YOU ARE THE KEY. July 11, 2014

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1 YOU ARE THE KEY Jill B Roark, MPH Health Communication Specialist Health Communication Science Office National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention July 11, 2014

2 26 million: number of girls under 13 years of age in the United States 168,400: number who will develop cervical cancer if none are vaccinated 54,100: number who will die from cervical cancer if none are vaccinated For each year we stay at 30% coverage instead of achieving 80%... 4,400: number of future cervical cancer cases we will not prevent 1,400: number of cervical cancer deaths we will not prevent Adapted from Chesson HW et al, Vaccine 2011;29:

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4 Reduce Missed Clinical Opportunities to Recommend and Administer HPV Vaccines Objective 1.2: Providers should strongly encourage HPV vaccination of age-eligible males and females whenever other vaccines are administered.

5 Some clinicians don t provide a recommendation for HPV vaccine * Not mutually exclusive. ** Did not know much about HPV or HPV vaccine. National and State Vaccination Coverage Among Adolescents Aged Years United States, 2012 MMWR 2013; 62(34);

6 Most clinicians wait too long to make strong recommendations for HPV vaccine Allison et al.

7 Clinicians underestimate the value parents place on HPV vaccine Median Values Parent Provider's estimate Meningitis Hepatitis Pertussis Influenza HPV Adolescent vaccines Adapted from Healy et al. Vaccine. 2014;32:

8 Reduce Missed Clinical Opportunities to Recommend and Administer HPV Vaccines Objective 1.3: Healthcare organizations and practices should use electronic office systems, including EHRs and IIS, to avoid missed opportunities for HPV vaccination.

9 Evidence-based strategies to improve vaccination coverage Reminder/recall system Provider level (e.g., EMR prompts) Parent/patient level (e.g., postcards, telephone calls, text messaging) Standing orders Provider assessment and feedback Assessment of vaccination coverage levels within the practice and discussion of strategies to improve vaccine delivery Utilizing immunization information systems

10 Impact of Reminder/Recall on Vaccination Rates among Adolescents *p<0.05 Percent Vaccine Suh C et al. Pediatrics 2012;129:e

11 Percentages of adolescents years of age who received any vaccination at 4, 12, and 24 weeks: Text4Health-Adolescents, New York City, 2009 Stockwell et al. AJPH. 2012;102:e15-e21. 11

12 AFIX: Quality Improvement Assessment Incentives exchange Feedback

13 Increase Parents', Caregivers', and Adolescents' Acceptance of HPV Vaccines Objective 2.1: CDC should develop, test, and collaborate with partner organizations to deploy integrated, comprehensive communication strategies directed at parents and other caregivers, and also at adolescents.

14 HPV Vaccine is Cancer Prevention 1. HPV vaccine is safe, effective, and lasting protection against most cancers caused by HPV infection 2. HPV vaccination is best when given at 11 or 12 years of age 3. HPV vaccination rates have plateaued, leaving another generation at risk for HPV cancers

15 1. HPV Vaccine Is Safe, Effective, and Provides Lasting Protection A. HPV Vaccine is SAFE No serious sides effects HPV vaccine safety similar to MCV4 and Tdap vaccine safety B. HPV Vaccine WORKS High grade cervical lesions decline in Australia Prevalence of vaccine types declined by 56% in U.S. C. HPV Vaccine LASTS No evidence of waning immunity

16 2. HPV Vaccination is best at 11 or 12 A. HPV vaccine works best when the entire series has been given before exposure to HPV Very little exposure to HPV at 11 and 12 years of age 1/3 of 9th graders and 2/3 of 12th graders have engaged in sexual intercourse 24% of high school seniors have had sexual intercourse with four or more partners B. Higher immune response from HPV vaccine in preteens than in older teens

17 3. HPV Vaccination Rates have Plateaued A. Stagnant HPV vaccination rates are leaving another generation vulnerable to devastating HPV cancers Most of these cancers could be prevented with vaccination B. HPV vaccination rates are lagging behind the rates of the other vaccines for preteens and teens In 2012, 8 in 10 girls who had not yet started the HPV vaccine series had a missed opportunity; if these girls all received HPV vaccine, first dose coverage could be be 93% C. High HPV vaccination coverage is possible with the current healthcare structure At least 85% of teens aged years had a healthcare encoutner and received a vaccine.

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21 RECOMMENDED STATE ACTIVITIES 1. Support healthcare providers in recommending HPV vaccine for 11 and 12 year old girls and boys 2. Use data to drive immunization program decision making 3. Work with partners to advocate for HPV vaccination

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23 RECOMMENDED STATE ACTIVITIES 1. Support clinicians in recommending HPV vaccine for year olds Provide lunch-n-learn presentations on giving a strong recommendation for HPV vaccination Partner with coalitions and associations to provide CME programs about HPV vaccine Work with VFC coordinator to reach practices and clinics with HPV vaccine communication

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25 RECOMMENDED STATE ACTIVITIES 2. Use data to drive decision-making Consider what disparities exist and what can be done to improve coverage AFIX and ordering data can determine which clinicians/practices/clinics need the most assistance State-level data on Tdap and HPV vaccine coverage can highlight missed opportunities

26 AFIX cdc.gov/vaccines/programs/afix/index.html

27 RECOMMENDED STATE ACTIVITIES 3. Work with partner organizations to advocate for HPV vaccination State and local AAP and AAFP chapters Cancer coalitions/alliances/organizations American Cancer Society chapters

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29 Need More Specific Ideas? 1. SYNDICATE content to their website DOWNLOAD mattes article for publications 3. SHARE factsheets with parents & clinicians COLLABORATE to increase the campaign reach

30 For more information, visit: cdc.gov/vaccines/youarethekey questions or comments to CDC Vaccines for Preteens and Teens: Jill can be reached at:

31 HPV VACCINE IS CANCER PREVENTION and YOU are the key!

32 Questions for YOU! What questions about HPV vaccination do you get that you feel like you can t answer? What resources do you wish you had on teen/hpv vaccines? Is there anything that CDC could develop to assist you?

33 Questions for YOU! How are you working with cancer prevention organizations in your state? Have you identified a local pediatrician or cancer specialist who is a champion for HPV vaccine? Do they have media training?

34 Questions for YOU! NIS-Teen 2013 data will be released July 24 th and NIAM is in August. What activities will you do to piggyback on or support CDC s activities? What do you need from us to support your activities?