually Spread through sexual contact +10,000 women get cervical cancer in the US 3,700 die annually 2nd leading cause of cancer deaths among women around the world Human Papillomavirus (HPV) 

3. Gardasil� (Merck) is the first HPV vaccine licensed in the US (3 dose series) Protects against 4 major types of HPV Can prevent most genital warts and most cases of cervical cancer Licensed by the FDA: 6/8/2006 Added to the Federal VFC Program: 6/26/2006 But not funded until 12/2006 Added to the Texas VFC Program: 2/1/2007 ACIP Recommendations published in MMWR: 3/23/2007 HPV Vaccine Timeline

4. Gardasil� (Merck) Licensed for women 9 -26 years of age 3 dose series (est. $120/dose) Dose 1: Now Dose 2: 2 months after dose 1 Dose 3: 6 months after dose 1 (at least 12 weeks after the second dose) Not recommended for use in pregnancy If the vaccine series is interrupted, the series does not need to be restarted Can prevent most genital warts and most cases of cervical cancer HPV Vaccine

5. Eligible Groups in Texas for Public Vaccines Texas Vaccines For Children (TVFC) eligible females 9-18 years of age Texas HPV vaccine estimates Total females 9-18 years of age: 1.7 million Total TVFC eligible females: 52% HPV Vaccination in Texas

6. Federally funded vaccine supply program Distributes free vaccines to private and public providers for defined populations Serves children birth to 18 years of age who are Enrolled in Medicaid Uninsured Native American/Alaska Native Have health insurance, but it does not cover immunizations (underinsured). In these cases, these children must go to a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) for immunizations. What is VFC?

7. Resources CDC website for HPV Vaccine: http://www.cdc.gov/nip/vaccine/hpv/default.htm Merck's website for HPV: https://www.merckvaccines.com/gardasilProductPage_frmst.html

8. Hepatitis B Vaccination in HIV and STD Clinic Settings

9. Purpose To determine whether providing hepatitis B vaccine was feasible in the STD setting To offer vaccine to high-risk adult population in Texas

10. Timeline Pilot: December 2002 � May 2006 Immunization Division purchased 39,000 doses 18 sites volunteered to participate Eligibility: Persons 19 and older seeking testing, treatment, or counseling services Continuation: April 06 to Present One-time funds available from CDC Imm Branch, HIV/STD, and IDCU collaboration Two-year project Expanded to include HIV prevention services clinics in addition to STD clinics 34 STD clinics (24 lhds) 10 HIV clinics (8 agencies)

11. Methods Doses recorded by age and dose number Temperature log Inventory monitored on a monthly basis (reports due on 7th of each month) Vaccine is replenished as needed

14. List of Pilot Sites Abilene Taylor County Health Dept City of Amarillo Public HD Austin-Travis county HHSD Brazos County HD Corpus Christi-Nueces County HD Dallas County HHS El Paso County HD McAllen Clinic � Hidalgo County HD City of Lubbock City of Houston Medical Center Lyons West End Milam County HD San Antonio Metro HD Northeast Texas Public HD (Smith County) Texarkana Bowie Victoria City-County HD Wichita Falls-Wichita County Public HD

15. Doses Administered by Dose Number � Pilot7/03-5/06

16. Age Distribution of ClientsPilot, 7/03-5/06

17. Hepatitis B Vaccine Uptake Pilot, 7/03-5/06

18. On this map, the shaded areas indicate sites participating in the project. The blue dots identify the major cities in the state for a point of reference and not indicating participating sites. On this map, the shaded areas indicate sites participating in the project. The blue dots identify the major cities in the state for a point of reference and not indicating participating sites.

19. List of Participating STD Sites City of Amarillo Public HD Angelina County & Cities Health District Austin-Travis county HHSD Beaumont Public Health District Brazos County HD Cherokee County Collin County Health Dept Corpus Christi-Nueces County HD Dallas County HHS El Paso County HD Grayson HD Gregg HD Hays County HD Hidalgo County HD � McAllen Clinic City of Houston Laredo HD City of Lubbock Milam County HD Northeast Texas Public HD San Antonio Metro HD Victoria City-County HD Wichita Falls-Wichita County Public HD Williamson County HD

20. On this map, the shaded areas indicate sites participating in the project. The blue dots identify the major cities in the state for a point of reference and not indicating participating sites.On this map, the shaded areas indicate sites participating in the project. The blue dots identify the major cities in the state for a point of reference and not indicating participating sites.

21. List of Participating HIV Sites AIDS Arms Peabody Health Center AIDS services of North Texas Denton Plano AIDS Resources of Rural Texas Weatherford Abilene Permian Basin Community Centers- Basin Asst Services Health Horizons - Nacogdoches Clinic Legacy �Houston Nelson-Tebedo Health Resource Center Valley AIDS Council

22. Doses Administered by Dose Number, 7/06-4/07*

23. Age Distribution of Clients7/06-4/07*

24. Uptake Estimates STD sites 16 sites submitted data on number offered first dose 85% vaccinated with 1st dose 31% received the 2nd dose HIV sites 7 sites submitted data on number offered first dose 80% vaccinated with 1st dose 47% received the 2nd dose

25. Resources Interpretation of Hepatitis Markers: http://www.cdc.gov/ncidod/diseases/hepatitis/serology/index.htm Hepatitis B Vaccination Recommendations for Adults: http://www.cdc.gov/ncidod/diseases/hepatitis/recs/index.htm

26. Contact Information Mark Ritter, MHA mark.ritter@dshs.state.tx.us Ph. (512) 458-7111 ext. 6432 Rita Espinoza, MPH rita.espinoza@dshs.state.tx.us Ph. (512) 458-7111 ext. 6335 Fax (512) 458-7616