# Presentation: 139308

## HPV Vaccine Implementation

- Amy Groom, MPH
- IHS Division of Epidemiology and Disease Prevention
- _Amy.Groom@ihs.gov_
- (505) 248 - 4374

## Overview

- Vaccine Recommendations
- Vaccine Financing
- HPV recommendations
- Issues related to HPV vaccine implementation
- Future Considerations

## Vaccine Recommendations

- Advisory Committee on Immunization Practices (ACIP)
- Advises Dept. of Health & Human Services and CDC
- Develops written recommendations for the routine administration of vaccines
- Determines which vaccines are covered by the Vaccines for Children program
- Official recommendations published in CDC’s MMWR

## Childhood Vaccine Financing   “ . . .a patchwork of public and private sources”1

- Vaccines for Children (VFC)
- Federally-funded program that provides all ACIP recommended vaccines to eligible children 0 – 18 years.
- Medicaid eligible
- Uninsured
- American Indian or Alaska Native
- Underinsured  (limited)
- 317 Discretionary grants
- State funds
- Private insurance

- Lee et al. Gaps in vaccine financing for underinsured children in the United States.
- JAMA 2007;298(6):638-643.

## Vaccine Financing

**Differences in state vaccine financing result in variation between states re: who receives “free” vaccine**
**Universal states**: Through a combination of VFC, 317 and state funding, the state supplies ALL routinely recommended pediatric vaccines for ALL children.
**VFC only - ** Through the use of VFC funds, the state supplies all routinely recommended pediatric vaccines to VFC enrolled providers to vaccinate VFC eligible children only.

## State Vaccination Policy

- Universal
- Alaska
- New Hampshire
- New Mexico
- Rhode Island
- Vermont
- Washington

- VFC-only
- 	AlabamaCaliforniaColoradoDelawareIndianaIowaLouisianaGeorgia MissouriMontanaNebraskaOhioOklahomaOregonPhiladelphiaPennsylvaniaTennesseeVirgin IslandsVirginiaWest Virginia Wisconsin

*** CDC website, accessed August 15****th****, 2007**
- _http://www.cdc.gov/vaccines/programs/vfc/projects/data/vacc-supply-public-2006.htm_

## HPV Vaccine

## Timeline

- FDA Licensure – June 2006
- ACIP recommendation – June 2006
- VFC resolution – June 2006
- VFC contract for HPV vaccine – Oct. 2006
- ACIP HPV vaccine recommendation published  in MMWR– March 2007

## ACIP HPV Vaccine Recommendation*

- The recommended age for vaccination of females is 11--12 years. Vaccine can be administered as young as age 9 years. Catch-up vaccination is recommended for females aged 13--26 years who have not been previously vaccinated.

**CDC Website - HPV Recommendations MMWR:**
- _http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5602a1.htm?s_cid=rr5602a1_e_

## VFC HPV Vaccine Resolution

- Eligible groups: Females 9 through 18 years
- HPV vaccine is recommended for females at age 11 to 12 years old
- Catch-up vaccination is recommended for females 13 through 18 years of age who have not been previously vaccinated or who have not completed the full series.
- Eligible females as young as 9 years of age can be vaccinated.

## Availability

- As of March 2007  -  5 million doses distributed
- As of April 2007 – all states have purchased vaccine for VFC eligibles
- Supply is adequate
- States required to provide VFC vaccine to all VFC eligible 9 – 18 year olds
- May recommend 11 – 12 year olds
- Few states have purchased vaccine for 19 – 26 year olds
- Some have coverage through Medicaid
- Merck Patient Assistance program

## Policy Issues

- Funding in Universal states to cover non-VFC eligible patients Implementation of vaccine held up for VFC eligible children
- Legislation  - school entry laws, education requirements, insurance coverage,  funding, etc.
- Efficacy in women already sexually active
- Efficacy and funding for 19 – 26 year olds

## State HPV Vaccine Legislation 2007Education, Funding, or Mandates

-  Signed

- Introduced

## Implementation Issues 

- Capturing adolescents
- 3 doses required
- Consent
- Different group of providers (e.g OB/GYNs)
- Storage and handling
- Forecasting for immunizations
- Reminder/Recall for subsequent doses

## Future Considerations

- Bivalent HPV vaccine
- FDA decision ~ Jan 2008
- New ACIP HPV vaccine recommendations ~ Feb. 2008
- Quadrivalent vaccine  - other groups
- Older women – 2008
- Males – 2009

## Resources

- CDC
- _http://www.cdc.gov/vaccines_
- _http://__www.cdc.gov__/std_
- American College of OB/GYNs - _http://acog.org_
- American Cancer Society - _http://www.cancer.org_