Let s Get Teens Immunized Against HPV

Transcription

1 PAT OBULANEY, DNP, RN, ANP-C Let s Get Teens Immunized Against HPV In the US, 12,900 women diagnosed with cervical cancer yearly and 4,100 will die (CDC, 2013). Hispanic women have the highest incidence cervical cancer in U.S. related to lack of disease knowledge & poverty. Black women highest cervical cancer mortality rate (American Cancer Society, 2013). Most women diagnosed with cervical cancer before age 50 (Ages years). CERVICAL CANCER 99% cervical cancer related to human papillomavirus (HPV) 13 high- risk HPV genotypes cause cervical cancer. HPV- 16 & HPV- 18 cause 71% of cervical cancers. (NCI, 2014). HPV is most common STI. 6.2 million new HPV infections occur annually (CDC, 2013). 40 HPV genotypes are sexually transmitted from person to person- infecting oral, anal, or genital areas of men and women. HPV 1

2 Primary prevention for cervical cancer is the HPV vaccine (Gardasil/Cervarix). Inadequate HPV vaccine rate in U.S. Vaccine series is expensive. Inadequate patient education. Poor provider recommendation. PRIMARY PREVENTION Parents make decision regarding childhood HPV vaccination. Lack of sufaicient HPV/cervical cancer understanding to make well- informed decision. Language- appropriate, culturally- tailored HPV/CC educational programs increase education effectiveness PREVENTION EDUCATION It is important to educate parents & children about HPV infection prevention to reduce the rate of cervical cancer. EDUCATION 2

3 Ethnicity-appropriate pictures & clear brochure communication enhance parents receptivity to HPV vaccine for child. HPV vaccine uptake increases when recommended by healthcare providers. EDUCATION & RECOMMENDATION Early onset sexual activity, multiple sexual partners, high- risk sexual partners, and unprotected sex Tobacco Use First full- term pregnancy at young age Family history of cervical cancer Immunosuppression and STD history HPV RISK FACTORS Abstinence/ Limit Number of Partners HPV vaccination before sexually active (prior to potential HPV exposure). Avoid tobacco use Healthy living HPV PREVENTION 3

4 Gardasil Vaccine- three- injection series given at month 0, 2 & 6; (protects against four HPV strains- 6, 11, 16 & 18). Gardasil- 9 protects against 9 HPV strains Cervarix (3 dose series) protects against HPV 16 & 18. Not approved for males. CDC Recommendation: Give Gardasil to year old girls and boys against HPV (prior to sexual activity). 27% of 15 to 17 year- olds are sexually active. 56% decline in HPV- 16 and HPV- 18 infection rate among year- old females in U.S since vaccine introduced (ACOG, 2014). HPV VACCINE Lack of knowledge. Safety concerns/ Side effects. Parents feel it is not necessary. Child not yet sexually active. Concerns about inciting sexual promiscuity. Provider never recommended. VACCINE IMPEDIMENTS Provider recommendation will improve vaccination rate. Review: Safety Concerns Cost Sexual activity HPV VACCINATION 4

5 Most commonly reported symptoms: Injection site reactions Dizziness Syncope may include tonic/clonic movements Nausea Headache JAMA. 2009;302(7): Page 9 Prior severe, life- threatening allergic reaction to a dose of HPV vaccine. Prior severe (life threatening) allergy to any component of HPV vaccine. Persons with severe allergies including severe allergy to yeast. Not recommended for pregnant women. If moderately or severely ill, wait until individual recovers. WHO SHOULD NOT GET VACCINE? 5

6 Avoid HPV infections. Yearly well woman examination with cervical cancer screening (Pap test) starting age 21 years, and then every three years to detect precancerous changes. Pap w/ HPV test in women aged 30 years and older. Ages Pap with HPV every 5 years or Pap test alone every 3 years. CERVICAL CANCER PREVENTION Cervical cancer and HPV prevention education. Educate about HPV vaccines & cervical cancer screening Use language-appropriate brochures, DVD, or hand-outs. Non-judgmental approach PATIENT EDUCATION HPV prevention increases through: Health Promotion & Disease Prevention Education Provider Recommendation of HPV Vaccine Promotion of Well Child and Teen Visits Community Outreach Language- Appropriate Education COMMUNITY EDUCATION 6

7 Knowledge is power Well- informed decision- making Self respect gives strength EMPOWER THROUGH EDUCATION Patients view nurses as most trusted source of health related information. Be a reliable information source. PATIENT TEACHING Acosta, A.M., Bonney, L.E., Fost, M., Green, V.L., & del Rio, C. (2013, March 28). HPV Knowledge among a marginalized population [Letter]. Preventing Chronic Disease, 10. Retrieved from Allen, J.D., Othus, M.K.D., Shelton, R.C., Li, Y., Norman, N., Tom, L., & del Carmen, M.G. (2010). Parental decision making about the HPV vaccine. Cancer, Epidemiology, Biomarkers, and Prevention, 19, doi: / EPI American Cancer Society. (2013). What are the key statistics about cervical cancer? Retrieved from Cassidy, B., Braxter, B., Charron-Prochownik, D., & Schlenk, E.A. (2013). A quality improvement initiative to increase HPV vaccine rates using an educational and reminder strategy with parents of preteen girls. Journal of Pediatric Health Care, 28(2), Centers for Disease Control and Prevention. (2012). Cervical cancer rates by race and ethnicity. Retrieved from Guvenc, G., Akyuz, A., & Yenen, M.C. (2013). Effectiveness of Nursing Interventions to Increase Pap Smear Test Screening. Research in Nursing and Health, 36, Retrieved from Hughes, C.C., Jones, A.L., Feemster, K.A. & Fiks, A.G. (2011). HPV vaccine decision making in pediatric primary care: A semi-structured interview study. BioMed Central Pediatrics, 11, doi: / REFERENCES 7

8 Kepka, D., Coronado, G.D., Rodriguez, H.P., & Thompson, B. (2011). Evaluation of a radionovela to promote HPV vaccine awareness and knowledge among Hispanic parents. Journal of Community Health, 36(6), doi: /s Larkey, L.K., Lopez, A.M., Minnal, A., & Gonzalez, J. (2009). Storytelling for promoting colorectal cancer screening among underserved Latina women: A randomized pilot study. Cancer Control, 16(1), Retrieved from Moffitt Cancer Center. (2014). HPV vaccination rates might rise if more docs recommend it. Health Day. Retrieved from id=8&action=detail&ref=51799 Reiter PL, Stubbs B, Panozzo CA, Whitesell D, & Brewer NT. (2011). HPV and HPV vaccine education intervention: effects on parents, healthcare staff, and school staff. Cancer Epidemiological Biomarkers, 20(11), Retrieved from Sanchez, J., DeLaRosa, M., & Serna, C.A. (2013). Project Salud: Efficacy of a community-based HIV prevention intervention for Hispanic migrant workers in south Florida. AIDS Education and Prevention, 25(5), Retrieved from vid=3&sid=6dc7f8f8-76d0-472b-b943-ead %40sessionmgr113&hid=122 Shafer, A., Cates, J.R., Diehl, S.J., & Hartmann, M. (2011). Asking Mom: Formative research for an HPV vaccine campaign targeting mothers of adolescent girls. Journal of Health Communication: International Perspectives, 16(9), doi: / REFERENCES QUESTIONS OR COMMENTS? 8