HPV IMMUNIZATION GUIDELINES AND TIPS FOR PROVIDERS

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1 HPV IMMUNIZATION GUIDELINES AND TIPS FOR PROVIDERS

2 HPV Most types of HPV that infect humans are asymptomatic and transient There are certain oncogenic types that may persist and cause cancers of the cervix, vulva, vagina, anus, penis, and oropharynx There are also non-oncogenic types, which may cause genital warts and rarely, recurrent respiratory papillomatosis Adapted from HPV Vaccine Information for Clinicians - Fact Sheet. (2012, July 8). Retrieved February 23, 2015, from

3 HPV VACCINES Cervarix: a bivalent HPV vaccine Prevents HPV types 16 and 18, which cause 70% of cervical cancers Gardasil: a quadrivalent HPV vaccine Prevents HPV 16 and 18 as well as HPV types 6 and 11, which cause 90% of genital warts Licensed for use in males The vaccines will not treat existing diseases or conditions caused by HPV The vaccines are made from virus-like particles and contain no infectious material The vaccines do not contain thimerosal or mercury as a preservative Adapted from HPV Vaccine Information for Clinicians - Fact Sheet. (2012, July 8). Retrieved February 23, 2015, from

4 CDC AND AAP RECOMMENDATIONS Both vaccines are part of a 3-dose series administered routinely in 11 and 12 year old girls The quadrivalent vaccine is routinely recommended for 11 and 12 year old boys The vaccines may be given as early as 9 years and are also recommended for 13 through 26 year old females and 13 through 21 year old males who have not completed the series previously The vaccine may be given to males aged 22 through 26 years The vaccine is also recommended for men who have sex with men and immunocompromised patients through age 26 Adapted from HPV Vaccine Information for Clinicians - Fact Sheet. (2012, July 8). Retrieved February 23, 2015, from

5 CERVICAL CANCER Cervical cancer was previously the leading cause of cancer death amongst women Cancer screening using the pap test and treatment of precancerous cervical abnormalities have decreased the incidence and mortality of cervical cancer over the last 40 years Half of women diagnosed with cervical cancer have never been screened for cervical cancer Cervical cancer disproportionately affects women of lower socioeconomic status who lack access to medical care, are uninsured or are recent immigrants these are the groups who stand to benefit the most from HPV vaccination Adapted from HPV Vaccine Information for Clinicians - Fact Sheet. (2012, July 8). Retrieved February 23, 2015, from

6 TIPS AND TIME- SAVERS FOR TALKING WITH PARENTS ABOUT HPV VACCINE Adapted from Tips and Time-Savers for Talking with Parents About HPV Vaccine. (n.d.). Retrieved February 23, 2015, from

7 Recommend the HPV vaccine series the same way you recommend the other adolescent vaccines. For example, you can say Your child needs these shots today, and name all of the vaccines recommended for the child s age. Parents may be interested in vaccinating, yet still have questions. Taking the time to listen to parents questions helps you save time and give an effective response. CDC research shows these straightforward messages work with parents when discussing HPV vaccine and are easy for you or your staff to deliver. Adapted from Tips and Time-Savers for Talking with Parents About HPV Vaccine. (n.d.). Retrieved February 23, 2015, from

8 CDC RESEARCH SHOWS: The HPV vaccine is cancer prevention message resonates strongly with parents. In addition, studies show that a strong recommendation from you is the single best predictor of vaccination. TRY SAYING: HPV vaccine is very important because it prevents cancer. I want your child to be protected from cancer. That s why I m recommending that your daughter/son receive the first dose of HPV vaccine today. CDC RESEARCH SHOWS: Disease prevalence is not understood, and parents are unclear about what the vaccine actually protects against. TRY SAYING: HPV can cause cancers of the cervix, vagina, and vulva in women, cancer of the penis in men, and cancers of the anus and the mouth or throat in both women and men. There are about 26,000 of these cancers each year and most could be prevented with HPV vaccine. There are also many more precancerous conditions requiring treatment that can have lasting effects. Adapted from Tips and Time-Savers for Talking with Parents About HPV Vaccine. (n.d.). Retrieved February 23, 2015, from

9 CDC RESEARCH SHOWS: Parents want a concrete reason to understand the recommendation that year olds receive HPV vaccine. TRY SAYING: We re vaccinating today so your child will have the best protection possible long before the start of any kind of sexual activity. We vaccinate people well before they are exposed to an infection, as is the case with measles and the other recommended childhood vaccines. Similarly, we want to vaccinate children well before they get exposed to HPV. CDC RESEARCH SHOWS: Parents may be concerned that vaccinating may be perceived by the child as permission to have sex. TRY SAYING: Research has shown that getting the HPV vaccine does not make kids more likely to be sexually active or start having sex at a younger age. Adapted from Tips and Time-Savers for Talking with Parents About HPV Vaccine. (n.d.). Retrieved February 23, 2015, from

10 CDC RESEARCH SHOWS: Parents might believe their child won t be exposed to HPV because they aren t sexually active or may not be for a long time. TRY SAYING: HPV is so common that almost everyone will be infected at some point. It is estimated that 79 million Americans are currently infected with 14 million new HPV infections each year. Most people infected will never know. So even if your son/daughter waits until marriage to have sex, or only has one partner in the future, he/she could still be exposed if their partner has been exposed. CDC RESEARCH SHOWS: Emphasizing your personal belief in the importance of HPV vaccine helps parents feel secure in their decision. TRY SAYING: I strongly believe in the importance of this cancerpreventing vaccine, and I have given HPV vaccine to my son/daughter/grandchild/ niece/nephew/friend s children. Experts (like the American Academy of Pediatrics, cancer doctors, and the CDC) also agree that this vaccine is very important for your child. Adapted from Tips and Time-Savers for Talking with Parents About HPV Vaccine. (n.d.). Retrieved February 23, 2015, from

11 CDC RESEARCH SHOWS: Understanding that the side effects are minor and emphasizing the extensive research that vaccines must undergo can help parents feel reassured. TRY SAYING: HPV vaccine has been carefully studied by medical and scientific experts. HPV vaccine has been shown to be very effective and very safe. Like other shots, most side effects are mild, primarily pain or redness in the arm. This should go away quickly, and HPV vaccine has not been associated with any long-term side effects. Since 2006, about 57 million doses of HPV vaccine have been distributed in the U.S., and in the years of HPV vaccine safety studies and monitoring, no serious safety concerns have been identified. CDC RESEARCH SHOWS: Parents want to know that HPV vaccine is effective. TRY SAYING: In clinical trials of boys and girls, the vaccine was shown to be extremely effective. In addition, studies in the U.S. and other countries that have introduced HPV vaccine have shown a significant reduction in infections caused by the HPV types targeted by the vaccine. Adapted from Tips and Time-Savers for Talking with Parents About HPV Vaccine. (n.d.). Retrieved February 23, 2015, from

12 CDC RESEARCH SHOWS: Many parents do not know that the full vaccine series requires 3 shots. Your reminder will help them to complete the series. TRY SAYING: I want to make sure that your son/daughter receives all 3 shots of HPV vaccine to give them the best possible protection from cancer caused by HPV. Please make sure to make appointments on the way out, and put those appointments on your calendar before you leave the office today! Adapted from Tips and Time-Savers for Talking with Parents About HPV Vaccine. (n.d.). Retrieved February 23, 2015, from

13 TIPS TO INCREASE ADOLESCENT IMMUNIZATION RATES Adapted from AAP Immunization Resources Adolescent Immunizations: Strategies for Increasing Coverage Rates. (2013, July 1). Retrieved February 23, 2015, from

14 1. Patient reminder-recall: Consider contacting patients and parents using phone calls, mail reminder cards, text messages or patient portals that they are due for an immunization 2. Provider prompts or standing orders: Consider using the electronic health record to remind you when a patient needs an immunization You may also create a standing order for HPV vaccination in eligible children 3. Strong provider recommendation: Studies have shown that parents trust their pediatrician s guidance Give a strong recommendation for all vaccines on the current immunization schedule 4. Include all recommended vaccinations at every visit: Use sick-child and chronic care visits as a time to immunize Check what vaccinations are due every time a patient is in the office Adapted from AAP Immunization Resources Adolescent Immunizations: Strategies for Increasing Coverage Rates. (2013, July 1). Retrieved February 23, 2015, from

15 5. Provider Feedback: Use your electronic health record to compile an immunization rate report and determine the percentage of your patients that are up-todate on immunizations Benchmark this data against yourself annually as well as against the national and state or city data from the National Immunization Survey 6. Find an immunization champion in your practice: An immunization champion can serve as a steward and advocate of immunizations in your practice 7. Educate patients and parents: Educate parents and patients about each recommended vaccine and the disease it prevents Let them know at each visit what vaccines they can expect at their next appointment and provide handouts on these vaccines and diseases this allows them time to consider their questions Adapted from AAP Immunization Resources Adolescent Immunizations: Strategies for Increasing Coverage Rates. (2013, July 1). Retrieved February 23, 2015, from

16 8. Address costs: The Affordable Care Act now requires insurance companies to cover the costs of all recommended vaccines Some exceptions to this exist and thus it is important to talk to parents about options for paying a portion of the vaccination cost 9. Hold vaccine clinics at hours that are convenient for families Vaccination hours in the evenings or on Saturdays allows busy adolescents more opportunities to access vaccination services Adapted from AAP Immunization Resources Adolescent Immunizations: Strategies for Increasing Coverage Rates. (2013, July 1). Retrieved February 23, 2015, from

17 ADDITIONAL RESOURCES HPV Vaccine Information for Clinicians: Tips and Time Savers for Talking with Parents About HPV Vaccine: CDC HPV Vaccine Question and Answer: AAP HPV Vaccine Recommendations: AAP Immunization Resources Adolescent Immunizations: Strategies for Increasing Coverage Rates: AAP Immunization Resources Pre-teen Immunization: Addressing Common Concerns: Author: Micaela Robb-Mcgrath, University of Maryland Medical School Student

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