Increasing the public awareness and knowledge of HPV complications and prevention through vaccination is an effective intervention to increase vaccination rates and reduce overall public health cost and burden.https://scholarworks.uvm.edu/fmclerk/1141/thumbnail.jp

Hernandez, Jonathan M

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University of VermontScholarWorks @ UVMFamily Medicine Clerkship Student Projects College of Medicine2015Increasing Awareness of the HPV VaccineJonathan M. HernandezUVM COMFollow this and additional works at: http://scholarworks.uvm.edu/fmclerkPart of the Medical Education Commons, and the Primary Care CommonsThis Book is brought to you for free and open access by the College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion in FamilyMedicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contactdonna.omalley@uvm.edu.Recommended CitationHernandez, Jonathan M., "Increasing Awareness of the HPV Vaccine" (2015). Family Medicine Clerkship Student Projects. Book 104.http://scholarworks.uvm.edu/fmclerk/104INCREASING PUBLIC AWARENESS & KNOWLEDGE OF THE HPV VACCINE Thomas Chittenden Health Center (TCHC) Jonathan Hernandez November 2015 Project mentors: Dr. Pam Dawson, Dr. Dan Donnelly PROBLEM   More preteens and teens could be receiving the HPV vaccine   Guidelines recommend ages 9 – 26   At TCHC, there were largely 2 camps of unvaccinated children I saw:   Those whose parents held personal beliefs about the vaccines or the immune system   Those who had not yet been educated on HPV or the vaccine   Most patients I saw in their 20s had started the vaccine   The majority of preteens and teens I saw had not received the HPV vaccine   It may be too late to wait until patients can decide for themselves   The parents that are lacking education should be identified and receive it   It may be impossible to change some patient’s personal beliefs COST & BURDEN IN U.S.   Cost of HPV infection for both men and women [1]   Estimated lifetime total cost ages 15–24 y.o. = $2.9 billion   Treatment of anogenital warts in all age groups in year 2000 = $167.4 million   Only HIV is more expensive in terms of STI   Cost of annual cervical screening and treatment for HPV-related disease [2]   Estimated avg. $26,415 per 1000 women   Ages 20 – 29 avg. $51, 863 per 1000 women due to higher prevalence   Estimated $3.4 billion annually   90% of cost attributed to strategies for prevention   Treatment of precancerous lesions   Routine paps and guideline recommendations   10% of cost due to treatment of cancer COMMUNITY PERSPECTIVE   MA, 18F, patient at TCHC   Currently 8 months pregnant and unvaccinated against HPV   Did not get vaccine because she is afraid of needles   Was not aware that HPV could cause cancer or how common it is   Willing to receive vaccine after receiving educational information   May already be too late for MA given she is already sexually active    IW, 16F, patient at TCHC   Currently unvaccinated   Mother does not want vaccine because she believes “body can fight the infection”   Interestingly she requested a flu vaccine   IW stated “I’m not of legal age to be sexually active”   When counseled alone and provided educational information, Ivy changed her mind   We still need to convince Ivy’s mother INTERVENTION   Target under-educated population with patient handout   Under-educated = does not know about complications of HPV infection   Educate all patients ages 9 – 26 and their parents   Specifically address in lay terms 3 main areas:   Define what HPV is   Describe what HPV can cause   Explain why the HPV vaccine is recommended for children   Provide additional sources of information RESPONSE   The most common reason for declining vaccine after receiving educational information was due to a parent’s personal beliefs   Among unvaccinated patients who were unaware of HPV complications, most were willing to receive vaccine after receiving educational information   Most preteens and teens were willing to receive vaccine when counseled alone, but they always deferred to the parent’s decision   Parent’s personal beliefs against vaccines were wide ranging:   “lack of safety data”   “body can fight the infection”   “not sexually active yet” EFFECTIVENESS & LIMITATIONS   The intervention was effective in the population of patients that had not been informed of the potential complications of HPV infection   The intervention was not effective when a parent declined due to personal beliefs against the vaccine   The results were limited by a small sample size:   TCHC is not primarily a pediatric clinic   The length of the intervention thus far has only been 5 weeks   The intervention is also challenged by the fact that decision making capacity is deferred to parents in most of the target patients RECOMMENDATIONS   Really focus on targeting parents with education when children reach the age of 9, which is current recommended guideline   Most persuasive point = increased efficacy when given at younger age   The intervention is effective in the right population   Identify those who have not received educational information   Assume everyone is under-educated until they are vaccinated   It may be impossible to change some patient’s personal beliefs   Provide these patients with educational information and support their decision   Unfortunately some patients are at risk due to their parent’s decisions   Counsel these patients alone at every visit and provide educational information   Given time patients whose parents decline may request on their own REFERENCES   1. Insinga RP, Glass AG, Rush BB. The health care costs of cervical human papillomavirus—related disease. American Journal of Obstetrics and Gynecology. 2004;191(1):114–120.   2. Chesson HW, Blandford JM, Gift TL, Tao G, Irwin KL. The estimated direct medical cost of sexually transmitted diseases among American youth, 2000. Perspectives on Sexual and Reproductive Health. 2004;36(1):11–19.   3. Villa LL, Ault KA, Giuliano AR, et al. Immunologic responses following administration of a vaccine targeting human papillomavirus Types 6, 11, 16, and 18. Vaccine 2006; 24:5571.   4. Uptodate searches: Recommendations for the use of human papillomavirus vaccines, Epidemiology of HPV infection   5. http://www.cdc.gov/hpv/ 

Increasing Awareness of the HPV Vaccine

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Increasing Awareness of the HPV Vaccine

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