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Grant recipients develop strategies to increase HPV immunization rates :

September 7, 2016

Training videos, educational webinars and use of electronic health records (EHRs) are among the strategies used by six AAP chapters to improve HPV immunization rates.

The Academy and Centers for Disease Control and Prevention recommend HPV vaccine for girls and boys at age 11 or 12 years. However, coverage remains lower than for other recommended adolescent vaccines.

The Academy awarded grants to six chapters to identify opportunities to increase adolescent immunization rates, with a focus on the HPV vaccine. Each chapter developed a program to fit the needs of pediatricians and families in their state. Following is a summary of each chapter’s efforts.

California Chapter 3

The chapter produced a training video and webinar to help pediatricians discuss the benefits of the HPV vaccine for 11- and 12-year-olds with patients and families. The video features pediatricians who recommend the HPV vaccine and respond to concerns raised by actors portraying patients and parents. The vignettes also include strategies for talking with parents who are hesitant.

Webinars covered information on the burden of HPV-related disease, vaccine uptake, strategies for counseling parents and patients, HPV disease from the gynecologic perspective, and the utility of reminder/recall systems.

“The webinar was well-done, informative and provided more information for me to really educate parents about the tremendous burden of HPV disease and the remarkable safety and efficacy of the vaccine,” said Eyla G. Boies, M.D., FAAP, project lead.

The video and webinar are available at

Kansas Chapter

The chapter created educational webinars for providers that cover general information on HPV, common misconceptions, effective counseling techniques, strategies for helping patients and parents overcome hesitancy, and the use of the state’s vaccine registry.

During site visits to practices and clinics, chapter members discovered an unexpected barrier to HPV immunization for those who qualify for the Vaccines for Children program.

“Patients are asked to go to their local health department for vaccines, and it is unclear how many are lost to this additional barrier,” said Kari R. Harris, M.D., FAAP, a chapter immunization champion.

If patients receive care from the health department, pediatricians are unsure if they received the full complement of recommended vaccines or only vaccines required for school attendance. In Kansas, only tetanus, diphtheria and acellular pertussis (Tdap) vaccine is required for secondary school and only meningococcal vaccine (MCV) is required for post-secondary schools.

Nursing staff has a tremendous impact on patients’ perception of vaccines and willingness to receive immunizations, especially the HPV vaccine.

“The team approach is very critical,” said Gretchen Homan, M.D., FAAP, another chapter immunization champion. “It’s not just the provider, it’s collaboration with all the office staff, the health department, the school nurses and the state registry.”

Louisiana Chapter

The chapter worked with the Office of Public Health to add HPV to the School Readiness Assessment that tracks practice-specific MCV, varicella and Tdap vaccination rates for 11- and 12-year-olds.

The state’s registry — Louisiana Immunization Network for Kids Statewide (LINKS) — has been updated to provide practice-specific data on the three doses of HPV, which are compared with other adolescent vaccinations to identify missed opportunities. The chapter worked with state and regional coordinators to train providers to use the LINKS system to track rates.

New York Chapter 1

The chapter partnered with eight large practices to determine the effectiveness of bundling discussions about HPV vaccine with other cancer prevention messages to improve adolescent HPV vaccination rates.

The practices were given cancer prevention booklets with information on HPV vaccine to distribute to all adolescents during well visits.

The chapter obtained practice-specific adolescent immunization rates for Tdap, quadrivalent meningococcal, HPV and influenza vaccines using each site’s EHRs. It will compare immunization rates in these practices to the state registry to determine if the distribution of booklets leads to an increase in HPV vaccination rates.

Ontario Chapter

The chapter created a database documenting gaps in adolescent immunization rates. It also identified barriers in education among parents, adolescents, providers and public health agencies. Presentations on program findings will be displayed at the Canadian Immunization Conference in December.

The chapter also collaborated with local pediatricians to develop a workshop for providers that addressed the burden of the disease, efficacy and safety of the HPV vaccine, and strategies to increase and track immunizations in practice. Focus groups identified barriers such as the lack of understanding patients have surrounding HPV disease and the vaccine. 

Texas Chapter

The chapter hosted a seminar on best practices for increasing immunization rates, including use of registries and tracking via EHRs. Information on effectively communicating the importance of the HPV vaccine with pediatricians, parents and patients also was emphasized. The seminar was attended by physicians, nurses, physician assistants, medical students and public health workers.

During a presentation on the safety and efficacy of HPV vaccine, Melinda Wharton, M.D., M.P.H., director of immunization services for the CDC, discussed the recommendations for HPV vaccination for boys and girls as well as the adolescent immunization rates in Texas and the U.S.

Chapter grants for these programs were made possible through an independent educational grant from Merck & Co.

See related story "A strong case for vaccination: HPV-associated cancer rates increasing"
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