Increasing HPV Vaccination Rates in NYS. Jim Kirkwood NYSDOH, Bureau of Immunization

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1 Increasing HPV Vaccination Rates in NYS Jim Kirkwood NYSDOH, Bureau of Immunization 1

2 National Estimated Vaccination Coverage Levels among Adolescents Years, National Immunization Survey Teen, Percent Vaccinated Tdap MCV4 1 HPV girls 3 HPV girls 1HPV boys 3 HPV boys Tdap: tetanus, diphtheria, acellular pertussis vaccine. MCV4: meningococcal conjugate vaccine HPV: human papillomavirus vaccine Survey Year 2 2

3 NYS (Outside of NYC) Specific HPV Vaccination Rates 1 Tdap 1 MenACWY 1 HPV (females) 3 HPV (females) 1 HPV (males) 3 HPV (males) U.S. 88.5% 74.0% 53.8% 33.4% 20.8% 6.8% NYS 94.2% 80.5% 57.5% 41.3% 12.1% N/A surv/nisteen/data/tables_2012.htm 3 3

4 Why We Need to Do Better in HPV Vaccination of 12 year olds Currently 26 million girls less than 13 years old in the US. If none of these girls are vaccinated then: 168,400 will develop cervical cancer, and 54,100 will die from it. Vaccinating 30% would prevent 45,500 of these cases and 14,600 deaths. Vaccinating 80% would prevent 98,800 cases and 31,700 deaths. For each year we stay at 30% coverage instead of achieving 80%, 4,400 future cervical cancer cases and 1,400 cervical cancer deaths will occur. 4

5 Actual and Achievable Vaccination Coverage if Missed Opportunities Were Eliminated: Adolescents Years, NIS Teen 2012 Percent Vaccinated Among girls unvaccinated for HPV, 84% had a missed opportunity Actual Achievable 0 HPV-1 (girls) Vaccine Missed opportunity: Encounter when some, but not all ACIP recommended vaccines are given. HPV 1: Receipt of at least one dose of HPV. 5 5

6 Framing the Conversation Based on Formative Audience Research TALKING ABOUT HPV VACCINE 6

7 How Can Clinicians Help? 1. Give a STRONG recommendation Ask yourself, how often do you get a chance to prevent cancer? 2. Start conversation early and focus on cancer prevention Vaccination given well before sexual experimentation begins Better antibody response in preteens 3. Offer a personal story Own children/grandchildren/close friends children HPV related cancer case 4. Welcome questions from parents, especially about safety Remind parents that the HPV vaccine is safe and not associated with increased sexual activity 7

8 What s in a Recommendation? Studies consistently show that a strong recommendation from HCP is the single best predictor of vaccination In focus groups and surveys with moms, having a doctor recommend or not recommend the vaccine was an important factor in parents decision to vaccinate their child with the HPV vaccine Not receiving a recommendation for HPV vaccine was listed a barrier by mothers 8 8

9 Top 5 Reasons for Not Vaccinating Daughter, Among Parents with No Intention to Vaccinate in the Next 12 Months, NIS Teen 2012 Not sexually active Lack of knowledge Safety concerns/side effects Not recommended by provider Not needed or necessary** ** Did not know much about HPV or HPV vaccine Percent 9 9

10 Strength of HPV Vaccine Recommendation for Female Patients, Pediatricians and Family Physicians (N=609) 10 Allison et al. 10

11 Rationale for vaccinating early: Protection prior to exposure to HPV 82% 18 to 24 Markowitz MMWR 2007; Holl Henry J Kaiser Found 2003; Mosher Adv Data 2006

12 Avoid Missed Opportunities HPV vaccine can safely be given at the same time as the other recommended adolescent vaccines and should be bundled with others. Encourage providers to bundle Encourage providers to give HPV vaccine during routine sports, or camp physicals Review immunization record even at acute care visits Systems interventions depend on clinician commitment 12

13 Practice Wide Strategies to Decrease Missed Vaccination Opportunities Use ALL patient encounters to assess and provide vaccination or education (include siblings if present) Having in place standing orders for healthcare providers to identify opportunities to administer vaccines to adolescents Use ACIP catch up schedule as reference Educate staff on valid and invalid vaccine contraindications and precautions Use prompts during all office visits as reminders to staff and patients/parents about recommended immunizations 13 13

14 Communication Goals Parents need to: Realize HPV vaccine is CANCER PREVENTION Understand HPV vaccine is best at 11 or 12 years old Recognize importance of getting all 3 shots Health care professionals need to: Be familiar with all of the indications for HPV vaccine Make strong recommendations for receiving vaccine at 11 or 12 Be aware of, and interested in, systems that can improve practice vaccination rates 14 14

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17 CDC Funded Grant Awarded to NYS: Increasing Human Papillomavirus (HPV) Vaccination Coverage Rates Among Adolescents

18 Major HPV Grant Activities Incorporate stakeholders and their communities into HPV campaign NYS Cancer Consortium Rural Health Networks, FQHCs STD Local Health departments and their coalitions Statewide medical organizations School health Objective: Increase knowledge of HPV and increase vaccine demand 18 18

19 Reminder and Recall Letters Using NYSIIS Data Sending a reminder or recall letter and fact sheet to parents/guardians of and 13 year olds in NYS Target Audience: years old, have not started HPV vaccine series (remind) 13 years old, have not started (remind) years old, began series, not completed (recall) Estimated size: 330,000 children Target Date: April/May 19 19

20 Communication Campaign Media purchases to promote HPV vaccine to parents Broadcast Web advertisements, social media Outdoor advertising Working with various partners to help get HPV messages into provider offices Distribute communication materials and messages tested by CDC to stakeholders, providers and others Translate materials into multiple languages 20 20

21 Communications Toolkit for Partners Based on CDC in depth interviews with: Clinicians Mothers Tested material will include: Fact sheets along with order forms Newsletter articles Sample Facebook, twitter posts with links to materials, videos and PSAs

22 Provide Feedback to Providers during HPV AFIX visits Information on practice wide HPV rates Information on HPV vaccine and other adolescent vaccines Provide messages to help answer parents questions about HPV Share strategies to address barriers and missed opportunities for vaccination 22 22

23 How do we choose providers for a NYSDOH AFIX visit? According to CDC, AFIX visits should be chosen based on: Provider rates Size of practice Whether practice has received a visit NYSDOH will choose its providers based on Practices that are not receiving an AFIX Visit from LHD Ordering behavior (HPV:TDAP ratio) Size of practice Once chosen, we will inform LHDs who we plan to visit

24 HPV Resources CDC, Clinician specific web portal hcp/hpvresources.html CDC, Information for Health Care Professionals about Adolescent Vaccines NYSDOH, Q & A about HPV and HPV Vaccine Information for Providers /hpv_q_and_a.htm NYSDOH, Are Your Children Years Old?

25 HPV Resources (cont.) CDC, Tips and Time savers for Talking with Parents about HPV Vaccine hcp tipsheet hpv.pdf CDC, HPV also known as Human Papillomavirus vac/hpv/downloads/dis HPVcolor office.pdf CDC, HPV Vaccine for Preteens and Teens vac/hpv/downloads/pl dispreteens hpv.pdf Dear Colleague letter from CDC and other organizations