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Press Briefing Transcript

NIS Teens Briefing

Thursday, August 25, 2011

Tom Skinner: Thank you all for joining us today for a telebriefing on MMWR article out today by the CDC on national state areas of coverage among adolescents, ages 13 to 17 years of age for the United States, 2010.  With us today is Dr. Melinda Wharton, spelled w–h–a–r–t–o–n.  She's the Deputy Director of our National Center for Immunization and Respiratory Diseases.  She'll provide some brief opening remarks, and then we will move to your questions and answers.  Dr. Wharton.

Melinda Wharton: Thanks very much, Tom.  This afternoon I’ve got some bad news to report about our nation's health.  The national teen vaccination data we're releasing today in an MMWR article showed that far too few U.S. Girls are getting the HPV vaccine, a vaccine we know that can protect them against cervical cancer.  So my remarks today will focus on three areas.  First, I’ll provide some background about the national immunization survey and provide you a brief overview of this year's results.  Secondly, I’ll discuss cervical cancer and the HPV vaccine, so people can understand why this year's survey results are so very disappointing to us.  Finally, I’ll share some key actions that can be taken so we can do better going forward.

The article that's being published today provides data from the 2010 national immunization survey on teen vaccination coverage rates.  This is our report card that lets us know how we're doing with vaccination of our nation's teens against vaccination preventable disease.  A survey, random telephone survey of more than 19,000 parents of teenagers 13 to 17 years of age and provides us immunization coverage estimates for three vaccines recommended routinely at 11 to 12 years of age.  The Tetanus, diphtheria, pertussis, human papillomavirus or HPV vaccine, meningococcal conjugate.  So let me go over briefly first the overall results from the survey.  Coverage for one dose of pertussis increased by 13 percentage points to about 69%.  There were differences by race and ethnicity. Given there's so much pertussis in the United States, it continues to be important for adolescents to get this vaccine.  With meningococcal conjugate vaccine, we saw an increase of 9 percentage points over last year up to 63%.  Coverage was actually higher among Hispanic adolescents than among whites. 

The HPV vaccine is given as a three–dose series; with one dose we had an increase of 4.4 percentage points to 49%.  But for all three doses, only 32% of girls had received the series which is 5 percentage points over last year.  Of the girls who began the HPV vaccine series, 30% did not receive all three doses.  The completion of the three–dose series was lower among blacks and Hispanics than among whites, and also lower for those living below poverty.  So overall we do see good improvement in Tdap and meningococcal and with such high rates of pertussis being seen, it's critical preteens get Tdap vaccine to protect them from pertussis.  Meningococcal vaccine is a vaccine that can prevent very serious disease caused by the meningococcal bacteria which is an infection that can lead to lifelong disease and even death and rapidly progressive. And even with medical care, outcomes of this infection can be very serious.  So that also is an important vaccine for kids to receive.  Where there's room for improvement with both but we're making good progress. 

In contrast with HPV vaccine, we're just not doing as well and the coverage is lagging very far behind where we are for two other vaccines we recommend for use in young adolescents.  So, why does it matter?  HPV is a vaccine that covers cervical cancer.  CDC reports that ever year there are 12,00 women living in the United State who will be diagnosed with cervical cancer and4,000 will die.  The disease is most frequently diagnosed in women in their 30s and 40s, but it's important to protect girls before they become sexually active.  HPV is a common infection with about 6 million people becoming infected each year.  The HPV vaccine is recommended by CDC for 11 to 12–year–old girls to protect against the types of HPV that cause cervical cancer.  The vaccine is given as a three–dose series over six months, and it's important to get all three shots to have full protection. 

At this point more than 35 million doses of the vaccine have been distributed and the safety record is very good.  When we first recommended the vaccine, we looked forward to seeing strong and steady increases in coverage over time like we've seen following the introduction of other vaccines.  But not enough of our nation's girls –– but not as many of our nation's girls are receiving this lifesaving vaccine as they should.  If we don't do a much better job, we're leaving another generation vulnerable to cervical cancer later in life.  What's it going to take to do better.? Well, we're learning more about the reasons why HPV vaccine coverage is lagging.  This include factors not taking opportunities to vaccinate, awareness among parents of the vaccine even and importance for preteen girls.  Also, not necessarily receiving a strong recommendation from their pediatrician or family physician.  The vaccines for children program does make vaccines available at no cost to doctors to serve the children who are eligible for the vaccines for children program, which are children under 19 years of age who are eligible for Medicaid, are American Indian, Alaska Native, or who don't have health insurance.  Parents, health providers, and everyone who supports child health and immunization as well as our community partners can all help to increase HPV vaccination and prevent today's girls from developing cervical cancer over the next several decades.  Providers can make a strong recommendation to administer the vaccine at 11 to 12 years of age.  We know this makes an enormous impact on parents' decision to vaccinate.  If they vaccinate every girl on time and help schedule appointments for the full series, we know that will help.  Parents need to know their daughter’s vaccination status.  If their daughter hasn't started HPV vaccine series and is 11 to 12 years of age, make an appointment to do so.  If the daughter is older, it's important to get the series started.  I’ve got two teenager daughters myself, and I know that this is –– it's not that easy sometimes to do.  People are very busy.  It's a complicated immunization schedule.  It's a multi–dose series and it's hard to get all these things done.  But we're talking about preventing cervical cancer and we've got a vaccine that can do it.  As a parent, I’d really like to emphasize the importance. 

Finally, all of our partners can make big efforts to help educate the community.  We've got new tools up on our teen vaccine website and new materials available.  So in closing, we use our national immunization survey data as a measurement tool to see where we are.  It's easy to get discouraged when we see that we're not doing so well on HPV vaccination coverage for girls.  But the good news is, we can do better at this.  We've got in our possession a very powerful tool, a vaccine that prevents cancer.  And we can improve things starting right now.  If we all take actions to protect girls starting today, we'll have generations of women who will never be diagnosed with cervical cancer and that would be a great outcome to have.  Thanks very much.

Tom Skinner: Okay, Shirley.  If there are any questions, we're ready for them, please.

Operator: Thank you.  At this time if you'd like to ask a question, please press star one and record your name clearly.  Again press star one to ask a question.  One moment for our first question.  Our first question comes from Mike Stobbe with AP.  You may ask your question.

Mike Stobbe: Hi, thanks to you all for doing this call and taking my question.  I know it can take years for a new vaccine –– for the rates to rise to the kind of level we see with, for example, measles and things in the 90% range.  It sounds like you all are still disappointed that after four years we're at this level.  What did you expect?  What do we see with vaccines after four years, I guess it's better than 49%.  The second question was, I don't think you said why you thought the HPV rate is lower than the other vaccines.  Is there something about the sexual connections that's involved?  Also I want to ask you why Idaho and Mississippi were so low and Massachusetts and Rhode Island so high in terms of the state vaccination rate.

Melinda Wharton: I think you snuck in more than one question.

Mike Stobbe: Sorry.

Melinda Wharton: Okay.  First, in terms of what we expect.  Well, I think we've got a comparison with the national survey.  What's troubling about the 2010 data, we saw double digit or near double digit increases with the other two vaccines we recommend for this age group and we're just doing much better with Tdap and meningococcal conjugate vaccine than with the other.  The fact the lines are no longer parallel, they are diverging and troubled us and made us want to call attention and mobilize and get progress made.  As far as why we think it's lower, I think there's multiple things going on.  It's a three–dose series rather than a single vaccine, and it's harder to get three doses in than it is one.  There also is some evidence that providers maybe not making a stronger recommendation for this vaccine as they are for the other vaccines we recommend for preteens.  Part of this, I’m sure, has to do with the perception that this age is just too young, that girls aren't sexually active at that age and therefore they don't need the vaccine.  Of course that's why we recommend the vaccine at this age.  This is a preventive vaccine, not a therapeutic vaccine.  It won't work unless it's given prior to onset of sexual activity.  That's why we recommend it so young, so we can get the vaccine in long before it may be needed.  But so that's why –– that's why it's recommended the age it's given.  That's the important thing to do.  As far as the specific states are concerned, you know, I really can't comment on the state issues. I think that's something that you'd have to follow up with the states on.  But as far as the states that do well, it's our impression generally that these are states that have strong infrastructure, made a focus of administering these vaccines.  There tends to be strong relationships between state and public health and the provider community and it may reflect relative priorities within those states but I really couldn't comment on individual states.

Mike Stobbe: Thank you. 

Tom Skinner: Next question, Shirley.

Operator: Thank you.  The next question comes from Emma Hitt with MedScape.  You may ask your question.

Emma Hitt: Yes, thanks for taking my call.  You kind of answered this already.  But I was wondering if you had any direct advice for physicians who encounter parental resistance due to the fact that HPV is sexually transmitted.  How should they handle that and talk to their patients? 

Melinda Wharton: Thanks for asking that question.  I think it's important to convey to parents what I said previously.  We recommend –– we know that their daughters are young.  That's why we recommend a vaccine at that age.  The vaccine needs to be given before kids become sexually active.  We don't know exactly when that's going to be.  Even if we know our children very well, we don't really know when that's going to be, so we give the vaccine very young, so we know we've got it in to provide them protection when the time comes that they need that protection.  And also –– it's probably also true that many parents are not going to be as concerned about this as provider think they may be, so if a provider makes a recommendation for this vaccine the same way they recommend Tdap and meningococcal conjugate vaccine, it may be parents won't have questions about it.  Some of this, I think, areconcerns that providers have that may not be realized if they actually make the strong recommendation to the parent.

Emma Hitt: Great.  Thank you. 

Operator: Thank you.  Again, if you have a question, press star one.  Our next question comes from Denise Mann with WebMD. 

Denise Mann: Thanks for taking my question.  When it first came back there was a lot of pushback from parents and pediatricians, partially because of it related to sexual activity and also a new vaccine.  Can you answer this and do you think it plays a role in the slower uptake? 

Melinda Wharton: Thanks for that question.  The vaccine has been out for years now.  We know more than 35 million doses have been distributed.  The vast majority of that has been given.  We've got a year's worth of safety data, a reassuring safety profile.  For parents that were concerned the vaccine is too new, it's not too new anymore.  We have a lot of experience with the vaccine and that experience provides a reassuring picture of the safety of the vaccine.

Denise Mann: Thank you.

Tom Skinner: Next question, Shirley.

Operator: One moment, please.  I’m showing no more questions.

Tom Skinner: Okay.  We'll announce one more time how to ask a question, give it a little bit more time, then we'll close if there are no questions.

Operator: Again, just press star one to ask a question.  And one moment, please.  Thank you.  Our next question comes from Denise Mann.  You may ask your question.

Denise Mann: Just a follow–up.  What about males?  Are there any plans to strengthen –– I know it can be used in boys.  Any comment on the rates we saw there in 2010? 

Melinda Wharton: The vaccine has been licensed for use in boys and young men for a while now, but we don't have a routine recommendation for use in boys and men.  This hasn't really been a program focus at this point.

Denise Mann: Okay.

Tom Skinner: Any more questions, Shirley? 

Operator: At this time I’m showing no more questions.

Melinda Wharton: Okay.  Well, thank you all so much.  I’m glad to have a chance to talk to you today.  Again, I just want to emphasize that we really have the power to protect young girls from cervical cancer going forward.  Unless we take advantage of the tools available to us, including the very effective and safe vaccines that are now available, we will fail to prevent disease that could be prevented.  We've really got the tools available to do better, and it's important we do that going forward.  Thanks very much.

Tom Skinner: Thank you, Shirley.  Thank you all for joining us today. 

Operator: That concludes today's conference.  We thank you for your participation.  At this time you may disconnect your lines. 

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