1 Presenter disclosure Presenters Name Ajit Johal I have the following relationships with commercial interests Advisory BoardSpeakers Bureau AA Pharma Sanofi Pasteur SpeakerConsulting Fees ID: 933526
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Slide1
The Role of Pharmacists in Reducing the Risk of HPV-related Cancers and Diseases
1
Slide2Presenter disclosurePresenter’s Name: Ajit JohalI have the following relationships with commercial interests:Advisory Board/Speakers Bureau – AA Pharma
, Sanofi PasteurSpeaker/Consulting Fees: Eli Lily, Novartis, Boeringher Ingelhiem, Mckesson Canada, Ensemble IQ, Valeneva
INCOther: Current/past Employee of UBC Faculty of Pharmaceutical Sciences
Speaking Fees for current learning activity: I have received a speaker’s fee from Merck Canada for this learning activity
2
Slide3Commercial Support DisclosureThis learning activity has received support from the Merck Canada
3
Slide4The Role of Pharmacists in Reducing the Risk of HPV-related Cancers and Diseases
R
evi
ew the current key adult Human Papilloma Virus (HPV) immunization recommendations
Examine the evidence behind adult HPV immunization
Discuss the strategic role of pharmacists
for
improving adult immunization rates
Appreciate the value of the pharmacist recommendation for HPV vaccination
4
Slide5https://immunizebc.ca/immunization-during-covid-19
5
Slide66
Vaccination Status Reporting Regulation (VSRR)
Effective July 1, 2019, VSRR allows the Medical Health Officer (MHO) to require a parent/ guardian to provide a vaccination status record for their school-aged child.
During the first year of implementation, HPV (and Hepatitis B) are not included in the VSRR since they do not present the risk of outbreaks in school settings but reasons for non-vaccination including refusal are continued to be documented in Health Authority immunization registries in the usual manner.Parents/guardians can check the Vaccine Status Indicator
in ImmunizeBC to see if their school-aged child’s records are complete.
Slide77
Vaccination Status Reporting Regulation (VSRR)
Important that pharmacists notify local Health Authority (and patient’s physician) of immunizations provided to 19 years of age or younger.
Best Practice and Standard of Care to fax all administered immunizations for patients aged 5-19 to the local regional health unit
Slide88
Slide9HPV Diseases and Cancers“Guiding the Conversation
Who?
What?
When?Why?How?
9
Slide10HPV Diseases and Cancers“Guiding the Conversation
What is HPV?
10
Slide11Human Papillomavirus (HPV)1,2 Small DNA virus More than 100 HPV genotypes The most common sexually transmitted infectionNearly all sexually active men and women get HPV at some point in their livesSkin-skin transmissionCategorized on cancer risk:
Low-risk: types 6, 11High-risk: types 16, 18, 31, 33, 45, 52, 58
Health Canada and the Public Health Agency of Canada Government of Canada. Human Papillomavirus Vaccine - Canadian Immunization Guide: Part 4 - Active Vaccines. https://
www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-9-human-papillomavirus-vaccine.html. Published July 18, 2007. Accessed January 5, 2018.Centre for Disease Control and Prevention. Human Papillomavirus (HPV) Statistics. Accessed March 20, 2018. Available at: https://www.cdc.gov/std/hpv/stats.htm
Slide12Cervical cancer
Other anogenital cancers
Head and neck cancer
Cancer precursors at many sites
High risk HPV i.e. 16, 18
Burden of HPV infection12National Cancer Institute. HPV and Cancer. Accessed February 4, 2018. Available at: https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet
Trottier and Burchell. Epidemiology of mucosal human papillomavirus infection and associated diseases. Public Health Genomics. 2009;12:291-307.
Low risk HPV i.e. 6, 11
Recurrent respiratory papillomatosisAnogenital warts
HPV
Slide13Estimated HPV contribution in cancer13Data are from GLOBOCAN 2012.
https://www.cdc.gov/cancer/hpv/statistics/cases.htm reviewed by August 2, 2019
Slide14HPV Diseases and Cancers“Guiding the Conversation
How is it transmitted?
14
Slide15HPV transmission: HPV is easily acquired and transmitted even without sexual intercourseHPV is spread through skin contactHPV often has no visible signs or symptoms = Asymptomatic TransmissionIn a clinical study of female college students (n = 82): when used 100% of the time, the male condom offered approx. 60% protection against acquiring HPV3
No commercial screening test availableNo post-exposure prophylaxisNo test of cure15
1. Winer RL, et al. Am J Epidemiol 2003; 157(3):218-26.2. CDC. Available at:
www.cdc.gov/STD/HPV/STDFact-HPV.htm. Accessed October 2010.3. Winer RL, et al. N Engl J Med 2006; 354(25):2645-54.
Slide16“Normal” Immunology
Pathogen enters host and has contact with blood or lymphatics
Innate immune system
detects
pathogen
Innate immune system attempts to
neutralize
Innate immune system
activates the adaptive immune response
(antibodies produced)
HPV Immunology
1
HPV in natural infection is
exclusively intraepithelial
(
no exposure
to blood or lymphatics)
There is
little or no opportunity
for the adaptive immune response
to be activated
.
The opportunity for long-lived memory cell generation
does not exist
.
A “natural infection” therefore
does not always confer immunity
.
1.
Stanley M. Gynecol Oncol. 2010 Jun;118(1 Suppl):S2-7
16
Slide17HPV Diseases and Cancers“Guiding the Conversation
How can we prevent it?
17
Slide18Strategies forHPV preventionGET VACCINATED!HPV vaccines prevent up to 99-100% of HPV infections
18Health Canada and the Public Health Agency of Canada Government of Canada. Human Papillomavirus Vaccine - Canadian Immunization Guide: Part 4 - Active Vaccines. Accessed on March 3rd 2021. Available at: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-9-human-papillomavirus-vaccine.html.
Limit number of sexual partners
Use a condom
Quit smoking
Get regular PAP tests
Having multiple partners increases the risk of getting HPVA condom provides excellent protection against other STI’s, but because it doesn’t cover all skin, it doesn’t guarantee complete protection against HPV
Smoking (tobacco or marijuana) makes the body less able to fight HPV infections and can cause cancers
PAP tests can detect pre-cancerous changes that can be treated before cancer develops
Slide19192v: bivalent; 4v: quadrivalent; 9v: nine-valent.Cervarix Product Monograph. GlaxoSmithKline Inc.;
Joura et al. N Engl J Med. 2015;372:711-23.HPV
vaccines
High-risk genotypes
Low-risk genotypes
(anogenital warts and
recurrent respiratory papillomatosis)
O: original to 4v HPV vaccineN: new in 9v HPC vaccine
45N
9v HPV Vaccine
2
33
N
31N11
O6
O18
O16O
11
6
18
16
4v HPV Vaccine
2
18
16
2v HPV Vaccine
1
58
N
52
N
Slide20Pharmacists’ Role in HPV Immunization“Guiding the Conversation
Who is it recommended for?
20
Slide21HPV vaccines in Canada
1
HPV Quadrivalent Vaccine (4vHPV)
2
16
18
6
11
HPV 9-valent Vaccine (9vHPV)
4
31
33
6
11
45
52
58
16
18
Low-risk (wart-causing) HPV genotypes
High-risk (cancer-causing) HPV genotypes
HPV bivalent Vaccine (2vHPV)
3
16
18
Canada is one of the first countries that approved HPV vaccines
2006
First HPV Vaccine Approved
4vHPV Vaccine
for Females 9-26 years
2015
9vHPV VACCINE APPROVED
9vHPV Vaccine
for Females 9-45 years, Males 9-26 years
2010
2vHPV Vaccine Approved
2vHPV Vaccine
for Females 9-26 years
1.
The National Advisory Committee on Immunization (NACI) Statement on HPV 2007-2017;
2.
Gardasil Product Monograph. Merck Canada Inc.;
3.
Cervarix
Product Monograph. GlaxoSmithKline Inc.;
4.
Gardasil 9 Product Monograph Merck Canada Inc.
2020
4
9vHPV VACCINE APPROVED
for Males up to 45 years
21
Slide22Provincial HPV Vaccination Programs HR = High-Risk; MSM = Men who have sex with men; ≥ 15 year old = 3 dose ; <15 year old
& Immunocompetent = 2 dose
9vHPV vaccine in all school programs Universal Gender Neutral Vaccination
Various high-risk populations included with different coverage ratesCatch-up programs in place with various coverage rates
Date last updated: August 2020
PROVINCE/TERRITORY
Eligibility
Implementation Date
Uptake Rate
BC
9vHPV vaccine - allMales/Females: Gr. 6
(2 dose)1; HIV+ 9-26yo23 & HR
males 9-26yo8Transgender 9-26 yo8
; Catch up: Females and males (born in 2006 or later) vaccination initiated before 19 and catch up to 26
Sept 2008,
Sept 20158, Sept 2016
Sept 201726Nov 20178July 2019
Gr 6 F: 66.1%
M: 63.5% (2019) 14Gr 9 F: 66.8%
(2019) 14
AB
9vHPV vaccine - all
Males/Females: Gr. 6 (2 dose) 43;
MSM and transgender women 17-26yo36Catch up:
Up to
age 26 for both males and females
;
Hematopoietic Stem Cell Transplant recipient, Organ transplant candidates and recipients
43
Sept 2008,
Sept 2014,
Sept 2016
24
,Feb 2018
36
,Sept 2018,
July 2020
43
By age 12
M
: 63%
F: 65.6%
(2019)
25
SK
9vHPV vaccine - all
32
Males/
Females: Gr. 6
(2 dose)
1
;
HIV+ males 9-17yo
12
Catch up:
Females born since 1996; Males born since 2006
Females and males younger than 27 years old with specific medical conditions
Publicly Funded Immigrant and Refugee Immunization
44
Sept 2008,
Sept, 2015,
Feb 2016
Sept
2017
28
Oct 2018
44
F: 69%
(2017)
40
MB
9vHPV vaccine - all
31
Males/
Females: Gr. 6
(2 dose)
1
;
HIV+ and immunocompromised 9-26/9-45
; Dx RRP (past or present); Men
<
18 incarcerated (past or present
),
Gay bisexual male & Transgender 9-26, Sexual assault victims male 9-26 & female 9-45,
Female 9-45
yr
with new HG-cervical pathology,
Catch up:
Females: Born 1997 or later
18;
Males: Gr.
8/
9 (born 2002 or later)
2
Sept 2008,
Sept, 2015,
Sept 2016,
2018
Jan 2019
2
Apr 2019
69.4%
(2017)
13
22
Slide23Provincial HPV Vaccination Programs
9vHPV vaccine in most school programs except QC
Universal Gender Neutral VaccinationNot all provinces have high-risk populations included
Not all provinces have catch-up programs in placeHR = High-Risk; MSM = Men who have sex with men; ≥ 15 year old = 3 dose ; <15 year old & Immunocompetent = 2 dose
Date last updated: August 2020
PROVINCE/
TERRITORY
EligibilityImplementation Date
Uptake Rate
ON
9vHPV vaccine - all38
Males/Females: Gr. 75 (2 dose)1;
Catch up: Females: Gr. 8-12 ;
MSM: up to 26yo21
Sept 2007, Sept 2015, 201737,38
Sept 2016 (Gr. 7)
F: 62.4%M: 57.5%
(2017-2018) 35
QC
First dose: 9vHPV vaccine, second dose: 2vHPV vaccine
Males/Females: Gr. 4 (2 dose)1 ; Females, <18 yo
3Catch up Males: Secondary 3; High risk boys 9-17 yo.
Males/Females 9-26yo Immunosuppressed/HIV+4 MSM: 9 to 26 yo9;
9vHPV vaccine: all other groups22
Sept 2008,
April 2014
Jan 2016
(MSM),
Sept
2018
22
F: 79%
M: 77%
(2018-2019)
16
NB
9vHPV vaccine - all
30
Males/
Females: Grade 7
(2 dose)
1
Catch-up
: females (born >1995) and males (born >2005) until they reach 27 years old
Sept 2008,
Sept 2015,
Sept
2017
27,
30
Sept 2019
49
F: 74.9%
M: 72.8%
(2018-19
)
41
NS
9vHPV vaccine - all
Males/
Females: Grade 7
(2 dose)
1
HIV and MSM 9-45 yo
47
Sept 2007,
Sept 2015,
Sept 2015,
2018
F: 73.4%
M: 84.9%
(2016-2017)
42
PEI
9vHPV vaccine - all
Males/
Females: Grade 6
(2 dose)
10
;
HR males (18-26yo), MSM (all ages), HR females (18-45yo)
11
Males/Females who missed the vaccine in grade 6 since 2007
Sept 2007,
2017
Apr 2013,
Apr 2016
F: 84.3%
M: 85.0%
(2015-2016)
39
NL
9vHPV vaccine - all
Males/
Females: Grade 6
(2 dose)
1
Sept 2007,
Sept 2015
Sept 2017
29
2018
92%
(2015-2016)
48
23
Slide24Provincial HPV Vaccination Programs HR = High-Risk; MSM = Men who have sex with men; ≥ 15 year old = 3 dose ; <15 year old
& Immunocompetent = 2 dose
9vHPV vaccine in all school programs
Universal Gender Neutral VaccinationNot all territories have high-risk populations included and catch-up programs in place
PROVINCE/
TERRITORY
Eligibility
Implementation DateUptake Rate
Northwest Territories
9vHPV vaccine - all
Males/Females: Grade 4-6 (2 dose)1
Catch up: Females and males up to 26 yo
Sept 2009Sept 2015,
Sept 2017
55%(2015-2016)48
Yukon
9vHPV vaccine - all
Males/Females: Grade 6 (2 dose) 1
Catch up : Females: 15 to 18 yoFemales and Males HIV+ 9 - 45
yo Males high risk (9 - 26 yo) - MSM; Street involved
33
Fall 2009Sept 2015, Sept 2017
66.5%
(2016-2017)48
Nunavut
9vHPV vaccine - all
Males
31
/
Females: Grade 6
(2 dose)
20
, 31
Winter 2010
Sept 2015,
Sept
2017
N/A
Date last updated: August 2020
24
Slide25What about MALES?
Slide26Percent Seroconversion by Genital HPV Type
HPV 6
HPV 11
HPV 16
HPV
18
n
%
Median Time (Days)
12
12.5
223
3
9.1
182
8
4.1
317
2
2.6
311
In the HIM study, seroconversion was lowest for high-risk HPV types.
Only 7.7% of men developed detectable serum HPV antibodies within 36 months following HPV DNA detection of a genital, anal, or oral infection with HPV 6,11,16, or 18.
Seroprevalence assessed among a subgroup of men 18–70 years of age at baseline (n=384) from the HIM study.
HIM=HPV Infection in Men.
1.
Giuliano AR et al. Papillomavirus Res. 2015;1:109–115.
MALES HAVE A LOW RATE OF SEROCONVERSION FOLLOWING HPV INFECTION, REGARDLESS OF ANATOMIC SITE OF INFECTION
1
26
Slide27Percent Seroconversion by Genital HPV Type
HPV 6
HPV 11
HPV 16
HPV
18
n
%
Median Time (Days)
12
12.5
223
3
9.1
182
8
4.1
317
2
2.6
311
In the HIM study, seroconversion was lowest for high-risk HPV types.
Only 7.7% of men developed detectable serum HPV antibodies within 36 months following HPV DNA detection of an genital, anal, or oral infection with HPV 6,11,16, or 18.
Seroprevalence assessed among a subgroup of men 18–70 years of age at baseline (n=384) from the HIM study.
HIM=HPV Infection in Men.
1.
Giuliano AR et al. Papillomavirus Res. 2015;1:109–115.
MALES HAVE A LOW RATE OF SEROCONVERSION FOLLOWING HPV INFECTION, REGARDLESS OF ANATOMIC SITE OF INFECTION
1
Males have a higher risk of persistent HPV infection due to their inability to produce antibodies against it!
27
Slide28282005
ASIR (per 100,000)
Cervical Cancer
Oropharyngeal Cancer
in males
Oropharyngeal Cancer in female
Vaginal Cancer
Penial Cancer
Vulvar Cancer
Anal Cancer
Figure 7.3:
Trends in age-standardized incidence rates (ASIR) for HPV-associated cancers Canada,1992-2012§§ Quebec data are available to 2010Canadian Cancer Statistics 2016
Trends of HPV-related diseases in Canada from 1992-2012
The rate of Cervical Cancer
decreased between 1992 and 2005, and remained relatively stable thereafter.The rate of
Oropharyngeal Cancer has increased significantly (3.1% increase in males per year, 1.1% increase in females per year).
Slide29HPV Vaccination for the
Prevention of Head & Neck Cancers: US FDA Approvalhttps://www.fda.gov/vaccines-blood-biologics/vaccines/gardasil-9
The 9-valent HPV vaccine has received accelerated approval in the United States for the prevention
of oropharyngeal cancer and other head & neck cancers caused by HPV types 16, 18, 33, 45, 52, and 58.
And is currently being investigated for the prevention of oral persistent HPV infection in males 20-45 years of age in a
randomized, placebo-controlled confirmatory trial (V503-049; NCT04199689).
29
Slide30I don’t think I need it. I had
an abnormal pap in my 20’s
and I was told that it was too
late for me to receive this
vaccine. Plus, I am concerned about the side effects.
Slide31HPV infection has a bimodal distribution inwomen31*p<0.005; **p<0.01.
HPV: human papillomavirus; HR: high risk; LR: low risk.Liu et al. BMC Infect Dis. 2014 19;14:708. HPV prevalence (%)
Age Group (years)
TotalSingle HRSingle LR
Multiple
**
**
**
**
**
**
*
≤20
n=370
21~30
n=4939
31~40
n=5432
41~50
n=3902
51~60
n=472
>60
n=152
Slide32Giuliano AR, et al. Cancer Epidemiol Biomarkers Prev 2008; 17(8):2036-43. HPV prevalence in malesenrolled in the HIM Study (n = 1,160)
32
Slide3333
4vHPV vaccine reduces the incidence of subsequent HPV-related disease*
Joura EA, Garland SM, Paavonen J, et al. Effect of the human papillomavirus (HPV) quadrivalent vaccine in a subgroup of women with cervical and vulvar disease: retrospective pooled analysis of trial data.
BMJ. 2012;344:e1401.*Cervical intraepithelial grade 1 or worse, genital warts, vulvar intraepithelial neoplasia grade 1 or worse, or vaginal intraepithelial neoplasia grade 1 or worse.
46%
reduction
Subsequent HPV-related disease
Slide34Recurrent HIGH-GRADE Cervical dysplasia
1
Objective:
To verify if HPV vaccination (4vHPV vaccine) after surgery could reduce the risk of clinical disease relapse in women
(18-45 years of age)
treated for CIN2+
Risk Reduction 81.2%
11
/172 (6.4%)
2/172 (1.2%)
Clinical Disease Relapse (CIN2+) irrespective
of causal HPV type
HPV82
HPV33
HPV types distribution identified at clinical disease recurrence in vaccinated group
Non-vaccine type
Non-vaccine type
1.
Ghelardi A et al.
Gynecol Oncol. 2018 Nov;151(2):229-234.
; CIN= Cervical Intraepithelial Neoplasia;
Women 18-45 years; 3 doses 4vHPV; 1st dose: 30 days post-surgery; Follow-up: up to 4 years
4vHPV vaccine shows
>80% risk reduction
in disease relapse prevention up to 4 years post-surgery
None of the recurrent cases
among vaccinated patients are caused by vaccine-type of HPV
SPERANZA Projects
Prospective Study
34
Slide3535Health Canada and the Public Health Agency of Canada Government of Canada. Updated Recommendations on Human Papillomavirus (HPV) Vaccines: 9-valent HPV vaccine 2-dose immunization schedule and the use of HPV vaccines in immunocompromised populations. Accessed on February 13, 2018. Available at: https://www.canada.ca/en/public-health/services/publications/healthy-living/updated-recommendations-human-papillomavirus-immunization-schedule-immunocompromised-populations.html
NACI recommendationIn the absence of vaccination, it is estimated that 75% of sexually active Canadians will have a sexually transmitted HPV infection at some point in their lives. Even if a person is already infected with one or more vaccine HPV type(s), the vaccine will provide protection against the other HPV type(s) contained in the vaccine.
Slide36The HPV9 vaccine is recommended, but not provided free, for the following individuals:Women 19-45 years of ageBoys and men 9 to 26 years of age
Men 27 years of age and older who have sex with men
36
Slide37Another Statistic?
This study indicates that HPV infection can be acquired nonsexually and is already common at an early age (22.9% of the oral samples collected immediately after birth were positive for HPV DNA).
37
Slide38Common adverse effectsInjection site reactions Injection site pain (82% to 92%)Swelling (24% to 44%)Redness (24% to 48%)Normally mild to moderate in intensity and resolves in a few days
Safety profile of HPV9 is comparable to HPV4Health Canada and the Public Health Agency of Canada Government of Canada. “Human Papillomavirus Vaccine - Canadian Immunization Guide: Part 4 - Active Vaccines,” July 18, 2007. https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-9-human-papillomavirus-vaccine.html.
Clinical trials and post-marketing surveillance have found no increase in the number or type of serious adverse events in recipients of HPV vaccine compared with those who received placebo
HPV vaccine is administrated intramuscularly
Slide3939
Slide40Belgium Coca-Cola incident
Mass Psychogenic Illness MPI
Rapid Spread of “Symptoms”No Organic Cause Distressing Members of the same “Group”
in Coca-Cola products, which prompted a product
40
Slide4141
Slide421.
J
Obstet
Gynaecol
Can. 2019 May;41(5):599-607.e3.;
2. J Obstet
Gynaecol Can. 2019 Aug;41(8):1125-1133.e6.
Perceived Barriers of Cost
# 1Cost was seen as the number one barrier by92% to 95% of physicians. Perceived barriers of cost may limit recommendations for vaccination, particularly among older women or men.
Barrier to Vaccination among Canadian Physicians
1
Lack of physician recommendation# 1
Barrier to Get Vaccinated among Canadian Adults2
The number one reported barrier to vaccination for the general public was
not having a recommendation from a doctor
.
Cost was seen as a barrier by only 18% (male) and 20% (female) of participants.
Barriers to vaccination
42
Slide43Approved But Non-Funded Vaccines“ The greatest need is to change the widespread perception that vaccines should be publicly funded or ignored. The long-standing and total dominance of population over individual considerations for vaccines needs to end or the potential benefits of some vaccines will not be realized, to the detriment of those at risk. It is a form of discrimination against vaccines
compared with (preventive) drugs that urgently needs to be corrected”1
43
Slide44Estimated HPV contribution in cancer44Data are from GLOBOCAN 2012.
https://www.cdc.gov/cancer/hpv/statistics/cases.htm reviewed by August 2, 2019
Slide451.
Burns IT, et al. 2005; 54:S58-S62.;
2.
PHAC 2006 Canadian Adult Immunization Coverage Survey.
HEALTHCARE PROFESSIONAL’S RECOMMENDATION
Communication
1
Explaining the need for immunization
Clearly conveying the risk
Strong physician/provider recommendation
Recommendation is critical2
Medical recommendations make huge differences
45
Slide46Incomplete multi-dose vaccine series is common in practiceReasons for incomplete vaccine series:Lack of routine medical visitsLack of prioritization of vaccinationPopulation mobilityA relative lack of familiarity by patients and HCPs with the recommended schedules
Lack of tracking by health systemsA complete series is crucial to ensure protective immune response46
Gallagher KE, et al. Factors influencing completion of multidose vaccine schedules in adolescents: a systematic review. 2016; BMC Public Health (2016) 16:172 DOI 10.1186/s12889-016-2845-z
How do you feel that pharmacists can address the issue of incomplete HPV vaccines series?
Slide47HPV Vaccine Impact Monitoring Project Population-based surveillance 2008-2014
3300
aged 18-39 years with available data on CIN2+, typing results and vaccine history
women
Adjusted OR by number of doses received ≥24 months before CIN2+ detection
Median age at vaccination:
19 years
Worse
Median age at vaccination:
23 years
Johnson Jones ML et al. Am J Epidemiol. 2020 Apr 2;189(4):265-276.
Referent
0.96
0.61
Better than no vaccination
How Effective is 1 vs 2 vs 3 Doses of the HPV Vaccination in Providing Protection ?Pharmacists should emphasize the importance of completing HPV vaccination series in order to achieve optimal protection
Pharmacists should facilitate access to series completion by providing follow up appointments and reminders to complete 2nd and 3rd doses of the vaccine
47
Slide48How do you manageincomplete vaccines series?How many doses? If the vaccine schedule is interrupted, the vaccine series does not need to be restartedNeed minimum 4 weeks between 1st
and 2nd dose and minimum 12 weeks between 2nd and 3rd dose>15 years who received the first dose between 9 -15 years of age, a 2-dose schedule (0, 6m) can be used
IF HPV2 and HPV4 are no longer available, what do I do?Can complete the series with HPV9, which protects against the same types as HPV2 and HPV4
Males should only receive HPV9Health Canada and the Public Health Agency of Canada Government of Canada. “Human Papillomavirus Vaccine - Canadian Immunization Guide: Part 4 - Active Vaccines,” July 18, 2007. https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-9-human-papillomavirus-vaccine.html.
Slide49492v: bivalent; 4v: quadrivalent; 9v: nonavalent.Public Health Agency of Canada. An advisory committee statement (ACS) National Advisory Committee on Immunization. Updated recommendation on human papillomavirus (HPV) vaccines: 9-valent HPV vaccine and clarification of minimum intervals between doses in the HPV immunization schedule.
National Advisory Committee on Immunizations (NACI)HPV recommendations
Females
HPV2, HPV4, HPV9 vaccine
are recommended for females:
9-26 years of age for routine vaccinationMay be administered to
females over 26 years of age who have not been vaccinated previously or who have not completed the series
Males
HPV4 and HPV9 vaccines are recommend for males:9-26 years of age for routine vaccination
May be administered to males over 26 years of age who have not been vaccinated previously or who have not completed the series
General
2v and 4v HPV vaccine may be administered to immunocompetent individuals 9-14
years of age using either a 2-dose or 3-dose scheduleAny immunocompromised individual, immunocompetent HIV infected individuals and individuals who have not receive any dose of HPV vaccine by 15
years of age should continue to receive three doses of HPV vaccineThere is insufficient evidence
at this time to recommend, at a population level, re-immunization with 9v HPV vaccine in individuals who have completed an immunization series with another HPV vaccine.
Note: NACI recommendations do not have an upper age limit for vaccination for men or women.
Slide5050https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-9-human-papillomavirus-vaccine.htmlCanadian Immunization GuideHPV recommendations
Incomplete or interrupted vaccine schedules
An HPV vaccine series should be initiated, even if the series may not be completed according to schedule. If the vaccine schedule is interrupted, the vaccine series does not need to be restarted.
In individuals 15 years of age and older who received the first dose between 9 to less than 15 years of age, a 2-dose schedule can be used, with the second dose administered at least 6 months after the first dose.
Booster doses and re-immunization
Re-immunization with HPV vaccine is not indicated at this time, as protection lasts at least
10 years.
Interchangeability of vaccines
Whenever possible, the same HPV vaccine should be used to complete a vaccine series. If the vaccine used for previously received doses is not known, or not available, any of the HPV vaccines authorized for use in Canada may be used to complete the vaccine series. Because all HPV vaccines provide protection against HPV types 16 and 18, protective antibody concentrations against these types will likely be achieved if HPV vaccines are interchanged. HPV2 vaccine is not authorized for use in boys and men.
Slide51Case
44-year-old male – recently divorced
Ramipril 10 mg once daily
Rosuvastatin 5 mg once daily
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Slide52Case44 Year old male – recently divorced Ramipril 10mg once daily Rosuvastatin 5 mg once daily
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Slide53Vaccinations Across the Lifespan – immunize.io
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Slide55The Role of Pharmacists in Reducing the Risk of HPV-related Cancers and Diseases
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