# Presentation: 236096

## Background Topic: Communication

- Co-leads
- Gregory Zimet, *Indiana University School of Medicine*
- Tanya Johnson, *ORISE/CDC/National Immunization Program*
- Lindsay Newcomb,* ASPH/CDC/National Immunization Program*
- Members
- Ed Brink, *CDC/National Immunization Program*
- Magdalena Castro-Lewis, *National Alliance for Hispanic Health*
- Terry Dwelle, *North Dakota Department of Health*
- Vicki Evans, *CDC/National Immunization Program*
- Missy Fleming, *American Medical Association*
- Allison Friedman, *CDC/NCHSTP*
- Sharon Humiston, *University of Rochester School of Medicine and Dentistry*
- Jessica Kahn, *Cincinnati Children’s Hospital Medical Center*
- Susan Rosenthal, *UTMB Children’s Hospital*
- Judy Schmidt, *CDC/National Immunization Program*
- Hilda Shepeard, *CDC/NCHSTP*
- Deborah Wexler, *Immunization Action Coalition*

## What to say and who to say it to: Communication regarding the new vaccines for adolescents 

- Gregory Zimet
*Indiana University *
*School of Medicine*
- for the Communications
- Background Topic Group

## Vaccine Success

- Ultimate reduction of incidence of
- infection & disease depends upon:
- Development of safe & efficacious vaccine
- Development of systems of delivery
- Development of effective communication strategies

## 3 New & Emerging Vaccines

- Meningococcal conjugate vaccine (MCV-4)
- Newly licensed in U.S.
- Pertussis vaccine (TdaP)
- May be licensed and available soon
- Human papillomavirus (HPV) vaccine
- 2006-2007?

## Communication Approaches

- Will need to consider commonalities across the three vaccines
- Will also need to take into account differences among the vaccines

## Lines of Communication

## Questions Addressed

- What potential communication approaches are common to meningococcal disease, pertussis, & HPV and the vaccines that prevent them?
- What communication approaches are specific to individual vaccines?
- Meningococcal vaccine
- Pertussis vaccine
- HPV vaccine
- When do communication messages increase immunization coverage without other interventions?

## Questions Addressed

- What potential communication approaches are common to meningococcal disease, pertussis, & HPV and the vaccines that prevent them?
- What communication messages are specific to individual vaccines?
- Meningococcal vaccine
- Pertussis vaccine
- HPV vaccine
- When do communication messages increase immunization coverage without other interventions?

## Common Communication Issues 

- FDA approval & ACIP recommendations
- Pre- or early-adolescent target
- Protecting the health of adolescents
- Culturally and linguistically appropriate
- Enhancement of health professionals’ cultural proficiency
- Work with community-based organizations
- Importance of research to develop and test different communication approaches & messages

- .

## Common Communication Issues – Part 2

- Targeted message approaches
- Considers linguistic & cultural issues common to a particular demographic group
- A way to make mass media/larger group communication strategies more relevant
- Tailored message approaches
- Particularly appropriate in clinical settings
- Elicitation of parent/adolescent attitudes
- Response takes those attitudes into consideration
- Respectful approach to vaccine opposition

- .

## Questions Addressed

- What potential communication approaches are common to meningococcal disease, pertussis, & HPV and the vaccines that prevent them?
- What communication messages are specific to individual vaccines?
- Meningococcal vaccine
- Pertussis vaccine
- HPV vaccine
- When do communication messages increase immunization coverage without other interventions?

## Meningococcal Infection

- Rare, but devastating infection
- Non-vaccine related prevention strategies important & effective
- Availability of chemoprophylaxis
- Early detection and emergent prevention during outbreaks

- .

## Conjugate Meningococcal Vaccine

- Vaccine recently licensed
- Conjugate vaccine supersedes polysaccharide vaccine
- 11-12 year olds one of several priority groups
- Communication strategies already developed
- Information for parents and adolescents
- Information for school personnel
- Information for providers & insurance companies

- .

## Pertussis Infection

- Common infection
- Often unrecognized by providers & parents
- Outbreaks in school settings common
- Missed school & work

- .

## Pertussis Vaccine 

- Licensure likely soon
- Booster vaccine needed due to waning immunity
- Focus on high incidence & frequent outbreaks
- Education of providers & parents to recognize the problem

- .

## HPV Infection

- Very common sexually transmitted infection
- Poor knowledge among parents & providers
- Most infections benign
- Some persistent infections causally associated with cervical cancer
- Current screening approaches helpful, but imperfect

- .

## HPV Vaccine 

- FDA approval – 2006-2007?
- No connection to previously available vaccine
- Potential prevention of 70% of cervical cancers
- Sexual transmissibility makes pre-adolescence ideal age group to vaccinate
- Need to provide balanced message
- Over-emphasis on frequency of benign infection may cause problems
- Unrealistic reassurance of vaccination may cause problems

- .

## HPV Vaccine: Other Issues 

- Concern about parental acceptance of vaccine for sexually transmissible infection
- But numerous research studies show high parental interest in protecting their children against STI & their sequelae, including cervical cancer
- Concern about health care providers’ willingness and ability to communicate with parents & adolescents about HPV vaccine
- How will HPV vaccination be handled by the media?

- .

## Questions Addressed

- What potential communication approaches are common to meningococcal disease, pertussis, & HPV and the vaccines that prevent them?
- What communication messages are specific to individual vaccines?
- Meningococcal vaccine
- Pertussis vaccine
- HPV vaccine
- When do communication messages increase immunization coverage without other interventions?

## Communication Messages 

- Information-based communication messages
- Can increase awareness about the infection/disease and about the availability of vaccine
- May have some, but probably limited, effect on rates of vaccination
- May be most effective within the context of coordinated delivery system
- Other issues may limit effectiveness of communication
- Cost
- Pragmatic considerations

- .

## Early Adolescent Health Care Visit

- Well-child visit for early adolescents not well-established
- Would be ideal setting for communication about vaccines & for vaccination
- New vaccines:
- Would benefit from an established 11 or 12 year old visit
- Might help to establish such a visit
- Alternative settings
- Schools
- Community centers
- Detention facilities