HPV Vaccine Recommendations & CurrentIssues             Gregory Zimet, PhD         Professor, Department of Pediatrics    ...
Disclosures   Investigator on HPV-related research grants funded by    Merck’s Investigator-Initiated Science Program
Outline Current status of HPV vaccine  recommendations HPV vaccine safety HPV vaccination rates Summary & recommendati...
CURRENT STATUS OF HPVVACCINE RECOMMENDATIONS
HPV Vaccine Licensure: FDA Quadrivalent Vaccine   Females 9-26 years old (licensed in 2006)   Males 9-26 years old (lic...
ACIP HPV Vaccine Recommendations for FEMALES Quadrivalent (licensed 2006):   For prevention of vaginal, vulvar, and cerv...
ACIP HPV Vaccine Recommendations for MALES Quadrivalent vaccine only:   2009 – permissive recommendation; 2011 – routine...
Other Recommendations Previous sexual activity not a contraindication No testing for prior HPV exposure necessary HIV-i...
Other Recommendations Though no known danger exists, HPV vaccine is  not recommended for pregnant women Cervical cancer ...
HOT TOPIC #1: SAFETY
HPV Vaccines are Safe Safety continues to be closely monitored by  several different systems* VAERS data to date show no...
HPV Vaccines are Safe Examination of multiple studies that compared  vaccine recipients to placebo recipients*:   About ...
HPV Vaccines are Safe All of the evidence to date indicates that HPV  vaccination is much safer for children &  adolescen...
HOT TOPIC #2: HPV VACCINATIONRATES
Indiana: Cervical cancersummary   Hispanic women have higher incidence of    invasive cervical cancer compared to other  ...
From: Swanson, Weathers, Rakowski. “CancerDisparities in Indiana: An Epidemiologic Profile”.IUSCC, IU Public Health, ACS.
From: Swanson, Weathers, Rakowski. “CancerDisparities in Indiana: An Epidemiologic Profile”.IUSCC, IU Public Health, ACS.
2010 HPV Vaccination Rates for 13-17year old girls*80%70%60%                                 73%50%                       ...
2009 Indiana HPV Vaccination Ratesfor 13-17 year old girls*60%               1st Dose50%40%                  52%30%   37% ...
2010 Vaccination Rates: Otherfindings* Indiana is 4th from the bottom in HPV  vaccination Male vaccination: Nationally,1...
Contrasts: Race & Hispanic Ethnicity*80%70%                             75%60%                                    65%50%  ...
Contrasts: Poverty Status*80%70%60%                        73%50%                                              Poverty Lev...
SUMMARY
Summary: The good, the bad, and theugly The good   HPV vaccines are very effective   HPV vaccines are very safe   All ...
Recommendations Develop and test new and creative strategies to  increase acceptance of vaccine and reduce  disparities i...
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HPV Vaccination Recommendation

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HPV Vaccination Recommendation

  1. 1. HPV Vaccine Recommendations & CurrentIssues Gregory Zimet, PhD Professor, Department of Pediatrics Section of Adolescent Medicine Indiana University School of Medicine
  2. 2. Disclosures Investigator on HPV-related research grants funded by Merck’s Investigator-Initiated Science Program
  3. 3. Outline Current status of HPV vaccine recommendations HPV vaccine safety HPV vaccination rates Summary & recommendations
  4. 4. CURRENT STATUS OF HPVVACCINE RECOMMENDATIONS
  5. 5. HPV Vaccine Licensure: FDA Quadrivalent Vaccine  Females 9-26 years old (licensed in 2006)  Males 9-26 years old (licensed in 2009) Bivalent Vaccine  Females 9-26 years old (licensed in 2009)
  6. 6. ACIP HPV Vaccine Recommendations for FEMALES Quadrivalent (licensed 2006):  For prevention of vaginal, vulvar, and cervical precancers and cancers, genital warts, and anal precancers (AIN 2/3) Bivalent (licensed 2009):  For prevention of vaginal, vulvar, and cervical precancers and cancers Both vaccines:  Routine administration for 11-12 year old girls  Administration for 9-10 year old girls at provider’s/parental discretion  Administration for 13-26 year old females not previously vaccinated
  7. 7. ACIP HPV Vaccine Recommendations for MALES Quadrivalent vaccine only:  2009 – permissive recommendation; 2011 – routine recommendation  For prevention of genital warts & anal precancers (AIN 2/3)  Routine administration for 11-12 year old boys  Administration for 9-10 year old boys at provider’s/parental discretion  Administration for 13-21 year old males not previously vaccinated  Males 22-26 may get vaccinated by not strongly recommended  Men who have sex with men (MSM) should be immunized up to
  8. 8. Other Recommendations Previous sexual activity not a contraindication No testing for prior HPV exposure necessary HIV-infected males and females 9-26 should get 3-dose quadrivalent vaccine series HPV vaccines can be co-administered during same visit with other recommended vaccines (e.g., MCV4; Tdap)
  9. 9. Other Recommendations Though no known danger exists, HPV vaccine is not recommended for pregnant women Cervical cancer screening recommendations should be followed regardless of vaccination status No evidence for prevention of penile cancers, oropharyngeal cancers, or RRP
  10. 10. HOT TOPIC #1: SAFETY
  11. 11. HPV Vaccines are Safe Safety continues to be closely monitored by several different systems* VAERS data to date show no concerns about safety** Study based on over 600,000 doses of vaccine found no increased risk for***:  Stroke  Seizures * Markowitz et al. Vaccine 2010. ** Slade et al. JAMA 2009.  Allergic reactions *** Gee et al. Vaccine 2011.  Many other conditions
  12. 12. HPV Vaccines are Safe Examination of multiple studies that compared vaccine recipients to placebo recipients*:  About 22,000 persons in each of the 2 groups  Severe adverse events examined included: adverse pregnancy outcomes, immune system problems, heart problems, and nervous system problems  Severe adverse events occurred rarely in both groups  NO DIFFERENCE FOUND *Lu et al. BMC Infect Dis 2011. BETWEEN THE VACCINE GROUP AND THE CONTROL GROUP
  13. 13. HPV Vaccines are Safe All of the evidence to date indicates that HPV vaccination is much safer for children & adolescents than:  Playing soccer  Taking Tylenol (acetaminophen)  Riding in or driving a car  Mowing the lawn
  14. 14. HOT TOPIC #2: HPV VACCINATIONRATES
  15. 15. Indiana: Cervical cancersummary Hispanic women have higher incidence of invasive cervical cancer compared to other women Black women have higher cervical cancer incidence and mortality than white women Indiana and national rates of cervical cancer incidence and mortality are roughly equivalent Lake county has a cervical cancer death rate that is nearly twice the national rate From: Swanson, Weathers, Rakowski. “Cancer Disparities in Indiana: An Epidemiologic Profile”. IUSCC, IU Public Health, ACS.
  16. 16. From: Swanson, Weathers, Rakowski. “CancerDisparities in Indiana: An Epidemiologic Profile”.IUSCC, IU Public Health, ACS.
  17. 17. From: Swanson, Weathers, Rakowski. “CancerDisparities in Indiana: An Epidemiologic Profile”.IUSCC, IU Public Health, ACS.
  18. 18. 2010 HPV Vaccination Rates for 13-17year old girls*80%70%60% 73%50% 58%40% 49% 1st Dose 3 Doses30% 34% 37%20% 29%10%0% U.S. Indiana Rhode Is. *CDC MMWR 2011.
  19. 19. 2009 Indiana HPV Vaccination Ratesfor 13-17 year old girls*60% 1st Dose50%40% 52%30% 37% 31%20%10%0% Indiana Marion Cty Lake Cty *CDC MMWR 2010.
  20. 20. 2010 Vaccination Rates: Otherfindings* Indiana is 4th from the bottom in HPV vaccination Male vaccination: Nationally,1%-2% received 1 or more doses Meningococcal vaccine  63% nationally  71% Indiana 2007-09 U. Mich. Health Systems  18% of 19-26 yr old women vaccinated* *CDC MMWR 2011 2008 North Carolina Survey Dempsey et al. Vaccine 2011 Reiter et al. Sex Trans Dis 2010  19% of 10-12 yr old girls vaccinated*
  21. 21. Contrasts: Race & Hispanic Ethnicity*80%70% 75%60% 65%50% 56% White, non- 56%40% Hisp 46% 49% Black, non-30% His.20%10%0% 1st Dose Series Completion *CDC MMWR 2011.
  22. 22. Contrasts: Poverty Status*80%70%60% 73%50% Poverty Level: 57% At or Above40% 52% 48% Below30%20%10%0% 1st Dose Series Completion *CDC MMWR 2011.
  23. 23. SUMMARY
  24. 24. Summary: The good, the bad, and theugly The good  HPV vaccines are very effective  HPV vaccines are very safe  All 11-12 year olds should be receiving HPV vaccine The bad  The U.S. in general has not done well with HPV vaccination, particularly with targeted age group  Indiana is 4th from the bottom of all states in HPV vaccination rates for 13-17 year old girls The ugly  Completion rates for non-Hispanic Blacks, Hispanics, and those who fall below the poverty line are unacceptably low
  25. 25. Recommendations Develop and test new and creative strategies to increase acceptance of vaccine and reduce disparities in series completion Focus on Lake County Look to Rhode Island, Massachusetts, Washington State, and South Dakota as examples of fairly successful HPV vaccination programs

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