Preventing HPV in the Mountain State Elaine Darling, MPH, Program Manager WV Immunization Network, The Center for Rural Health Development Webinar February 11, 2015

Objectives By the end of the webinar, participants will be able to: Express the importance of HPV vaccination for cancer prevention; Understand the rationale for HPV vaccination at ages 11 or 12; Be comfortable communicating about HPV vaccination.

Overview of WIN Coalition WV Immunization Network (WIN): Statewide immunization coalition focused on improving and sustaining immunization rates. WIN works to foster comprehensive, sustainable state and community policies and practices to ensure that West Virginia’s residents are protected from the consequences of vaccine-preventable diseases throughout their lifespan. The Center for Rural Health Development serves as the Lead agency for WIN. Coalition Noun - an alliance or union between groups, factions, or parties, especially for some specific reason. Word Origin: 1610s, "the growing together of parts," from French coalition (1540s), from Late Latin coalitus, "fellowship."

Overview of WIN Began in 1996 with 30 members, now has approximately 300 members. Members from both public and private sectors, including: Physicians, nurses, physician’s assistants, pharmacists, healthcare administrators Primary and secondary school personnel, parents, representatives from school-based health clinics Local Health departments, state agencies, and other public health professionals University health sciences faculty and students Businesses, vaccine manufacturers, and more WIN is a public-private partnership that works in close partnership with the WVBPH’s Division of Immunization Services. Steering Committee guides the work of WIN. Regional Coalitions meet in Morgantown and Beckley/Lewisburg

Overview of WIN The goals that guide the development of WIN’s strategic plan are: Immunization Registry. Increase the percentage of public and private provider sites in West Virginia participating in the registry. Provider Quality Assurance. Ensure that all providers have accurate, up-to-date information on vaccine-preventable diseases, immunization issues, and evidence-based vaccination practices. Service Delivery. Ensure that immunization services are readily accessible to all West Virginians of all ages, especially high risk and underserved populations. Consumer Education. Ensure that West Virginia’s citizens of all ages have accurate information regarding immunizations to assure immunizations for all age groups. Advocacy. Work with public and private policy makers in West Virginia to create an environment that protects our citizens from vaccine-preventable disease.

HPV: You are the Key to Cancer Prevention Materials available at: http://www.cdc.gov/vaccines/who/teens/for-hcp/hpv-resources.html

Cervical Cancer Rates in WV WV ranks second highest in the nation for cervical cancer incidence rate (10.1 cases per 100,000 population per year) WV ranks highest in the nation for cervical cancer mortality (4.8 deaths per 100,000) Every year in West Virginia, around 100 women are diagnosed with cervical cancer and more than 30 women die of the disease.

HPV vaccines Bivalent HPV vaccine: Quadrivalent HPV vaccine: Recommended for protection against HPV types 16 and 18, for the prevention of cervical cancers and precancers in females. Quadrivalent HPV vaccine: Recommended for protection against HPV types 16, 18, 6 and 11, for the prevention of cervical, vulvar, vaginal cancers and precancers in females, as well as anal cancers and precancers and genital warts in both females and males. Among persons not previously exposed to a targeted HPV type, the trials demonstrated nearly 100% vaccine efficacy in preventing cervical precancers, vulvar and vaginal precancers, and genital warts in women caused by the vaccine types, as well as 90% vaccine efficacy in preventing genital warts and 75% vaccine efficacy in preventing anal precancers in men. Nine-valent HPV vaccine

Nine-valent HPV vaccine Approved by FDA in December 2014 for the prevention of cervical, vulvar, vaginal and anal cancers caused by HPV types 16, 18, 31, 33, 45, 52 and 58, and for the prevention of genital warts caused by HPV types 6 or 11. 9-valent HPV vaccine adds protection against five additional HPV types—31, 33, 45, 52 and 58— which cause approximately 20 percent of cervical cancers and are not covered by previous HPV vaccines. ACIP has not yet made a recommendation on this vaccine (anticipated in beginning of 2015).

CDC and AAP Recommendations for HPV Vaccine Routine HPV vaccination of males and females at ages 11-12 years Catch-up vaccination for 13-21 years of age for males and 13-26 years for females. Permissive use for ages 9-10 years for both males and females and 22-26 for males. Both vaccines given in 3 shots over 6 months. Adolescent Immunization Schedule available at: http://www.cdc.gov/vaccines/who/teens/downloads/parent-version-schedule-7-18yrs.pdf

WV’s Adolescent Immunization Rates Healthy People 2020 Goal for Adolescent Vaccination: 80%

WV’s Adolescent Immunization Rates

Giving a Strong Recommendation Giving a strong recommendation for the HPV is one of the best ways to improve HPV vaccination uptake. Parents trust their healthcare provider’s opinion more than anyone else when it comes to vaccination. If we give HPV vaccine when other adolescent vaccines are given, our rates would be close to 90% and 4,400 cases of cervical cancer would be prevented nationwide.

What can you do?

Patient Education Available at: https://www.youtube.com/watch?v=FdowV-iHuH8&feature=youtu.be

Patient Education Tools WIN develops tools to educate patients and the public about immunizations and vaccine-preventable diseases Educational Materials developed and available for free to WIN Members, healthcare providers, school nurses and others across WV. Adolescent Immunization Posters & Postcards Faces of Vaccine-Preventable Diseases Videos (available on DVD, at www.immunizenow.org, and on YouTube) New Faces videos on HPV/Cervical Cancer and Hepatitis B only available online at http://immunizenow.org/WIN/MHCP/Toolkits/Faces%20of%20Vaccine-Preventable%20Diseases/ and https://www.youtube.com/user/ImmunizeNowWV

Patient Education Tools 1-2-3 Pap: Easy Steps to Prevent Cervical Cancer Developed for WIN by UK Rural Cancer Prevention Center Evaluations found that females that viewed the video were twice as likely to complete the full HPV 3-dose vaccine series. Free DVD can be ordered through WIN http://www.uky.edu/publichealth/rural-cancer-prevention-center/videos

Other sources of information CDC’s Vaccine Homepage: http://www.cdc.gov/vaccines/ Immunization Action Coalition: http://www.immunize.org Children's Hospital of Philadelphia's Vaccine Education Center: http://vec.chop.edu/service/vaccine-education-center/ WIN’s website: http://immunizenow.org/

Thank you! Elaine Darling Program Manager, West Virginia Immunization Network The Center for Rural Health Development, Inc. 75 Chase Dr. Hurricane, WV 25526 (304) 397-4071 ● Elaine.darling@wvruralhealth.org