4 minute read
Diseases By Edward Dick, MD
Stopping Shots in the Dark:
By Edward Dick, MD
Introduction
The current COVID-19 health emergency underscores the challenges and importance of preventing disease before it occurs through an effective immunization program. A coalition of the American Cancer Society and ImmunizeSA conducted a survey to identify current states of awareness, opportunities and obstacles to achieving optimal immunization. The 15-item survey was conducted online with participants from the Bexar County Vaccines for Children (VFC) Program, Bexar County Chapter of the Texas Academy of Pediatrics and physician members of the Bexar County Medical Society (BCMS). The survey was conducted from January to April 2020 and had an 85% response rate (107 total respondents). Of the respondents, 42% were in private practice, and 96% of the respondents participated in the VFC program. Respondents included multiple practice roles, including medical assistants, nurses, physicians and other medical providers. The survey consisted of 10 general immunization questions and five optional questions on HPV vaccinations (79% response rate).
Lessons Learned: Highlights
Of the respondents, 81% reported using standing orders to administer Advisory Committee on Immunization Practices (ACIP) recommended vaccines. Ninety nine percent of the respondents indicated that their ACIP standing orders include HPV vaccinations. Almost all the respondents (99%) indicated familiarity with the ImmTrac2 immunization registry, and 94% knew that in Texas, pediatric patients who turn 18 years old must consent again into ImmTrac2 when they turn 18.
On the optional HPV vaccine survey, providers were asked to respond to questions about general knowledge of the human papilloma virus, the HPV vaccine and issues related to its administration. Figure 1 illustrates eight items related to the HPV vaccine. Figure 1: What do you understand to be true about the HPV vaccine?
HPV vaccine is cancer prevention 95.95%
2 doses should be given to patients 9-14 years of age. 95.95%
3 doses should be given to patients above the age of 15 years 93.24% The vaccine is safe for both males and females 97.30%
The HPV Vaccine prevents six types of cancers The HPV Vaccine is safe, and the only known side effects are mild, like those of other vaccines 54.05%
87.84%
A common method for administering the vaccine is "Same Day, Same Way." This method encourages administration of the HPV vaccine while also administering other age-appropriate vaccines 81.08% I am not familiar with the HPV Vaccine 2.70%
Responses indicated high awareness and agreement that the HPV vaccine prevents cancer, however, only slightly more than half of the respondents knew that it prevented six types of cancer.
Figure 2 illustrates the barriers respondents encountered to HPV vaccination. According to the respondents, there were three main barriers to patient adoption of the HPV vaccine. Respondents indicated that parents/patients had concerns about the vaccine (76%), parents refused the vaccine (81%) and the lack of requirement for school entry hinders vaccine adoption (65%). In contrast to the role of parent refusal of the vaccine, only 31% of the respondents indicated patient refusal was an impediment to vaccine adoption. Cost was a barrier in less than 7% of the cases.
Figure 2: What barriers have you experienced with the HPV vaccine? Discussion
The survey indicated a high level of participation and an awareness of the importance of vaccines on the part of medical providers. Continued barriers to successful vaccination include techniques to address and work through parent objections to HPV vaccines. One successful approach to parental and patient objections has been the “same way, same day” techniques of the American Cancer Society that normalize the HPV vaccine as a natural complement of recommended vaccines. While respondents indicated an awareness that the HPV vaccine prevents cancer, they were not as aware of the six types of cancers that it prevents. Greater awareness of the extent and types of cancers on the art of both provider, parents and patients may shift the debate and make more people take the vaccine. Both the Immunize SA and American Cancer Society offer extensive resources on vaccines for patients in general and doctors to increase immunization coverage and reduce vaccine-preventable diseases. During the COVID Public Health Emergency (PHE) the value and challenges of preventing disease through effective immunizations is more apparent.
Acknowledgements
Thank you to the American Cancer Society South Texas HPV Vaccination Task Force and Metro Health for conducting the survey and compiling the results in this study.
Resources American Cancer Society https://www.cancer.org/health-care-professionals/hpv-vaccinationinformation-for-health-professionals/hpv-vaccination-resources-forhealth-professionals.html Immunize SA https://www.immunizationcoalitions.org/networkmembers/?coal=immunize-san-antonio-izsa_oid353 ImmTrac2 https://www.dshs.texas.gov/immunize/immtrac/default.shtm
Edward Dick, MD is the Director of Clinical Complex Care Management at Methodist Healthcare Ministries. He is a member of the Bexar County Medical Society.
