Multifaceted HPV Vaccination Strategies in California

Achieving the Promise Avoiding the Pitfalls

Heidi M. Bauer, MD MS MPHCalifornia Department of Public HealthSTD Control Branch

ISSTDR Seattle July 2007

Acknowledgements

Eileen Yamada Terri Thorfinnson Kurt Snipes Tammy Pilisuk Joyce Lisbin Gail Bolan And the many California stakeholders!

Overview

The rationale

The process: keys to success

Challenges and accomplishments

Future efforts

What are the benefits of the HPV vaccine in the

US? Cervical cancer is still a problem:

• 11,150 new cases and

• 3,670 deaths projected in 2007

Pap screening is secondary prevention Vaccine affords primary prevention:

• > 10,000 cervical and anogenital cancers• ~ 4,000 head and neck cancers• 160,000 abnormal Pap tests• > 300,000 cases of genital warts

Rationale for Workgroup

Intervention crosses multiple agencies

Pool resources and expertise

Create and promote consistent messages

Opportunity to create partnerships between

state government and advocacy,

professional, and healthcare organizations

The Process: Keys to Success

California HPV Vaccine Workgroup

Lead agencies: Immunization

STD Control

Cancer Detection

State government partners: Office of Women’s HealthDept of EducationMaternal Child Adolescent HealthOffice of Family PlanningOffice of AIDS

Workgroup Process

Strategic planning

Sharing resources

Stakeholder involvement

• External stakeholder interviews

• Statewide HPV Vaccine Summit

• Meaningful partnerships

Controversies Framing of the vaccine:

Cancer vs. STD prevention?

Rationing of resources for target populations

Minor consent

School mandates

Unanswered questions

Challenges and Accomplishments

Challenge #1:

Lack of public awareness of HPV, the connection with cervical cancer, and the availability of an effective vaccine

www.HPVvaccineCA.org* 9/06-6/07: > 2,000 hits; 2,600 page views

www.ccrcal.org

www.GetImmunizedCA.org

Platform: MCV4 Tdap Varicella HPV Influenza

* 4,000 providers, local PH programs, partner organizations* 26,000 print brochures in English; 15,000 brochures in Spanish

www.HPVvaccineCA.org

Challenge #2:

Lack of knowledge about HPV vaccine among health care provider and public health professionals

www.cdlhn.com * 1/07-6/07: ~ 350 downloads

* > 35,000 copies to 4,500 VFC providers, local IZ coordinators, etc

www.HPVvaccineCA.org

www.CalMedFoundation.org

* > 1,700 hits to index page and > 7,500 page views

Challenge #3:

Ensuring access to the vaccine among those who will benefit most

California VFC Program

As of June 15: 221,000 doses distributed to 2,400 VFC providers

Estimated 250,000 doses distributed within private sector

Challenge #4:

Lack of surveillance data to assess the public health impact of the vaccine

Cervical Disease Surveillance

Collaboration with California Emerging Infection Program:

Demonstration project to monitor CIN 2/3 within one county

Feasibility study for expansion and continuation

Future Efforts Conduct surveys to assess knowledge of

HPV and vaccine uptake

Provider surveys to understand barriers

Promote immunization registry for preteen vaccines

Provide technical assistance on policy issues

Develop and distribute materials for high-risk populations

Conclusions The unique challenges of implementing an

HPV vaccination program require an ongoing statewide collaborative effort to engage and coordinate a wide variety of stakeholders

Our work reinforces the effective role that state health departments have in supporting the introduction of HPV vaccines

Thank You!

Visit us! California HPV Vaccine Workgroup: www.HPVvaccineCA.org

Or write: Heidi.Bauer@cdph.ca.gov