HPV and Adolescent Vaccine Toolkit: Clinician Guide CONTENTS I. 2018 IMMUNIZATION SCHEDULES & SCREENING RESOURCES Recommended & Catch-up Immunization Schedule (Birth-18 Years) Lists the ages or age range each vaccine is recommended. Schedules are updated annually. Please visit https://www.cdc.gov/vaccines/schedules/ for the most up-to-date schedules. Clinician FAQ: CDC Recommendations for HPV Vaccine 2-Dose Schedules Helps explain the new HPV vaccine recommendation for adolescents (2 doses recommended for adolescents starting the series before their 15th birthday; 3 doses recommended for adolescents starting the series after their 15th birthday) and provides tips for talking to parents about the change. HPV 2-Dose Decision Tree Follow the decision tree chart to determine whether your patient needs two or three doses of HPV vaccine. II. ADDRESSING VACCINE HESITANCY Talking to Parents About the HPV Vaccine A collection of questions parents may have surrounding the HPV vaccine and responses healthcare providers can use to address the concerns. Let’s Talk Vaccines: A Guide to Conversations About Immunizations Parents ask tough questions! Use this resource from Northwest Vax to provide a strong recommendation using the Ask. Acknowledge. Advise model. III. BEST PRACTICES AND STRATEGIES FOR IMPROVING IMMUNIZATION COVERAGE RATES Strategies for Improving Adolescent Immunization Coverage Rates Use the strategies in this AAP resource to help your practice improve adolescent immunization coverage rates among your patients. Documenting Parental Refusal to Have Their Children Vaccinated Provides tips from the AAP on ways to communicate with and educate parents who refuse immunizations. Includes a template for use by health care providers to document refusals. CONTENTS CONTINUED Adolescent Vaccine Information for Healthcare Professionals Provides information on the four routinely recommended adolescent vaccines: Tdap, HPV, Influenza and Meningococcal. Top 10 List for HPV #VaxSuccess Lists 10 strategies clinicians can use to attain and maintain high HPV vaccination rates in their clinics. Using Standing Orders for Administering Vaccines: What You Should Know Describes standing orders and promotes its use in the delivery of immunization services to patients to increase vaccination coverage rates. IV. DATA & STATISTICS HPV Cancer & Prevention Profile—Texas Provides an overview of HPV vaccination rates compared to that of Tdap and Meningococcal vaccines in the U.S and Texas. Also, provides a comparison of the incidence of HPV-associated cancers in the U.S. and Texas and the percentage of cancers linked to HPV. Average Annual Number of New Cancers Probably Caused by HPV: AAP An AAP graph detailing the average annual number of new cases probably caused by HPV in women and men. Incidence of Diseases Covered in Adolescent Vaccine Series: AAP An AAP graph detailing the annual incidence of diseases that can be prevented with the adolescent vaccine series. Deaths from Diseases Covered in Adolescent Vaccine Series: AAP An AAP graph detailing the estimated annual deaths from diseases that can be prevented with the adolescent vaccine series. CONTENTS CONTINUED V. QUALITY IMPROVEMENT TOOLS Plan, Do, Study, Act (PDSA) Model for Improvement Resource An AAP resource providing quality improvement strategies guiding clinicians on the planning stages of identifying a problem, implementing the solution and measuring outcomes. Huddle Your Way to Better Immunization Rates An AAP resource providing ideas on how to incorporate immunizations into your practice’s daily huddles. VI. OTHER RESOURCES Promotional Materials for Adolescent Vaccines Flyers included in both English and Spanish that can be displayed in your practice promoting all adolescent vaccines. Visit www.cdc.gov/vaccines/ed/patient-ed.htm for additional promotional materials. Vaccine Information Statements and Important Information about VISs VISs are information sheets produced by the CDC, that explain both the benefits and risks of a vaccine to vaccine recipients. Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. Enclosed are the most current VISs for the recommended adolescent vaccines in English, Spanish and Vietnamese. Visit www.cdc.gov/vaccines/hcp/vis/current-vis.html for a link to all current VISs. Video Resources Provides links to videos detailing personal stories of individuals and families affected by vaccine-preventable diseases. Download a QR Scanner App on your phone for easy access to videos! I I 2018 Immunization Schedules & Screening Resources . Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, UNITED STATES, 2018 The table below shows vaccine acronyms, and brand names for vaccines routinely recommend- ed for children and adolescents. The use of trade names in this immunization schedule is for • Consult relevant ACIP statements for detailed recommendations identification purposes only and does not imply endorsement by the ACIP or CDC. (www.cdc.gov/vaccines/hcp/acip-recs/index.html). Vaccine type Abbreviation Brand(s) • When a vaccine is not administered at the recommended age, Diphtheria, tetanus, and acellular pertussis vaccine DTaP Daptacel administer at a subsequent visit. Infanrix Diphtheria, tetanus vaccine DT No Trade Name • Use combination vaccines instead of separate injections when Haemophilus influenzae type B vaccine Hib (PRP-T) ActHIB appropriate. Hiberix Hib (PRP-OMP) PedvaxHIB • Report clinically significant adverse events to the Vaccine Adverse Hepatitis A vaccine HepA Havrix Event Reporting System (VAERS) online (www.vaers.hhs.gov) or by Vaqta Hepatitis B vaccine HepB Engerix-B telephone (800-822-7967). Recombivax HB • Report suspected cases of reportable vaccine-preventable diseases Human papillomavirus vaccine HPV Gardasil 9 to your state or local health department. Influenza vaccine (inactivated) IIV Multiple • For information about precautions and contraindications, see www. Measles, mumps, and rubella vaccine MMR M-M-R II Meningococcal serogroups A, C, W, Y vaccine MenACWY-D Menactra cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html. MenACWY-CRM Menveo Meningococcal serogroup B vaccine MenB-4C Bexsero MenB-FHbp Trumenba Approved by the Pneumococcal 13-valent conjugate vaccine PCV13 Prevnar 13 Pneumococcal 23-valent polysaccharide vaccine PPSV23 Pneumovax Advisory Committee on Immunization Practices Poliovirus vaccine (inactivated) IPV IPOL (www.cdc.gov/vaccines/acip) Rotavirus vaccines RV1 Rotarix RV5 RotaTeq American Academy of Pediatrics Tetanus, diphtheria, and acellular pertussis vaccine Tdap Adacel (www.aap.org) Boostrix Tetanus and diphtheria vaccine Td Tenivac No Trade Name American Academy of Family Physicians Varicella vaccine VAR Varivax (www.aafp.org) Combination Vaccines American College of Obstetricians and Gynecologists DTaP, hepatitis B and inactivated poliovirus vaccine DTaP-HepB-IPV Pediarix DTaP, inactivated poliovirus and Haemophilus influenzae DTaP-IPV/Hib Pentacel (www.acog.org) type B vaccine This schedule includes recommendations in effect as of January 1, 2018. DTaP and inactivated poliovirus vaccine DTaP-IPV Kinrix Quadracel Measles, mumps, rubella, and varicella vaccines MMRV ProQuad U.S. Department of Health and Human Services Centers for Disease Control and Prevention Figure 1. Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger—United States, 2018. (FOR THOSE WHO FALL BEHIND OR START LATE, SEE THE CATCH-UP SCHEDULE [FIGURE 2]). These recommendations must be read with the footnotes that follow. For those who fall behind or start late, provide catch-up vaccination at the earliest opportunity as indicated by the green bars in Figure 1. To determine minimum intervals between doses, see the catch-up schedule (Figure 2). School entry and adolescent vaccine age groups are shaded in gray. 19-23 Vaccine Birth 1 mo 2 mos 4 mos 6 mos 9 mos 12 mos 15 mos 18 mos 2-3 yrs 4-6 yrs 7-10 yrs 11-12 yrs 13-15 yrs 16 yrs 17-18 yrs mos Hepatitis B1 (HepB) 1st dose 2nd dose 3rd dose Rotavirus2 (RV) RV1 (2-dose See 1st dose 2nd dose series); RV5 (3-dose series) footnote 2 Diphtheria, tetanus, & acellular 1st dose 2nd dose 3rd dose 4th dose 5th dose pertussis3 (DTaP: <7 yrs) Haemophilus influenzae type b4 rd th 1st dose 2nd dose See 3 or 4 dose, (Hib) footnote 4 See footnote 4 Pneumococcal conjugate5 1st dose 2nd dose 3rd dose 4th dose (PCV13) Inactivated poliovirus6 1st dose 2nd dose 3rd dose 4th dose (IPV: <18 yrs) 7 Annual vaccination (IIV) Influenza (IIV) Annual vaccination (IIV) 1 or 2 doses 1 dose only Measles, mumps, rubella8 (MMR) See footnote 8 1st dose 2nd dose Varicella9 (VAR) 1st dose 2nd dose Hepatitis A10 (HepA) 2-dose series, See footnote 10 Meningococcal11 (MenACWY-D See footnote 11 1st dose 2nd dose >9 mos; MenACWY-CRM ≥2 mos) Tetanus, diphtheria, & acellular Tdap pertussis13 (Tdap: >7 yrs) 14 See footnote Human papillomavirus (HPV) 14 See footnote 12 Meningococcal B12 Pneumococcal polysaccharide5 See footnote 5 (PPSV23) Range of recommended Range of recommended ages Range of recommended ages Range of recommended ages for non-high-risk No recommendation ages for all children for catch-up immunization for certain high-risk groups groups that may receive vaccine, subject to individual clinical decision making NOTE: The above recommendations must be read along with the footnotes of this schedule. FIGURE 2. Catch-up immunization schedule for persons aged 4 months–18