HPV VACCINATION IN SANDYFORD SERVICES

Transcription

1 HPV VACCINATION IN SANDYFORD SERVICES 1. General infrmatin n HPV Vaccinatin 2. HPV vaccinatin in females 3. Yung Wmen Only 4. HPV vaccinatin in MSM 1. General infrmatin General Infrmatin fr clinicians and clients Human papillmavirus (HPV) infects the surface f the skin and mucsa f the upper respiratry and angenital tracts. The majrity f HPV infectins are asymptmatic and infectin is usually cleared withut the need fr treatment. Hwever persistent infectin with high risk HPV types such as types 16 and 18 can lead t cancer mst ntably cancer f the cevix, anus, thrat and penis. HPV 6 and 11 cause genital warts. HPV is ne f the mst cmmn sexually transmitted infectins in the UK. HPV infectins are spread primarily by sexual cntact with an infected partner, particularly thrugh sexual intercurse but als by nn-penetrative genital cntact, including ral sex. Vaccine-Infrmatin Gardasil is the recmmended vaccine and prvides prtectin against fur HPV strains: HPV-16 and HPV-18 (high risk HPV types that can lead t cancer) and HPV-6 and HPV-11(HPV types that cause apprximately 90 per cent f all angenital warts). The vaccine is made frm virus-like particles (VLPs) that are nt infectius and cannt cause HPV-assciated cancers r genital warts as they d nt cntain the virus s DNA. VLPs are very immungenic and induce high levels f antibdy prductin by the bdy. Gardasil has been shwn t be highly effective in preventing the types f HPV infectin fr which it is indicated. Prir infectin with ne HPV type des nt diminish the efficacy f the vaccine against ther HPV types included in the vaccine. HPV vaccines have nt been shwn t have an impact n an existing infectin but may bst immunity and prevent re-infectin r reduce reccurrences. Gardasil is a very safe vaccine. The mst cmmn adverse reactin bserved were injectin-site reactins (77.1%). Other reactins cmmnly reprted are headache, myalgia, fatigue, and lw grade fever. Gardasil is an inactivated vaccine and will nt be affected by, nr interfere with ther inactivated r live vaccines. Cntraindicatins Cnfirmed anaphylactic respnse t a previus dse r any cmpnent f the vaccine. Defer vaccinatin if recipient has fever r is acutely unwell. Page 1 f 6

2 Administratin HPV vaccines are supplied as suspensins f virus like particles (VLPs) in pre-filled syringes. During strage a white precipitate may develp and the vaccines shuld be shaken befre use t frm a white milky clud. Vaccines are given by intramuscular injectin int deltid muscle. Anaphylaxis is pssible but extremely rare. Vasvagal reactin can ccur during vaccinatin. Gardasil is a black triangle prduct and, as such, all adverse incidents shuld be reprted t the Cmmissin n the Safety f Medicines using the yellw card reprting system ( 2.HPV Vaccinatin - females Backgrund The Scttish Gvernment supprted HPV vaccinatin prgram fr all yung wmen aged years has been implemented since September This is delivered thrugh schls. Yung wmen excluded frm the prgram r nt attending schl shuld receive the vaccine thrugh their GP. Frm September 2012 Gardasil has been used as HPV vaccinatin in females and frm 2014 the dsing schedule changed frm 3 t 2 dses fr thse cmmencing a curse under the age f 15 years ld. In thse ver the age f 15 years a 3 dse schedule is still recmmended. Sandyfrd has been authrised t prvide vaccinatin t vulnerable yung wmen, identified at the time f cnsultatin as being eligible t receive the vaccine but wh are unable t access vaccine thrugh the schl prgram. Once such a client is identified, arrangements shuld be made within Sandyfrd fr the vaccine t be administered. Small supplies f the HPV vaccine are available in Sandyfrd Central and in sme selected hubs. Inclusin Criteria Vulnerable yung wmen aged 12 years and ver but under 18 years (17 years and 364 days) presenting t Sandyfrd services wh are excluded frm schl and unable t access the schl vaccine prgram. Wish t be included and able t cnsent Exclusin criteria Age 18 years r ver (unless the curse was cmmenced prir t age 18 yrs. It is reasnable t cmplete a curse under such circumstances) Pregnancy (limited data) Page 2 f 6

3 Dsage & schedule Gardasil 1x IM n initial day f attendance and 6 mnths (if under 15 years f age) Secnd dse : the minimum time between the 1 st and 2 nd dses shuld be 6 mnths, and the 2 nd dse shuld be given within 24 mnths f the 1 st dse If the curse is interrupted, even if greater than 24 mnths, resume the curse with the same vaccine. There is n need t repeat the curse. Wmen knwn t be HIV infected shuld have a 3-dse curse due t lack f clinical evidence f efficacy in this grup fr the 2-dse schedule. Recrd Keeping / Dcumentatin Cnsent shuld be btained and recrded clearly n the electrnic client recrd and the relevant prescriptin and administratin details recrded. 3. Yung Wmen Only All eligible yung wmen will be recalled thrugh the Schl Health System. An Unscheduled Frm shuld be cmpleted and returned t: Screening Department, 1 st Flr, Building 2, Templetn Business Centre, 62 Templetn Street, Glasgw, G40 1DA fr every HPV vaccine administered. Frms are available in Public Flders at \\Fileserver3\public flders\01 Prtcls, Plicies and Guidelines\Guidelines. Titled Unscheduled HPV Frm. It is pssible t cnfirm the vaccine status f any client presenting by cntacting the Schl Health System Team during ffice hurs: Schl Health System Team Cntact details (crrect at July 2017) Carlanne Griffiths Child Health Team Leader fr Schls Telephne Templetn Business Centre 62 Templetn Street Glasgw G40 1DA Page 3 f 6

4 4. HPV vaccinatin MSM Frm July 2017, the HPV vaccine will be ffered pprtunistically at Sandyfrd (central and hubs) t men wh have sex with men (MSM) up t and including the age f 45 attending services. Why MSM? In all men 80-85% f anal cancers, 30-70% f r-pharyngeal cancer and 50% f penile cancers are assciated with HPV infectin. MSM bear a significantly increased burden f HPV related disease cmpared t hetersexual men. HPV type 16-assciated anal cancers in particular are far mre cmmn in MSM. Men aged 46 and abve are nt ffered HPV vaccinatin as research/review has shwn the HPV vaccinatin t have a health benefit and be cst effective t MSM up t the age f 40 this has been extraplated t the age f 45 but nt beynd this. Since September 2008, a natinal HPV Immunisatin Prgramme fr girls has been delivered t help prevent cervical cancer. In additin t reductin f lw- and highgrade cervical abnrmalities in yung Scttish wmen, the current HPV vaccine prgramme induces herd prtectin, which prvides substantial prtectin t hetersexual bys and men. MSM accessing Sexual Health/HIV services are knwn t be at higher risk f HPV infectin and disease. A curse f three injectins is needed and current studies suggest that prtectin is maintained fr at least 10 years. The secnd dse shuld be administered at 1 mnth and the third dse administered at 4 mnths, ideally cmpleted within 12 mnths. If the vaccine curse is interrupted, it shuld be resumed but nt repeated. Gardasil 1x IM : n initial day f attendance, 1 mnth, 4 mnths What t d when an MSM 45 years r under attends Sandyfrd Prvide client with a Patient Infrmatin Leaflet and ffer HPV vaccinatin Prvide any further infrmatin client may need If client declines vaccinatin, recrd n NaSH (Special frms BBV page, see belw) If client accepts vaccinatin: recrd n NaSH that vaccinatin cmmenced (Special frms BBV page, see screensht 1 belw) prescribe HPV vaccinatin n NaSH prvide HPV vaccinatin card (same as Hepatitis B) make 1 mnth appintment fr secnd vaccinatin set up SMS fr 4 mnth recall fr third vaccinatin in Special Frms -patient actins and recalls see screensht 2. Page 4 f 6

5 1. Recrding f HPV Vaccinatin. 2. SMS reminder Patient Actin and Recall Page 5 f 6

6 References Giulian AR, Nyitray AG, Kreimer AR, Pierce Campbell CM et al., EUROGIN 2014 radmap: Differences in human papillmavirus infectin natural histry, transmissin and human papillmavirus-related cancer incidence by gender and anatmic site f infectin. Int J Cancer 2014; Jul 17. di: /ijc Kreimer AR, Cliffrd GM, Byle P, Franceschi S. ( 2005) Human Papillmavirus Types in Head and Neck Squamus Cell Carcinmas Wrldwide: A Systematic Review. Cancer Epidemil Bimarkers Prev ; 14: Chin-Hng PV, Vittinghff E, Cranstn RD, Buchbinder S et al. (2004), Age-Specific prevalence f anal human papillmavirus infectin in HIV-negative sexually active men wh have sex with men: the EXPLORE study. J Infect Dis; 190: Daling JR, Weiss NS, Hislp TG, Maden C et al. (1987), Sexual practices, sexually transmitted diseases, and the incidence f anal cancer. N Engl J Med; 317: Pllck KG, Kavanagh K, Ptts A, Lve J, Cuschieri K, Cubie H, Rbertsn C, Cruickshank M, Palmer TJ, Nicll S, Dnaghy M. (2014). Public Health England. Immunisatin against infectius diseases: Human papillmavirus (HPV) 18a. Page 6 f 6