you are the key to hpv cancer prevention understanding the burden of hpv disease, the importance of...
TRANSCRIPT
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You are the Keyto HPV Cancer Prevention
Understanding the Burden of HPV Disease, the Importance of the HPV Vaccine Recommendation,
and Communicating about HPV Vaccination
Dana H. GreenwoodChief Nurse ConsultantImmunization DivisionIN State Dept Health
November 7, 2014
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Disclosure
I have not financial disclosures or conflicts of interest
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Objectives1. Describe the burden of HPV infection in the
United States2. Share best practices for talking with parents
about the HPV vaccine
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HPV Rate Girls: 54.1% (series initiation) 34.6% (series completion)
HPV Rate Boys: 18.2% (series initiation) 8.1% (series completion)
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HPV INFECTION & DISEASEUnderstanding the Burden
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HPV Types Differ in their Disease Associations
Mucosal sites of
infection
Cutaneoussites of
infection
~ 80 Types
“Common” Hand and Foot
Warts
~40 Types
Genital WartsLaryngeal PapillomasLow Grade Cervical
Disease
Low risk (non-oncogenic)HPV 6, 11
High risk (oncogenic)HPV 16, 18
Cervical Cancer Anogenital Cancers
Oropharyngeal Cancer Cancer Precursors Low Grade Cervical
Disease
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HPV Infection
Most females and males will be infected with at least one type of HPV at some point in their lives Estimated 79 million Americans currently infected 14 million new infections/year in the US HPV infection is most common in people in their teens and
early 20s
Most people will never know that they have been infected
Jemal A et al. J Natl Cancer Inst 2013;105:175-201
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Cancers Attributed to HPV, U.S.
CDC, United States Cancer Statistics (USCS), 2006-2010
Cancer site
Average number of cancers per year in sites where HPV
is often found
Percentage of cancers per year probably caused
by HPV
Average number of cancers per year probably caused
by HPV†
Male Female Both Sexes Male Female
Both Sexes
Anus 1,549 2,821 4,370 91% 1,400 2,600 4,000
Cervix 0 11,422 11,422 91% 0 10,400 10,400
Oropharynx 9,974 2,443 12,417 72% 7,200 1,800 9,000
Penis 1,048 0 1,048 63% 700 0 700
Vagina 0 735 735 75% 0 600 600
Vulva 0 3,168 3,168 69% 0 2,200 2,200
TOTAL 12,571 20,589 33,160 9,300 17,600 26,900
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Average Number of New Cancers Probably Caused by HPV, by Sex, United States 2006-2010
CDC, United States Cancer Statistics (USCS), 2006-2010
Women (n = 17,600)
Oropharynxn=1,80010%
Anusn=2,60015%
Cervixn=10,40059%
Vaginan=6003%
Vulva n=2,200 13%
Men (n = 9,300)
Anusn=1,40015%
Oropharynxn=7,20077%
Penisn=7008%
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HPV VACCINEEvidence-Based HPV Prevention
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HPV Prophylactic Vaccines
HPV Virus-Like Particle
Recombinant L1 capsid proteins that form “virus-like” particles (VLP)
Non-infectious and non-oncogenic
Produce higher levels of neutralizing antibody than natural infection
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HPV VaccineQuadrivalent/HPV4
(Gardasil) Name Bivalent/HPV2(Cervarix)
Merck Manufacturer GlaxoSmithKline
6, 11, 16, 18 Types 16, 18
Females: Anal, cervical, vaginal and vulvar precancer
and cancer; Genital warts Males: Anal precancer and
cancer; Genital warts
IndicationsFemales: Cervical precancer and
cancerMales: Not approved for use in
males
Hypersensitivity to yeast ContraindicationsHypersensitivity to latex (latex
only contained in pre-filled syringes, not single-dose vials)
3 dose series: 0, 2, 6 months Schedule (IM) 3 dose series: 0, 1, 6 months
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ACIP Recommendation and AAP Guidelines for HPV Vaccine
Routine HPV vaccination recommended for both males and females ages 11-12 years
Also ages 13-21 years for males; 13-26 for females
Vaccine can be given starting at age 9 years of age for both males and females; vaccine can be given ages 22-26 years for males
CDC. Quadrivalent Human Papillomavirus Vaccine: Recommendations of ACIP. MMWR 2007;56(RR02):1-24.
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HPV Vaccination Schedule
ACIP Recommended schedule is 0, 1-2*, 6 months Following the recommended schedule is
preferred Minimum intervals
4 weeks between doses 1 and 2 12 weeks between doses 2 and 324 weeks between doses 1 and 3
Administer IM
CDC. Quadrivalent Human Papillomavirus Vaccine: Recommendations of ACIP. MMWR 2014;63(RR05):1-30.
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HPV Vaccine Is Safe, Effective, and Provides Lasting Protection
HPV Vaccine is SAFE Safety studies findings for HPV vaccine similar to safety
reviews of MCV4 and Tdap vaccines HPV Vaccine WORKS
Vast reductions in high grade cervical lesions decline in Australia
80% of school aged girls vaccinated Prevalence of vaccine types declines by more than half in US
With only 33% of teens fully vaccinated
HPV Vaccine LASTS Studies suggest that vaccine protection is long-lasting; no
evidence of waning immunityGarland et al, Prev Med 2011; Ali et al, BMJ 2013; Markowitz JID 2013; Nsouli-Maktabi MSMR 2013
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HPV VACCINE COVERAGE
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Adolescent Vaccination CoverageUnited States, 2006-2013
MMWR 2014; 63(29);625-633.
2006 2007 2008 2009 2010 2011 2012 20130
10
20
30
40
50
60
70
80
90
100
86
77.8
57.3
37.6
34.6
13.9
TdapMCV41 HPV girls3 HPV girls1HPV boys3 HPV boys
Survey Year
PercentVaccinated
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Missed Opportunities: IndianaFemales Only
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HPV Vaccine Series InitiationGirls 13-17 Years, by State, 2013
0
10
20
30
40
50
60
70
80
90
State
Perc
ent
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Top 5 reasons for not vaccinating daughter, among parents with no intention to vaccinate
in the next 12 months, NIS-Teen 2013
Lack of knowledge
Not needed or necessary
Safety concern/Side effects
Not recommended
Not sexually active
0 5 10 15 20
Percent
CDC. National and State Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2012MMWR 2014; 63(29);625-633.
13%
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FRAMING THE CONVERSATIONTalking about HPV vaccine
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The Conversations with Parents
1. Give a STRONG recommendation
2. Start conversation early and focus on cancer prevention
3. Offer a personal story
4. Welcome questions from parents, especially about safety
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Framing the HPV Vaccine Conversation
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Bundle Them Up!
Successful recommendations group all of the adolescent vaccines Recommend HPV vaccine the same way and on the
same day you recommend Tdap and meningococcal vaccines.
A strong recommendation from you is the main reason parents decide to vaccinate Many parents responded that they trusted their child’s
doctor and would get the vaccine for their child as long as they received a recommendation from the doctor
Unpublished CDC data, 2013.
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Surely, this kid isn’t going to be having sex anytime soon, right? Guess again.
47% of high school students have already engaged in sexual intercourse (vaginal-penile) 6% of these students had sexual intercourse
before age 13 years 1/3 of 9th graders and 2/3 of 12th graders have
engaged in sexual intercourse 1 in 7 high school students (all grades) have had
sexual intercourse with 4 or more partnersJemal A et al. J Natl Cancer Inst 2013;105:175-201Kahn. MMWR. 2014; 63(4)
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Rationale for vaccinating early: Protection prior to exposure to HPV
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HPV VaccineDuration of Immunity
Studies suggest that vaccine protection is long-lasting; no evidence of waning immunity Available evidence indicates protection for at least
8-10 years Multiple cohort studies are in progress to monitor
the duration of immunity
Romanowski B. Long term protection against cervical infection with the human papillomavirus: review of currently available vaccines. Hum Vaccin. 2011 Feb;7(2):161-9.
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COMMUNICATION TOOLSResources for HPV vaccine conversations
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“You Are the Key” HPV portal for Providers
cdc.gov/vaccines/YouAreTheKey
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Factsheets Resources for Patients
cdc.gov/vaccines/who/teens/products/print-materials.html
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Adolescent Immunization Schedule
cdc.gov/vaccines/schedules/easy-to-read/preteen-teen.html
Resources for Patients
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Vaccines for Preteens and Teens Website
cdc.gov/vaccines/teens
Resources for Patients
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Acknowledgments
A BIG thank you to the CDC’s adolescent vaccination team for contributing the slides for today’s presentation!
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HPV VACCINE IS CANCER
PREVENTIONAnd YOU are the key!
#WeCanStopHPV