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hot topic: data shows that back-to-school months are the best time to vaccinate 

Immunization Graphic Although summer is just getting started, it is not too soon to start thinking about back-to-school immunizations. This is a great time to get the kids vaccinated or caught up with adolescent vaccines.

In a report released on PubMed.org, the findings from a data analysis conducted to analyze the Citywide Immunization Registry, a population-based immunization information system in New York City, revealed that adolescent vaccine administration was greatest during the back-to-school months of August to October and was highest for Tdap. It also showed that  human papillomavirus (HPV) rates  vary seasonally but  peak during back-to-school season. 

While it is always a good idea to bundle Tdap, HPV, and Meningococcal vaccine administration to adolescents at any time of year, the back-to-school months of August to October seem to present the ideal time to prevent disease in your patients, including cancers caused by HPV, through immunizations.  

Data suggests that as adolescents age the number of visits - preventative and all others - start to decline, and the type of provider they see may change as well. In an  article published in JAMA Pediatrics , it states that  preventive visits made by females declined moderately after the age of 14 years and declined further after the age of 17 years (P<.001 by age group) ( Figure 2 ). Preventive visits made by males declined somewhat after the age of 13 years and again more substantially after the age of 17 years (P<.001 by age group). More than three times as many preventive visits were made by early adolescents than by late adolescents (P<.001). 

What is the key takeaway of all these articles? It is important to vaccinate adolescents at age 11 or 12 with a strong provider recommendation for all appropriate vaccines and leverage all opportunities.  
 
To be successful in implementing a vaccine program at your practice, consider a multi-pronged approached including education, provider prompts, and performance feedback as demonstrated in this  article in Pediatrics, an American Academy of Pediatrics publication.  
registration now open:
Back-to-School Showcase: Resources to Help You Become an HPV Champion

Wednesday, June 27, 2018
1:00 p.m. to 2:00 p.m. ET

Summer is known as the unofficial "vaccination season," the period of the year when school-age children are receiving the vaccines they need before they start school in the fall. This webinar will feature upcoming summer and back-to-school HPV vaccination campaigns and resources to help health care professionals take advantage of the back-to-school timeframe to boost their HPV vaccination rates.
 
National Immunization Awareness Month (NIAM) is also right around the corner. To help your practice  promote HPV vaccination during this summer and throughout the month of August, NPHIC will present updates to its NIAM communication toolkits as well as plans for the month of August.
Science corner: WHY A 9-VALENT HPV VACCINE?

There are hundreds of HPV types, with about 40 types that infect mucosal epithelium. In 2014, a 9-Valent HPV licensed was approved in the United States to include types 6/11/16/18/31/33/45/52/58. The Advisory Committee on Immunization Practices (ACIP) summarizes the disease burden of HPV in the U.S. attributed to the nine types in the vaccine. HPV is associated with cervical, vulvar, and vaginal cancer in females, penile cancer in males, and anal cancer and oropharyngeal cancer in both females and males. The burden of HPV infection also includes cervical precancers, including cervical intraepithelial neoplasia grade 2 or 3 and adenocarcinoma in situ (≥CIN2). The majority of all HPV-associated cancers are caused by HPV 16 or 18. In the United States, approximately 64% of invasive HPV-associated cancers are attributable to HPV 16 or 18 and 10% are attributable to the five additional types in 9vHPV: HPV 31, 33, 45, 52, and 58. HPV 16 or 18 account for 66% and the five additional types for about 15% of cervical cancers (12). This vaccine is truly cancer prevention.

There is data to suggest that geography places a role in the distribution and prevalence of HPV types . In a recent study , the researchers estimated the proportion of cervical intraepithelial neoplasia (CIN) cases attributed to 14 HPV types, including quadrivalent (qHPV) (6/11/16/18) and 9-valent (9vHPV) vaccine types, by region. They summarized that the 5 new HPV types (31/33/45/51/58) in the 9vHPV vaccine accounted for approximately 14-18% of CIN1 in North America and Asia, and 17-18% of CIN2/3 in North America and Latin America. Irrespective of region, if future 9vHPV vaccination programs are effectively implemented in HPV naïve adolescents and young women, a substantial number of cervical lesions could be prevented. 9vHPV vaccination programs would also eliminate many invasive procedures associated with CIN treatment in countries with existing and without cervical cancer screening programs.

Resource Alert
Did you miss any of the Improving HPV Vaccine Rates in Delaware project e-newsletters that were distributed by Quality Insights earlier this year? We don't want you to miss out on any of the valuable information and resources that were shared. Use the links below to access two of these important items:
patient perspective: 
videos show the impact of cancer from the human point of view

This month, Quality Insights continues to share the human perspective of having HPV related cancers. Below are links to three videos. In the first video, Justine Almada provides her perspective on being a caregiver for her mom who passed away from HPV anal cancer. Next, Frank Summers gives his insights on surviving HPV oral cancer in his 40's. And in the third video, Dr. Rebecca Perkins provides her views on HPV and vaccination as a gynecologist.   
coalition & society news: HPV RESOURCES AT YOUR FINGERTIPS

The Centers for Disease Control and Prevention (CDC) offers an online series of 15 webinars called the " Pink Book Webinar Series." Offered on Wednesdays at noon from June through September, this webinar series provides an overview of the principles of vaccination, general recommendations, and immunization strategies for providers, and specific information about vaccine-preventable diseases and the vaccines that prevent them. 

Each one-hour webinar explores a chapter from the 13th edition of "Epidemiology and Prevention of Vaccine-Preventable Diseases," also known widely as "The Pink Book." Please register here if you are interested. The HPV webinar is scheduled to air on September 12, 2018.  
 
Have a question about dosing, disease, or safety? The Immunization Action Coalition Ask the Experts website houses many great questions and answers for all your immunization needs.
"Vaccines save lives; fear endangers them, it's a simple message 
parents need to keep hearing."

- Jeffrey Kluger
contact information

For more details about the HPV Vaccine Improvement Project , please contact Lisa Gruss.

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This project is in collaboration with the Division of Public Health (DPH) - Comprehensive Cancer Control Program, Immunization and Vaccines 
for Children, and the Centers for Disease Control and Prevention (CDC). Publication number DEDPH-HPV-060618