Five Key Steps to Improve HPV Vaccination Rates in Your Practice Tuesday, December 9, 2014 11:00 AM ET
Agenda Welcome & Program Goals Accelerating HPV Vaccine Uptake: A Public Health Priority Joseph A. Bocchini, Jr., MD, NFID HPV Program Chair HPV Vaccination: Barriers and Opportunities Noel T. Brewer, PhD, UNC Mobilizing Practices to Advocate for HPV Vaccination Joseph A. Bocchini, Jr., MD Questions & Answers
Webinar Housekeeping Please note that today s webinar is being recorded All phone lines will be placed on mute throughout the program To hear audio: Phone: 877-668-4490; Access code: 792 511 534 Computer: Follow WebEx directions After the presentations, there will be a Question & Answer period To ask a question, please use the question and answer box on the right hand side of your screen At the end of the webinar, participants will be automatically redirected to an online evaluation and CE post-test
CME Credit/Webinar Evaluation The National Foundation for Infectious Diseases (NFID) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. NFID designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit TM. Online evaluation and post-test will be available following the webinar at: http://bit.ly/1zkgbtr Certificate will be available for print or download following completion of online evaluation and passing post-test score
Disclosures Joseph A. Bocchini, Jr. has no financial relationships to disclose Noel Brewer: Grant funding, advisory boards, or paid speaker by Merck & Co., Inc., GSK, Pfizer Inc. Marla Dalton (NFID Staff): served as an advisor or consultant for Pfizer Inc.; and owns stock, stock options, or bonds from Merck & Co., Inc. Ellyn Terry (NFID Staff): served as an advisor or consultant for MedImmune; and received financial support from Sigma Tau Pharmaceuticals, Inc.
Learning Objectives At the conclusion of this webinar, participants will be able to: Discuss why age 11-12 years is ideal for adolescents to be vaccinated against HPV List the types of cancers that are prevented by HPV vaccine, for both females and males Demonstrate effective communication strategies and list resources available to educate themselves and others about HPV and provide a strong recommendation for HPV vaccination List the top five key steps to improve HPV vaccination rates in their practice
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Accelerating HPV Vaccination Uptake: A Public Health Priority Joseph A. Bocchini, Jr., MD Chair, NFID HPV Initiative Professor and Chair of Pediatrics Section of Pediatric Infectious Diseases Louisiana State University Health Sciences Center
The Problem: HPV Vaccine Uptake Lags Far Behind Other Adolescent Vaccines Adolescent Vaccination (13-17 years of age), United States, 2006-2013 MMWR 2014; 63(29);625-633.
No State Comes Close to Meeting Healthy People Goal (80%) Completion of 3-dose HPV series in US females 13-17 years of age, 2013 Source: CDC. MMWR Wkly Rep. 2014;63;29 19 Overall US coverage among female adolescents is 37.6%
HPV Vaccines Are Safe and Effective HPV vaccines are one of the most effective >95% efficacy in clinical trials for precancer endpoints and genital warts Post licensure studies show high effectiveness and large impact from vaccination on prevalence and incidence of genital warts HPV vaccines have a good safety record The most common adverse events reported are mild For serious adverse events reported, no associations found with vaccination syncope From June 2006 through March 2014, approximately 67 million doses of HPV4 were distributed in the US, and from October 2009 through March 2014, a total of 719,000 doses of HPV2 were distributed
Low Vaccine Coverage = Needless Risk for Preventable Cancers Percent of Cancers Caused by Vaccine-Preventable HPV Infection Cancers caused by HPV 16 or 18 In addition: HPV-16 associated oropharyngeal cancers are on the rise. Incidence is expected to surpass cervical cancer incidence by 2020 Type of Cancer Muñoz N. Int J Cancer. 2004;111(2):278. Schiffman M. Lancet. 2007;370(9590):890. Jayaprakash V. Oral Oncol. 2011;47(11):1048. Chaturvedi AK. J Clin Oncol. 2011;29(32):4294.
Estimated HPV and HPV 16/18-Associated Cancers, Both Sexes, 2006-2010 Average annual number of cases* HPV Associated* HPV 16/18 associated** Cervix 11,422 10,400 9,000 Vagina 735 600 400 Vulva 3,168 2,200 1,350 Anus & rectum (W) 2,821 2,600 2,590 Oropharynx (W) 2,443 1,800 1,380 Total (Females) 20,589 17,600 14,720 Penis 1,048 700 310 Anus & Rectum (M) 1,549 1,400 1,410 Oropharynx (M) 9,974 7,200 5,360 Total (Males) 12,571 9,300 7,080 *CDC, United States cancer Statistics (USCS), 2006-2010; **2004-2007 data: Watson M et al. Cancer 2008. Data source: National Program of Cancer Registries and SEER, covering 83% of US population; Gillison ML, et al. Cancer 2008
HPV Vaccination as a Public Health Priority: A Call to Action www.adolescentvaccination.org/hpv-cta
Actual and Potentially Achievable Vaccination Coverage of >1 HPV among Adolescent Girls if Missed Opportunities* Were Eliminated, NIS-Teen Potential Actual Among unvaccinated girls, 84% had a missed opportunity for HPV vaccination *Missed opportunity defined as having a healthcare encounter where at least one vaccine was administered but HPV was not; MMWR. 2013; 62:591-5
Increasing HPV Vaccine Uptake Must Be a Public Health Priority Increasing HPV vaccination is one of the most profound opportunities for cancer prevention Increasing HPV vaccination rates to 80%* would prevent 53,000 additional future cervical cancer cases among girls now 12 years old or younger Thousands of non-cervical HPV-associated cancers likely could also be prevented A growing proportion of future HPV-associated cancers (esp. oropharyngeal cancers) will occur in males *Healthy People 2020 goal: 80 percent of girls ages 13-15 complete HPV vaccine series
HPV Vaccination: Barriers and Opportunities Noel T. Brewer, PhD Gillings School of Global Public Health Lineberger Comprehensive Cancer Center University of North Carolina Disclosures: Grant funding, advisory boards, or paid speaker Merck, GSK, Pfizer, FDA
Diagnosed with genital warts HPV vaccination impact on genital warts in young Australians 16% HPV vaccination available for females 12% Females <21 years 8% Males <21 years 4% 0% 2004 2005 2006 2007 2008 2009 2010 2011 BMJ (Ali et al., 2013)
Parents Many reasons for not getting HPV Vaccine for child Not needed 17% Safety concerns/side effects 16% Lack of knowledge 10% Not sexually active 11% Not recommended 9% National Immunization Survey Teen, 2010. (Darden et al., 2013)
(Hume, 1878)
Clinicians Parents Receiving a recommendation is a strong predictor of HPV vaccination OR= 18 (range 2.2-172) 7 studies; n=18,955, range 32-16,139
HPV vaccine initiation, boys Clinician Recommendation 60% 55% 40% 20% 0% 1% No recommendation Recommendation AJPH (Reiter et al., 2013)
Your HPV vaccination recommendation is uniquely influential
HPV vaccine importance rating HPV Vaccine Importance 10 8 9.3 6 4 5.2 2 0 According to parents According to providers Vaccine (Healy et al., 2014) 25
Recommendation Style Accepted vaccine Announcement It s time for shots. 74% Participatory Did you want to get some vaccines for her today? 4% Pediatrics (Opel et al., 2013)
Mobilizing Practices to Advocate for HPV Vaccination : Five Key Steps Joseph A. Bocchini, Jr., MD Chair, NFID HPV Initiative Professor and Chair of Pediatrics Section of Pediatric Infectious Diseases Louisiana State University Health Sciences Center
A Call to Action for US Healthcare Professionals 1. Recommend HPV vaccine with the same strength and conviction used to recommend other adolescent vaccines 2. Educate yourself about HPV and HPV vaccines 3. Inform your colleagues and staff to ensure consistent, positive message delivery to patients, parents 4. Communicate vaccination benefits to patients, parents at every opportunity 5. Make vaccination procedures routine and focus on ways to reduce missed opportunities National Foundation for Infectious Diseases. Call to Action: HPV Vaccination as a Public Health Priority. August 2014. http://www.adolescentvaccination.org/hpv-cta
HCP Recommendations (and How They re Made) Matter HCP recommendations are the single most persuasive reason adolescents get vaccines 1-3 Altering the order of recommendations (put HPV first) may have a positive impact on uptake Parents more likely to accept vaccine if HCPs use a presumptive style (83% uptake) vs. participatory (26% uptake) style (p < 0.001) 4 Presumptive: Well, we have to do some shots today Participatory: What do you want to do about shots? 1. Brewer NT. Sex Transm Dis. 2011;38(3):197; 2. Gust DA. Pediatrics. 2008;122(4):718; 3. NFID. Survey: Disconnect in what doctors think they say about vaccine s and what patients hear. http://www.adultvaccination.org/newsroom/events/2010-cdcvaccination-rates-news-conference/2010-survey-backgrounder.pdf ; 4. Opel DJ. Pediatrics. 2013;132(6):1037.
A Call to Action for US Healthcare Professionals 1. Recommend HPV vaccine with the same strength and conviction used to recommend other adolescent vaccines 2. Educate yourself about HPV and HPV vaccines 3. Inform your colleagues and staff to ensure consistent, positive message delivery to patients, parents 4. Communicate vaccination benefits to patients, parents at every opportunity 5. Make vaccination procedures routine and focus on ways to reduce missed opportunities National Foundation for Infectious Diseases. Call to Action: HPV Vaccination as a Public Health Priority. August 2014. http://www.adolescentvaccination.org/hpv-cta
Resources and Call to Action available at: http://www.adolescentvaccination.org/professionalresources/hpv-resource-center
A Call to Action for US Healthcare Professionals 1. Recommend HPV vaccine with the same strength and conviction used to recommend other adolescent vaccines 2. Educate yourself about HPV and HPV vaccines 3. Inform your colleagues and staff to ensure consistent, positive message delivery to patients, parents 4. Communicate vaccination benefits to patients, parents at every opportunity 5. Make vaccination procedures routine and focus on ways to reduce missed opportunities National Foundation for Infectious Diseases. Call to Action: HPV Vaccination as a Public Health Priority. August 2014. http://www.adolescentvaccination.org/hpv-cta
Key Elements of HPV Educational Efforts Barrier (A) Parents need more information (B) Not sexually active/children don t need vaccine so young (C) Safety/efficacy concerns (D) Poor completion rates/3-shot series (E) Lack of perceived benefit for males Tools should include (A1) General disease information (A2) Positioning of vaccine as cancer prevention (B3) Emphasis of age 11-12 recommendation (B4) Explanation of importance of vaccination before sexual debut (C5) Discussion of safety/efficacy (D6) Reminder of 3-shot series (D7) Addressing of system-level barriers (e.g., cost) (E8) Emphasis of male vaccination/benefit for men President s Cancer Panel Report. Bethesda, MD: National Cancer Institute; 2014; Holman DM, et al. JAMA Pediatr. 168(1):76-82; CDC. Tips and Time-savers for Talking with Parents about HPV Vaccine. http://www.cdc.gov/vaccines/who/teens/for-hcptipsheet-hpv.pdf
A Call to Action for US Healthcare Professionals 1. Recommend HPV vaccine with the same strength and conviction used to recommend other adolescent vaccines 2, Educate yourself about HPV and HPV vaccines 3. Inform your colleagues and staff to ensure consistent, positive message delivery to patients, parents 4. Communicate vaccination benefits to patients, parents at every opportunity 5. Make vaccination procedures routine and focus on ways to reduce missed opportunities National Foundation for Infectious Diseases. Call to Action: HPV Vaccination as a Public Health Priority. August 2014. http://www.adolescentvaccination.org/hpv-cta
Rationale for Recommendation for Immunization of 11-12 Year Olds Modeling shows greater impact if given universally before onset of sexual activity targeting risk groups not possible Antibody response in 11-15 year olds is greater than 16-26 year olds Antibody titers have persisted for > 8 years Vaccine is well tolerated in this age group Implementation advantage: visit at age 11-12 already scheduled as immunization visit CDC. MMWR. 2007;56(RR-2):1-24; Amanna IL. Immunol Rev. 2010;236:125.
A Call to Action for US Healthcare Professionals 1. Recommend HPV vaccine with the same strength and conviction used to recommend other adolescent vaccines 2. Educate yourself about HPV and HPV vaccines 3. Inform your colleagues and staff to ensure consistent, positive message delivery to patients, parents 4. Communicate vaccination benefits to patients, parents at every opportunity 5. Make vaccination procedures routine and focus on ways to reduce missed opportunities National Foundation for Infectious Diseases. Call to Action: HPV Vaccination as a Public Health Priority. August 2014. http://www.adolescentvaccination.org/hpv-cta
Questions & Answers Joseph A. Bocchini, Jr., MD Chair, NFID HPV Initiative