Creating an effective vaccination program
The following commonsense guidelines, which we have implemented at our medical center, should be helpful in organizing an effective HPV vaccination program for your office or department4,9,10:
- One clinician in the department or practice should be designated the “vaccination champion.” This individual should provide colleagues with periodic updates, emphasizing the importance of the HPV vaccine and other vaccines, such as Tdap (tetanus, diphtheria, pertussis), influenza, COVID, pneumococcal, hepatitis B, herpes zoster (shingles), and RSV (respiratory syncytial virus).
- One staff member in the practice or department should be designated as the go-to person for all logistical matters related to vaccines. This individual should be responsible for estimating usage, ordering vaccines, and storing them properly. He or she also should be knowledgeable about the cost of the vaccines and insurance reimbursement for the vaccines.
- Signs and educational materials should be posted in strategic locations in the office, advising patients of the importance of timely vaccination for themselves and their adolescent children.
- At every encounter, patients should be encouraged to receive the HPV vaccine series if they are in the appropriate age range and social situation for vaccination. They should not be required to have HPV testing before vaccine administration.
- Key leaders in the department or practice should lobby effectively with their pediatrician colleagues and with public and private insurance companies to encourage timely administration and proper coverage of this important immunization.
Other measures to reduce the risk of HPV-mediated malignancies
Practitioners should advise their patients to:
- Be circumspect in selection of sexual partners.
- Use male or female condoms when engaging in vaginal, anal, and/or oral sex with multiple partners, particularly those who may have genital or oral condylomas.
- Have regular Pap tests, every 3 to 5 years, depending upon age. More frequent testing may be indicated if there is a history of previous abnormal testing.
- Seek prompt medical or surgical treatment for genital or oral condylomas.
CASE Resolved with HPV vaccination
This patient is an excellent candidate for catch-up vaccination. She should receive the first dose of the 9-valent HPV vaccine at the time of her postpartum appointment. The second dose should be administered 1 to 2 months later. The third dose should be administered 6 months after the first dose. She also should have a Pap test, either cytology alone or cytology plus HPV screening. If the latter test is chosen and is reassuring, she will not need retesting for 5 years. If the former test is chosen, she should have a repeat test in 3 years. ●
Key points: HPV vaccination—why and when
- The overwhelming majority of precancerous lesions and overt malignancies of the genital tract and oropharynx are caused by oncogenic strains of HPV.
- Most of these cancers could be prevented if patients were vaccinated with the 9-valent HPV vaccine.
- The HPV vaccine should be offered to all children beginning at age 11 and to selected high-risk children at age 9. For children aged 14 years and younger, 2 doses of the vaccine are sufficient to induce a robust immune response. The second dose should be administered 6 to 12 months after the first dose.
- Individuals in the age range 13 to 26 years should be offered catch-up vaccination if they have not been previously vaccinated.
- Persons in the age range 27 to 45 years also should be offered vaccination if they have developed a new high-risk profile.
- Persons older than age 15, or those of any age with immunocompromising conditions, should receive 3 doses of the vaccine. The second dose should be administered 1 to 2 months after the first dose, and the third dose should be given 6 months after the first dose.
- The vaccine does not prevent the progression of preexisting infection or clear an infection that is already present at the time of vaccination.
- As a general rule, the vaccine should be deferred during pregnancy, although no adverse effects have been documented when the vaccine has been administered to pregnant women.