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Ask Me About HPVI

Flovida DepavtllV\eVtt of Hea(t1'l

What is an HPV Ambassador?

A community or healthcare liaison who is trained to educate others on the importance of the HPV vaccine in preventing related cancers and other HPV related diseases. This person is trained to talk with and answer questions from the community which may include: parents, students, and healthcare professionals.

What does an HPV Ambassador do?

Ambassadors are committed to the cause of protecting people against HPV and other vaccinepreventable diseases. Ambassadors believe in the HPV vaccine and share that information whenever possible with others. Ambassadorsidentify themselves by wearing an HPV Ambassador Button and will give information onwhere and how to get vaccinated against HPV and also where to screen the SYL documentary.Ambassadors will share information by talking,blogging, tweeting and connecting with thecommunity in various settings. Ambassadorslead by example and share their convictionsthrough words and actions. #BeHPVFree

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HOW DO YOU BECOME AN HPV AMBASSADOR?

To become an Ambassador, trainees will be required toattend a screening of theSomeone You Love (SYL)documentary and complete 1-hour of “You are the Key”training and role play.Following initial training,yearly refreshers will be available to Ambassadors.

Lady Ganga

1.L,WI YOU ARE THE KEY TO R rll CANCER PREVENTION

You are the Key to HPV Cancer Prevention - Update

Andrea M Peaten Community Immunizations Liaison

HPV Ambassador Program Consultant Florida Department of Health

Funding for this presentation was made possible by the Centers for Disease Control and Prevention, cooperative agreement number, NH23IP000960. The views expressed in the written materials an by speakers and moderators do not necessarily

reflect the official policies of the Department of Health and Human Services, nor does the mention of trade names, commercial practices or organizations imply endorsement by the US Government.

NATIONAL AHEC ORGANIZATION

Flor-ida Depar-tWleVLt of Hea/tt,,.

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National AHEC Organization HPV Immunization Project

Florida HEALTH

YOU ARE 1 EK Y TO CANCER PREVENTION

Jointly provided by The National AHEC Organization and <Insert AHEC Name>

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Understanding the Burden

HPV INFECTION & DISEASE

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HPV Types Differ in their Disease Associations

Mucosal sites of infection

Cutaneous sites of infection

~ 80 Types

“Common” Hand and Foot

Warts

~40 Types

Genital Warts Laryngeal Papillomas

Low Grade Cervical Disease

Low risk (non-oncogenic) HPV 6, 11 most common

High risk (oncogenic) HPV 16, 18 most common

Cervical Cancer Anogenital Cancers

Oropharyngeal Cancer Cancer Precursors

Low Grade Cervical Disease


HPV Infection

Most females and males will be infected with at least one type of mucosal 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

Satterwhite et al. Sex Transm Dis. 2013


Cancers Caused by HPV per Year, U.S., 2009-2013

Cancer site

Percentage probably Number probably caused by any HPV type caused by

any HPV type Female Male Both Sexes

Cervix 91% 10,600 0 10,600

Vagina 75% 600 0 600

Vulva 69% 2,500 0 2,500

Penis 63% 0 700 700

Anus 91% 3,200 1,600 4,800

Rectum 91% 500 200 700

Oropharynx 70% 2,000 9,600 11,600

TOTAL 19,400 12,100 31,500

Based on Viens et al. MMWR 2016. https://www.cdc.gov/cancer/hpv/statistics

https://www.cdc.gov/cancer/hpv/statistics

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HPV-Associated Cancer Rates by Sex, Race and Ethnicity, United States, 2009–2013



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HPV-Associated Oropharyngeal Cancer Rates by Sex, Race and Ethnicity, United States, 2009–2013



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HPV-Associated Cervical Cancer Rates by Race and Ethnicity, United States, 2009–2013



HPV vacci �

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Evidence-Based HPV Disease Prevention

HPV VACCINE

QJ Bivalent C: ·-u

u

~ Quadrivalent

> 0.

9-valent :I:

HPV Types Included in Vaccine

6 11 16 18 31 33 45 52 58


HPV Vaccine Comparison

Genital 63% of cancers 10% of cancers in body warts in body parts parts where HPV DNA is

where HPV DNA often found is often found

Adapted from Petrosky et al. MMWR. 2015.


Dosing Schedules Starting the vaccine series before the 15th birthday

Recommended schedule is 2 doses of HPV vaccine Second dose should be

administered 6–12 months after the first dose (0, 6–12 month schedule)

Minimum interval between dose one and dose two in a 2-dose schedule is 5 months

Starting the vaccine series on or after the 15th birthday*

Recommended schedule is 3 doses of HPV vaccine Second dose should be

administered 1–2 months after the first dose, and the third dose should be administered 6 months after the first dose (0, 1–2, 6 month schedule)

Minimum interval between dose one and dose three in a 3-dose schedule is 5 months

*and immunocompromised persons 9-26 years

Meites et al. MMWR. 2016.


HPV VACCINE SAFETY


United States Vaccine Safety System System Collaborators Description Vaccine Adverse Event Reporting System (VAERS)

CDC and FDA Frontline spontaneous reporting system to detect potential vaccine safety issues

Vaccine Safety Datalink (VSD)

CDC and 9 Integrated Health Care Systems

Large linked database system used for active surveillance and research ~9.4 million members (~3% of US pop.)

Clinical Immunization Safety Assessment (CISA) Project

CDC and 7 Academic Centers

Expert collaboration that conducts individual clinical vaccine safety assessments and clinical research

Post-Licensure Rapid Immunization Safety Monitoring Program (PRISM)

FDA and 6 partner organizations

Large distributed database system used for active surveillance and research ~170 million individuals


Over 10 Years of HPV Vaccine Safety Data

HPV vaccine is safe Reactions after vaccination may include Injection site reactions: pain, redness, and/or swelling in the arm

where the shot was given Systemic: fever, headaches

HPV vaccines should not be given to anyone who has had a previous allergic reaction to the vaccine or who has an allergy to yeast (Gardasil/Gardasil 9)

Brief fainting spells (syncope) and related symptoms (such as jerking movements) can happen soon after any injection, including HPV vaccine

Patients should be seated (or lay down) during vaccination and remain in that position for 15 minutes

Gee, et al. Hum Vaccin Immunother. 2016.


HPV Vaccine Duration of Protection

Studies suggest that vaccine protection is long-lasting

No evidence of waning protection Available evidence indicates protection for

at least 10 years Multiple studies are in progress to monitor

ACIP. Summary Report. June 22-23, 2016.


HPV Vaccination Is Safe, Effective, and Provides Lasting Protection

HPV Vaccine is SAFE Benefits far outweigh any potential risks Safety studies findings for HPV vaccination are reassuring

and similar to MenACWY and Tdap vaccine safety reviews

HPV Vaccine WORKS Population impact against early and mid outcomes have

been reported in multiple countries

HPV Vaccine Protection LASTS Studies suggest that vaccine protection is long-lasting No evidence of waning protection

Parent of preteen


Talking about HPV vaccine

FRAMING THE CONVERSATION

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Adolescent Vaccination Coverage United States, 2006-2015

Perc

ent V

acci

nate

d

100

90

80

70

60

50

40

30

20

10

0

≥1 MenACWY

≥2 MenACWY†

≥3 HPV (M)

≥1 Tdap

≥1 HPV (F)

≥1 HPV (M)

≥3 HPV (F)

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Survey Year

Reagan-Steiner et al. MMWR 2016.


Reasons parents won’t initiate HPV vaccination for children

Lack of knowledge

Not needed or necessary

Safety concern/Side effects

Not recommended

Not sexually active

0 5 10 15 20 Percent

Stokley et al. MMWR. 2014.


Value Parents Place on the Vaccines

Parent

9.4 9.5 9.5 9.3 9.3 9.2

0 1 2 3 4 5 6 7 8 9

10

Med

ian

Valu

es

Meningitis Hepatitis Pertussis Influenza HPV Adolescent vaccines

Adapted from Healy et al. Vaccine. 2014.


Clinician estimations

Parent Clinician's estimate

9.4 9.5 9.5 9.3 9.3 9.2 9.2 9.2 9.3

0 1 2 3 4 5 6 7 8 9

10

Med

ian

Valu

es




Clinicians underestimate the value parents place on HPV vaccine

Parent Clinician's estimate

9.4 9.5 9.5 9.3 9.3 9.2 9.2 9.2 9.3

7.0

5.2

7.8

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ian

Valu

es




What is an

EFFECTIVE recommendation

for HPV vaccination?


Same Way Same Day


Why does my child need HPV vaccine?


HPV vaccination is important because it prevents cancer.

That’s why I’m recommending that your child start the HPV vaccine

series today.


Is my child really at risk for HPV?


HPV is a very common and widespread virus that infects both females and males. We can help

protect your child from the cancers and diseases caused by the virus by

starting HPV vaccination today.


Why at 11 or 12 years old?


When should the bike helmet go on?

A. Before they get on their bike

B. When they are riding their bike in the street

C. When they see the car heading directly at them

D. After the car hits them

Temte JL. Pediatrics 2014.


When do we put our seat belts on?

A.Before turning on car

B. When leaving driveway

C. After a near accident

Temte JL. Pediatrics 2014.


As with all vaccine-preventable diseases, we want to protect your child early. If we start now,

it’s one less thing for you to worry about. Also, your child will only need two shots of HPV

vaccine at this age. If you wait until 15, your child will need three shots.

We’ll give the first shot today and then you’ll need to bring your child back in 6 to 12 months

from now for the second shot.


I’m just worried that my child will perceive this as a green

light to have S-E-X.


Numerous research studies have shown that getting the HPV vaccine does not make kids more likely to be sexually active or start having sex at a younger age. Starting the HPV vaccine

series today will give your child the best protection possible for the future.


Why do boys need HPV vaccine?


HPV infection can cause cancers of the penis, anus, and throat in men.

HPV infection can also cause genital warts.

Getting HPV vaccine today for your son can help prevent the infection that can

lead to these diseases.


Would you get HPV vaccine for your kids?


Yes, I have given HPV vaccine to my child. I believe strongly in the importance of

this cancer-preventing vaccine. The American Academy of Pediatrics, the American Academy of Family Physicians,

NIH cancer centers, and the CDC, also agree that getting the HPV vaccine is

very important for your child.


If a parent doesn’t say yes today… As

k • Clarify & restate their concerns to make sure you understand

Ackn

owle

dge • Emphasize it is the parents’ decision

• Acknowledge risks & conflicting info sources • Applaud them for wanting what is best for their child • Be clear that you are concerned for the health of their child,

not just public health safety

Advi

se • Allow time to discuss the pros & cons of the vaccine

• Be willing to discuss parents’ ideas • Offer written resources for parents • Tailor your advice using this presentation

Adapted from Henrickson Vax Northwest 2014.


If a parent declines today…

Declination is not final. The conversation can be revisited.

End the conversation with at least 1 action you both agree on.

Because waiting to vaccinate is the risky choice, many pediatricians ask the parent to sign a Declination Form.

1.L,WI YOU ARE THE KEY TO R rll CANCER PREVENTION

HPV VACCINE IS CANCER PREVENTION And YOU are the key!

#WeCanStopHPV

References • Advisory Committee on Immunization Practices. Summary Report. June 22-23, 2016. Available at https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2016-

06/june-22-23-2016-acip.pdf • Ali H, et al. Genital warts in young Australians five years into national human papillomavirus vaccination programme: national surveillance data BMJ 2013; 346 :f2032. • Baldur-Felskov et al. Trends in the incidence of cervical cancer and severe precancerous lesions in Denmark, 1997-2012. Cancer Causes Control 2015 Aug;26(8):1105-16. • Benard VB, Castle PE, Jenison SA, et al. Population-Based Incidence Rates of Cervical Intraepithelial Neoplasia in the Human Papillomavirus Vaccine Era. JAMA Oncol.

Published online September 29, 2016. doi:10.1001/jamaoncol.2016.3609 • Brewer NT, et al. Announcements versus conversations to improve HPV vaccination coverage: A randomized trial. Pediatrics. 2017 139(1). • Drolet et al. Population-level impact and herd effects following human papillomavirus vaccination programmes: a systematic review and meta-analysis. Lancet Infect Dis.

2015 May;15(5):565-80. • Gee, et al. Quadrivalent HPV vaccine safety review and safety monitoring plans for nine-valent HPV vaccine in the United States. Hum Vaccin Immunother. 2016 Jun;

12(6): 1406–1417. • Hariri S, et al. Population-based trends in high-grade cervical lesions in the early human papillomavirus vaccine era in the United States. Cancer, 121: 2775–2781. • Healy CM, et al. Parent and provider perspectives on immunization: are providers overestimating parental concerns? Vaccine. 2014; 32(5): 579-584. • Henrikson NB, et al. A public-private partnership addressing vaccine hesitancy in Washington State. 2014. Available at: http://vaxnorthwest.org/approach • Institute of Medicine. Adverse Effects of Vaccines: Evidence and Causality. The National Academies Press, 2012. • Koshiol JE, et al. Rate and predictors of new genital warts claims and genital warts-related healthcare utilization among privately insured patients in the United States. Sex

Transm Dis. 2004;31:748–752. • Machalek et al. Human Papillomavirus Prevalence in Unvaccinated Heterosexual Men After a National Female Vaccination Program. J Infect Dis (2017) 215 (2): 202-208.

Published: 03 November 2016. DOI: 10.1093/infdis/jiw530 • Markowitz LE, et al. Prevalence of HPV After Introduction of the Vaccination Program in the United States. Pediatrics. 2016;137(2). • Meites E, Kempe A, Markowitz LE. Use of a 2-Dose Schedule for Human Papillomavirus Vaccination — Updated Recommendations of the Advisory Committee on

Immunization Practices. MMWR. 2016;65(49);1405-8. • Petrosky et al. Use of 9-Valent Human Papillomavirus (HPV) Vaccine: Updated HPV Vaccination Recommendations of the Advisory Committee on Immunization Practices.

MMWR. 2015 64(11);300-304 • Pollock et al. Reduction of low- and high-grade cervical abnormalities associated with high uptake of the HPV bivalent vaccine in Scotland. Br J Cancer 2014 111, 1824–

1830. • Reagan-Steiner S, et al. National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2015. MMWR

Morb Mortal Wkly Rep. 2016;65:850–858. • Satterwhite et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013 Mar;40(3):187-93. • Schiffman M. Castle PE. Arch Pathol Lab Med. Human papillomavirus: epidemiology and public health. 2003 Aug;127(8):930-4. • Smith PJ, et al. HPV vaccination coverage of teen girls: the influence of health care providers. Vaccine. 2016 Mar 18;34(13):1604-10. • Stokley S,, et al. Human papillomavirus vaccination coverage among adolescents, 2007-2013, and postlicensure vaccine safety monitoring, 2006-2014--United States.

MMWR Morb Mortal Wkly Rep. 2014 Jul 25;63(29):620-4. • Temte JL. Comment: Timing of HPV Vaccine. Available at http://pediatrics.aappublications.org/content/early/2014/08/12/peds.2014-0442.comments#-timing-of-hpv-

vaccine-• Viens LJ, et al. Human papillomavirus–associated cancers—United States, 2008–2012. MMWR. 2016;65:661–6.

https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2016-06/june-22-23-2016-acip.pdf

http://vaxnorthwest.org/approach

http://pediatrics.aappublications.org/content/early/2014/08/12/peds.2014-0442.comments#-timing-of-hpv-vaccine-

Verbal Judo

What is Verbal Judo

Do not use Do use

Unprofessional language Professional language or or words words

Words that express Use of words to achieve personal feelings professional objectives

Self-referred language In contact w/audience

{such as "I" or "me"} We or us

Comments not in context Defined comments which are on target and specific

Off-target reactions Deflection and redirection

VERBAL KARATE vs VERBAL JUDO

� Flor-ido. Depo.rtW\evi.t of Heo.lth

• � Andrea M Peaten

Community Immunization Liaison Florida Department of Health Pinellas

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