HPV What are the issues?

1. HPV What are the issues? Anne McGowan Nurse Immunisation Co-ordinator Gwent Healthcare NHS Trust

2. Acknowledgements • Prof Alison Fiander, Head of Obs + Gynae Cardiff University • Jo Yarwood Imm’s Division DH • Dr Syed Ahmed Imm’s Co-ordinator Greater Glasgow and Clyde NHS • Dr Simon Cottrell VPDP NPHS

3. What is known about HPV? • General public • Not much • Health Care Professional • Not enough

4. Issues • Attitudes and Awareness • Communication • Training • Consent • Vaccine Safety • Experience of Hepatitis B in Scotland

5. How women perceive HPV • Highly educated women/women in health care • 30-70% had heard about HPV • 1-10% know link with cervical cancer • Waller et al 2003 London • Pitts M et al 2006 Australia

7. DH Commissioned research Qualitative work May/June 2007 among 11-12 yr old, their parents and HCP’s looking at attitudes

8. Aims of research • What do people understand about HPV and cervical cancer? • How do parents feel about their children having the vaccine? • What are their concerns? • What are their information needs?

9. Attitudes • Most participants very positive – vaccination is an important parental responsibility • Protector role • MMR controversy meant they were more conscious of vaccine risks for children than for adults • Mothers appear more involved in health generally

10. Awareness of HPV • Low awareness of HPV amongst parents • Strong awareness of cervical cancer • Women knowledgeable of prevalence, severity, testing through smears • Men aware but less informed

11. Findings • Some parents had reservations/concerns about sexual promiscuity • Parents expressed concerns about vaccine safety and consent issues • Young people generally thought it was a good idea and thought their parents would too but • Concerns about needles in arms • Health professionals very supportive but • Concerns about delivery mechanism and resources • All felt parental consent was necessary

12. Communication • Educational • Full explanation of aetiology of cervical cancer • The nature and safety record of HPVV • Reasons why it needs to be administered before onset of sexual activity • Instructional • Focus on what, who, when, where and how • Point people towards further information resources

13. Communication • Stepped level of information • Instruction v education • Prevention of cervical cancer is the primary purpose of the vaccine programme

14. The message HPV vaccine prevents cervical cancer and can save your daughters life make sure you get your daughter vaccinated.

15. Publicity • TV • Cinema adds • Magazine /Press • PR work • Information leaflets • Dispatches C4

16. DH /WAG support for training + communication • HPV slides • Train the trainers Wales April • Consent form and PGD • New Green book chapter • Leaflets • Fact sheets • Q and A • DVD

17. Consent • Green Book • Process • Information for young person’s own use and to share with parents • Withdraw at any time • Parents should be informed of dates of school sessions • Informed about data collection for efficacy and cancer register

18. Effective Implementation • Engage the schools, gain their support • Other stakeholders • Train the HCW’s delivering the programme so they are confident about benefits of vaccine

19. Vaccine • Gardasil and Cervarix • DH Procurement process • Safety profile studies have shown HPV vaccine to be safe and well tolerated • Rigorous safety testing is a requirement for licensing

20. Vaccine Safety Harper DM et al Lancet 2004, Villa et al Lancet 2005, Reported: Miller E HPV conference Oct 2007

21. Vaccine side effects • Mild to moderate swelling, redness and pain at injection site • Other less commonly reported side effects are • Slight temp • Sickness, diarrhoea, dizziness • Muscle aches • Anaphylaxis following vaccination is possible but extremely rare

22. Vaccine Safety • 13 million doses have been given to girls and young women. • The fainting episodes in Australia often seen in adolescents. • Reports of deaths in USA and Europe investigated and no links with vaccine found.

23. Size of campaign in Wales 20,000 girls in Year 8 (range Cardiff 7278 -400 Merthyr Tydfil ) Catch up 44300 in 2009 41550 in 2010 (Predicted numbers Feb 08 CH2000)

24. Hepatitis B experience in Scotland • Schools were supportive • 92% of pupils consented 0.8% actively refused • High uptake in adolescents • 91% 1st dose 80% all 3 • Deprivation levels most significant indicator of non compliance • Vital to educate HCW’s delivering programme re benefits • Work closely with school staff Ref Bramley JC et al. Universal B vaccination of UK adolescents; a feasibilty and acceptability study. Comm Dis + Public Health 2002:5(4) 318-20

25. Reasons for non compliance • Absentee rates about 10% in 51 /81 schools • Mop up clinics not effective • Not being able to go to GP for missed doses • Religion or funding status of the school did not influence uptake

26. Summary from campaign • Working parents reluctant to take time off work • Could have achieved higher uptakes if part of routine programme with subsequent ongoing mop ups • Support front line • Success depends on their support and commitment • Work closely with heads

27. Finally 400 lives will be saved

28. Thank You Source: Daily Mail 5th November 2007