Ask Me About HPVI -...
Transcript of Ask Me About HPVI -...
Ask Me About HPVI
Flovida DepavtllV\eVtt of Hea(t1'l
What is an HPV Ambassador?
A community or healthcare liaison who is trained to educate others on the importance of the HPV vaccine in preventing related cancers and other HPV related diseases. This person is trained to talk with and answer questions from the community which may include: parents, students, and healthcare professionals.
What does an HPV Ambassador do?
Ambassadors are committed to the cause of protecting people against HPV and other vaccinepreventable diseases. Ambassadors believe in the HPV vaccine and share that information whenever possible with others. Ambassadorsidentify themselves by wearing an HPV Ambassador Button and will give information onwhere and how to get vaccinated against HPV and also where to screen the SYL documentary.Ambassadors will share information by talking,blogging, tweeting and connecting with thecommunity in various settings. Ambassadorslead by example and share their convictionsthrough words and actions. #BeHPVFree
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HOW DO YOU BECOME AN HPV AMBASSADOR?
To become an Ambassador, trainees will be required toattend a screening of theSomeone You Love (SYL)documentary and complete 1-hour of “You are the Key”training and role play.Following initial training,yearly refreshers will be available to Ambassadors.
Lady Ganga
1.L,WI YOU ARE THE KEY TO R rll CANCER PREVENTION
You are the Key to HPV Cancer Prevention - Update
Andrea M Peaten Community Immunizations Liaison
HPV Ambassador Program Consultant Florida Department of Health
Funding for this presentation was made possible by the Centers for Disease Control and Prevention, cooperative agreement number, NH23IP000960. The views expressed in the written materials an by speakers and moderators do not necessarily
reflect the official policies of the Department of Health and Human Services, nor does the mention of trade names, commercial practices or organizations imply endorsement by the US Government.
NATIONAL AHEC ORGANIZATION
Flor-ida Depar-tWleVLt of Hea/tt,,.
" • AW1bassador- Pr-o9r-aW1
National AHEC Organization HPV Immunization Project
Florida HEALTH
YOU ARE 1 EK Y TO CANCER PREVENTION
Jointly provided by The National AHEC Organization and <Insert AHEC Name>
I
(Human papml l omav1rus)
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Understanding the Burden
HPV INFECTION & DISEASE
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
HPV Types Differ in their Disease Associations
Mucosal sites of infection
Cutaneous sites of infection
~ 80 Types
“Common” Hand and Foot
Warts
~40 Types
Genital Warts Laryngeal Papillomas
Low Grade Cervical Disease
Low risk (non-oncogenic) HPV 6, 11 most common
High risk (oncogenic) HPV 16, 18 most common
Cervical Cancer Anogenital Cancers
Oropharyngeal Cancer Cancer Precursors
Low Grade Cervical Disease
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HPV Infection
Most females and males will be infected with at least one type of mucosal 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
Satterwhite et al. Sex Transm Dis. 2013
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Cancers Caused by HPV per Year, U.S., 2009-2013
Cancer site
Percentage probably Number probably caused by any HPV type caused by
any HPV type Female Male Both Sexes
Cervix 91% 10,600 0 10,600
Vagina 75% 600 0 600
Vulva 69% 2,500 0 2,500
Penis 63% 0 700 700
Anus 91% 3,200 1,600 4,800
Rectum 91% 500 200 700
Oropharynx 70% 2,000 9,600 11,600
TOTAL 19,400 12,100 31,500
Based on Viens et al. MMWR 2016. https://www.cdc.gov/cancer/hpv/statistics
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HPV-Associated Cancer Rates by Sex, Race and Ethnicity, United States, 2009–2013
Based on Viens et al. MMWR 2016. https://www.cdc.gov/cancer/hpv/statistics
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Al YOU ARE THE KEY TO CAN1CER PREVENT10N
HPV-Associated Oropharyngeal Cancer Rates by Sex, Race and Ethnicity, United States, 2009–2013
Based on Viens et al. MMWR 2016. https://www.cdc.gov/cancer/hpv/statistics
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HPV-Associated Cervical Cancer Rates by Race and Ethnicity, United States, 2009–2013
Based on Viens et al. MMWR 2016. https://www.cdc.gov/cancer/hpv/statistics
HPV vacci �
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ftl YOU ARE THE KEY TO rlf CAN1CER PREVENT10N
Evidence-Based HPV Disease Prevention
HPV VACCINE
QJ Bivalent C: ·-u
u
~ Quadrivalent
> 0.
9-valent :I:
HPV Types Included in Vaccine
6 11 16 18 31 33 45 52 58
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HPV Vaccine Comparison
Genital 63% of cancers 10% of cancers in body warts in body parts parts where HPV DNA is
where HPV DNA often found is often found
Adapted from Petrosky et al. MMWR. 2015.
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
Dosing Schedules Starting the vaccine series before the 15th birthday
Recommended schedule is 2 doses of HPV vaccine Second dose should be
administered 6–12 months after the first dose (0, 6–12 month schedule)
Minimum interval between dose one and dose two in a 2-dose schedule is 5 months
Starting the vaccine series on or after the 15th birthday*
Recommended schedule is 3 doses of HPV vaccine Second dose should be
administered 1–2 months after the first dose, and the third dose should be administered 6 months after the first dose (0, 1–2, 6 month schedule)
Minimum interval between dose one and dose three in a 3-dose schedule is 5 months
*and immunocompromised persons 9-26 years
Meites et al. MMWR. 2016.
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HPV VACCINE SAFETY
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United States Vaccine Safety System System Collaborators Description Vaccine Adverse Event Reporting System (VAERS)
CDC and FDA Frontline spontaneous reporting system to detect potential vaccine safety issues
Vaccine Safety Datalink (VSD)
CDC and 9 Integrated Health Care Systems
Large linked database system used for active surveillance and research ~9.4 million members (~3% of US pop.)
Clinical Immunization Safety Assessment (CISA) Project
CDC and 7 Academic Centers
Expert collaboration that conducts individual clinical vaccine safety assessments and clinical research
Post-Licensure Rapid Immunization Safety Monitoring Program (PRISM)
FDA and 6 partner organizations
Large distributed database system used for active surveillance and research ~170 million individuals
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Over 10 Years of HPV Vaccine Safety Data
HPV vaccine is safe Reactions after vaccination may include Injection site reactions: pain, redness, and/or swelling in the arm
where the shot was given Systemic: fever, headaches
HPV vaccines should not be given to anyone who has had a previous allergic reaction to the vaccine or who has an allergy to yeast (Gardasil/Gardasil 9)
Brief fainting spells (syncope) and related symptoms (such as jerking movements) can happen soon after any injection, including HPV vaccine
Patients should be seated (or lay down) during vaccination and remain in that position for 15 minutes
Gee, et al. Hum Vaccin Immunother. 2016.
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HPV Vaccine Duration of Protection
Studies suggest that vaccine protection is long-lasting
No evidence of waning protection Available evidence indicates protection for
at least 10 years Multiple studies are in progress to monitor
ACIP. Summary Report. June 22-23, 2016.
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
HPV Vaccination Is Safe, Effective, and Provides Lasting Protection
HPV Vaccine is SAFE Benefits far outweigh any potential risks Safety studies findings for HPV vaccination are reassuring
and similar to MenACWY and Tdap vaccine safety reviews
HPV Vaccine WORKS Population impact against early and mid outcomes have
been reported in multiple countries
HPV Vaccine Protection LASTS Studies suggest that vaccine protection is long-lasting No evidence of waning protection
Parent of preteen
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Talking about HPV vaccine
FRAMING THE CONVERSATION
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Adolescent Vaccination Coverage United States, 2006-2015
Perc
ent V
acci
nate
d
100
90
80
70
60
50
40
30
20
10
0
≥1 MenACWY
≥2 MenACWY†
≥3 HPV (M)
≥1 Tdap
≥1 HPV (F)
≥1 HPV (M)
≥3 HPV (F)
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Survey Year
Reagan-Steiner et al. MMWR 2016.
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
Reasons parents won’t initiate HPV vaccination for children
Lack of knowledge
Not needed or necessary
Safety concern/Side effects
Not recommended
Not sexually active
0 5 10 15 20 Percent
Stokley et al. MMWR. 2014.
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Value Parents Place on the Vaccines
Parent
9.4 9.5 9.5 9.3 9.3 9.2
0 1 2 3 4 5 6 7 8 9
10
Med
ian
Valu
es
Meningitis Hepatitis Pertussis Influenza HPV Adolescent vaccines
Adapted from Healy et al. Vaccine. 2014.
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
Clinician estimations
Parent Clinician's estimate
9.4 9.5 9.5 9.3 9.3 9.2 9.2 9.2 9.3
0 1 2 3 4 5 6 7 8 9
10
Med
ian
Valu
es
Meningitis Hepatitis Pertussis Influenza HPV Adolescent vaccines
Adapted from Healy et al. Vaccine. 2014.
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
Clinicians underestimate the value parents place on HPV vaccine
Parent Clinician's estimate
9.4 9.5 9.5 9.3 9.3 9.2 9.2 9.2 9.3
7.0
5.2
7.8
0 1 2 3 4 5 6 7 8 9
10
Med
ian
Valu
es
Meningitis Hepatitis Pertussis Influenza HPV Adolescent vaccines
Adapted from Healy et al. Vaccine. 2014.
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
What is an
EFFECTIVE recommendation
for HPV vaccination?
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
Same Way Same Day
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
Why does my child need HPV vaccine?
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
HPV vaccination is important because it prevents cancer.
That’s why I’m recommending that your child start the HPV vaccine
series today.
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
Is my child really at risk for HPV?
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
HPV is a very common and widespread virus that infects both females and males. We can help
protect your child from the cancers and diseases caused by the virus by
starting HPV vaccination today.
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
Why at 11 or 12 years old?
ftl YOU ARE THE KEY TO rlf CAN1CER PREVENT10N
When should the bike helmet go on?
A. Before they get on their bike
B. When they are riding their bike in the street
C. When they see the car heading directly at them
D. After the car hits them
Temte JL. Pediatrics 2014.
ftl YOU ARE THE KEY TO rlf CAN1CER PREVENT10N
When do we put our seat belts on?
A.Before turning on car
B. When leaving driveway
C. After a near accident
Temte JL. Pediatrics 2014.
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
As with all vaccine-preventable diseases, we want to protect your child early. If we start now,
it’s one less thing for you to worry about. Also, your child will only need two shots of HPV
vaccine at this age. If you wait until 15, your child will need three shots.
We’ll give the first shot today and then you’ll need to bring your child back in 6 to 12 months
from now for the second shot.
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
I’m just worried that my child will perceive this as a green
light to have S-E-X.
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
Numerous research studies have shown that getting the HPV vaccine does not make kids more likely to be sexually active or start having sex at a younger age. Starting the HPV vaccine
series today will give your child the best protection possible for the future.
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
Why do boys need HPV vaccine?
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
HPV infection can cause cancers of the penis, anus, and throat in men.
HPV infection can also cause genital warts.
Getting HPV vaccine today for your son can help prevent the infection that can
lead to these diseases.
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
Would you get HPV vaccine for your kids?
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
Yes, I have given HPV vaccine to my child. I believe strongly in the importance of
this cancer-preventing vaccine. The American Academy of Pediatrics, the American Academy of Family Physicians,
NIH cancer centers, and the CDC, also agree that getting the HPV vaccine is
very important for your child.
ftl YOU ARE THE KEY TO rlf CAN1CER PREVENT10N
If a parent doesn’t say yes today… As
k • Clarify & restate their concerns to make sure you understand
Ackn
owle
dge • Emphasize it is the parents’ decision
• Acknowledge risks & conflicting info sources • Applaud them for wanting what is best for their child • Be clear that you are concerned for the health of their child,
not just public health safety
Advi
se • Allow time to discuss the pros & cons of the vaccine
• Be willing to discuss parents’ ideas • Offer written resources for parents • Tailor your advice using this presentation
Adapted from Henrickson Vax Northwest 2014.
I.L. I YOU ARE THE KEY TO R rlf CAN1CER PREVENT10N
If a parent declines today…
Declination is not final. The conversation can be revisited.
End the conversation with at least 1 action you both agree on.
Because waiting to vaccinate is the risky choice, many pediatricians ask the parent to sign a Declination Form.
1.L,WI YOU ARE THE KEY TO R rll CANCER PREVENTION
HPV VACCINE IS CANCER PREVENTION And YOU are the key!
#WeCanStopHPV
References • Advisory Committee on Immunization Practices. Summary Report. June 22-23, 2016. Available at https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2016-
06/june-22-23-2016-acip.pdf • Ali H, et al. Genital warts in young Australians five years into national human papillomavirus vaccination programme: national surveillance data BMJ 2013; 346 :f2032. • Baldur-Felskov et al. Trends in the incidence of cervical cancer and severe precancerous lesions in Denmark, 1997-2012. Cancer Causes Control 2015 Aug;26(8):1105-16. • Benard VB, Castle PE, Jenison SA, et al. Population-Based Incidence Rates of Cervical Intraepithelial Neoplasia in the Human Papillomavirus Vaccine Era. JAMA Oncol.
Published online September 29, 2016. doi:10.1001/jamaoncol.2016.3609 • Brewer NT, et al. Announcements versus conversations to improve HPV vaccination coverage: A randomized trial. Pediatrics. 2017 139(1). • Drolet et al. Population-level impact and herd effects following human papillomavirus vaccination programmes: a systematic review and meta-analysis. Lancet Infect Dis.
2015 May;15(5):565-80. • Gee, et al. Quadrivalent HPV vaccine safety review and safety monitoring plans for nine-valent HPV vaccine in the United States. Hum Vaccin Immunother. 2016 Jun;
12(6): 1406–1417. • Hariri S, et al. Population-based trends in high-grade cervical lesions in the early human papillomavirus vaccine era in the United States. Cancer, 121: 2775–2781. • Healy CM, et al. Parent and provider perspectives on immunization: are providers overestimating parental concerns? Vaccine. 2014; 32(5): 579-584. • Henrikson NB, et al. A public-private partnership addressing vaccine hesitancy in Washington State. 2014. Available at: http://vaxnorthwest.org/approach • Institute of Medicine. Adverse Effects of Vaccines: Evidence and Causality. The National Academies Press, 2012. • Koshiol JE, et al. Rate and predictors of new genital warts claims and genital warts-related healthcare utilization among privately insured patients in the United States. Sex
Transm Dis. 2004;31:748–752. • Machalek et al. Human Papillomavirus Prevalence in Unvaccinated Heterosexual Men After a National Female Vaccination Program. J Infect Dis (2017) 215 (2): 202-208.
Published: 03 November 2016. DOI: 10.1093/infdis/jiw530 • Markowitz LE, et al. Prevalence of HPV After Introduction of the Vaccination Program in the United States. Pediatrics. 2016;137(2). • Meites E, Kempe A, Markowitz LE. Use of a 2-Dose Schedule for Human Papillomavirus Vaccination — Updated Recommendations of the Advisory Committee on
Immunization Practices. MMWR. 2016;65(49);1405-8. • Petrosky et al. Use of 9-Valent Human Papillomavirus (HPV) Vaccine: Updated HPV Vaccination Recommendations of the Advisory Committee on Immunization Practices.
MMWR. 2015 64(11);300-304 • Pollock et al. Reduction of low- and high-grade cervical abnormalities associated with high uptake of the HPV bivalent vaccine in Scotland. Br J Cancer 2014 111, 1824–
1830. • Reagan-Steiner S, et al. National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2015. MMWR
Morb Mortal Wkly Rep. 2016;65:850–858. • Satterwhite et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013 Mar;40(3):187-93. • Schiffman M. Castle PE. Arch Pathol Lab Med. Human papillomavirus: epidemiology and public health. 2003 Aug;127(8):930-4. • Smith PJ, et al. HPV vaccination coverage of teen girls: the influence of health care providers. Vaccine. 2016 Mar 18;34(13):1604-10. • Stokley S,, et al. Human papillomavirus vaccination coverage among adolescents, 2007-2013, and postlicensure vaccine safety monitoring, 2006-2014--United States.
MMWR Morb Mortal Wkly Rep. 2014 Jul 25;63(29):620-4. • Temte JL. Comment: Timing of HPV Vaccine. Available at http://pediatrics.aappublications.org/content/early/2014/08/12/peds.2014-0442.comments#-timing-of-hpv-
vaccine-• Viens LJ, et al. Human papillomavirus–associated cancers—United States, 2008–2012. MMWR. 2016;65:661–6.
Verbal Judo
What is Verbal Judo
Do not use Do use
Unprofessional language Professional language or or words words
Words that express Use of words to achieve personal feelings professional objectives
Self-referred language In contact w/audience
{such as "I" or "me"} We or us
Comments not in context Defined comments which are on target and specific
Off-target reactions Deflection and redirection
VERBAL KARATE vs VERBAL JUDO
� Flor-ido. Depo.rtW\evi.t of Heo.lth
• � Andrea M Peaten
Community Immunization Liaison Florida Department of Health Pinellas