Final Learning Collaborative November/December 2016 National Immunization Partnership with the Academic Pediatric Association (NIPA) Wave 2 CDC Grant # 1H23IP000950

Agenda Attendance Review CORNET Data Two-Dose Schedule Project Feedback Post-Implementation Survey Reminder MOC Attestation Any questions? Contact Information

CORNET Data

Intervention: Prompts

Intervention: Standing Orders

Intervention: Reminder-Recall

Total Missed Opportunities

Missed Opportunities by Dose - Ask Rachel

Missed Opportunities by Gender

Missed Opportunities by Visit Type

Reason Not Vaccinated

Two-Dose Schedule

CDC Recommendations Two-dose schedule: Three-dose schedule: The 1st dose is recommended at 11-12 years old. The 2nd dose should be administered 6-12 months after the 1st dose. The two-dose schedule is recommended if the series is started before the 15th birthday. Three-dose schedule: Adolescents who start the series at 15-26 years old will need 3 doses. Adolescents aged 9-14 years old who have already received 2 doses less than 5 months apart will need a 3rd dose. 3 doses is recommended for those with weakened immune systems.

9vHPV 2-Dose Immunogenicity Trial Non-inferior geometric mean antibody titers (GMT) 2-dose girls/boys age 9-14 yrs vs. 3-dose women age 16-26 yrs HPV Type GMT (mMU/mL) There were also non-inferior GMTs in the 9-14 year olds who received 2 doses at 0,12 months, shown in blue, compared with women who received 3 doses at 0,2,6 months shown again in yellow. Again, you can see that the GMTs were not only noninferior but higher in the younger age group that received two doses for all 9 types. The GMT ratios ranged from 1.96 to 6.31. In October 2016, FDA approved 9vHPV as a 2-dose series for persons age 9–14 years 15 Luxembourg, presented at February 2016 ACIP Data from 1 month after the last dose http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM426457.pdf

Immunocompromising Conditions For immunocompromised persons (9 through 26 yrs) 3 doses of HPV vaccine (0, 1–2, 6 months) Primary or secondary immunocompromising conditions that might reduce cell-mediated or humoral immunity Examples: B lymphocyte antibody deficiencies, T lymphocyte complete or partial defects, HIV infection, malignant neoplasm, transplantation, autoimmune disease, or immunosuppressive therapy, since immune response to vaccination may be attenuated. Does not apply to children with asplenia, asthma, chronic granulomatous disease, chronic liver disease, chronic lung disease, chronic renal disease, CNS anatomic barrier defects (e.g., cochlear implant), complement deficiency, diabetes, heart disease, persistent complement component deficiencies, or sickle cell disease ACIP continues to recommend HPV vaccination for immunocompromised persons aged 9 through 26 years with 3 doses of HPV vaccine (0, 1–2, 6 months). Persons who should still receive 3-doses of HPV vaccine are those with primary or secondary immunocompromising conditions that might reduce cell-mediated or humoral immunity, such as HIV infection and other conditions listed here, since immune response to vaccination may be attenuated. 16

What is your clinic’s plan? Has your clinic begun following the two-dose schedule? What has been the reaction of faculty/residents/office staff? Have patients and families asked about the two-dose recommendation?

Project Feedback

Project Feedback The Project Team is considering adding a small number of chart reviews in order to assess for HPV immunization rates during Wave 3. How much of an impact do you think this will have on each practice? The Patient Tally Forms were meant to give the Project Team an idea of the number of charts each practice must review before identifying 16 patients (8 male/8 female) due for HPV vaccine each month. How did your practice adjust to the tally form? Other thoughts?

Post-Implementation Surveys Please Complete the post-Office Systems Inventory and post-Staff Impact Survey ASAP. Only 1 per site is necessary.

MOC Attestation Please submit MOC Attestation Forms to Holly ASAP. The deadline for 2016 is December 15th. All must be submitted to ABP prior to that date. If you need MOC for 2017, please email Holly directly.

Any questions?

Contact Information Please contact: Holly Tyrrell, MSSW Phone: 703/556 9222 x113 I Fax: 703/556 8729 Email: hollyce@academicpeds.org