On the Path to Prevention from the St. Jude HPV Cancer Prevention Program December 2021

The end of the year is a time for celebration, a time for reflection, and a time to recharge for the challenges and opportunities in the new year. I am reminded of an article in The Guardian on why it pays to take your time at moments like this. A couple of lines, in particular, sum up the importance of this practice: “When you press the pause button on a machine, it stops. But when you press the pause button on human beings, they start... You start to reflect, you start to rethink your assumptions, to reimagine what is possible, and reconnect with your most deeply held beliefs.”

I hope you can take time to enjoy the warmth and wonder of the holiday season. We thank you for your partnership with the St. Jude HPV Cancer Prevention Program.

In this month’s e-newsletter, we highlight exciting new opportunities and resources available to support HPV vaccination for cancer prevention. We invite you to join us for an upcoming series of research meetings focused on implementation science approaches to improve HPV vaccination. We also have the opportunity to feature the important work of the Recurrent Respiratory Papillomatosis Foundation, led by Kim McClellan, and celebrate their recent award from the Rare As One program.

Every month, our program will send an email like this. We hope you will share it with others who may be interested and ask them to subscribe, too. We also want to hear from you if you have opportunities and information we can share. Email PreventHPV@stjude.org with questions.

HPV vaccination is cancer prevention.

Recurrent respiratory papillomatosis (RRP) is a disease in which HPV can cause tumor growth in the respiratory tract. RRP is rare, and the tumors caused by RRP are primarily benign. Yet, for people with the disorder, RRP’s realities overshadow its rarity. The challenges and complications may include multiple surgeries and reduced quality of life.

The Recurrent Respiratory Papillomatosis Foundation (RRPF) is helping change the trajectory of the disease and improve quality of life. Kim McClellan, RRPF Board president, says that incorporating RRP into HPV conversations increases prevention opportunities, creates valuable connections, and catalyzes translatable research.

RRPF recently received a major award from the Chan Zuckerberg Initiative’s Rare As One project. The award, which provides funding for three years, includes training, mentoring, capacity building, research and network development grants. This partnership will accelerate the development of non-surgical treatment options for RRP, improve access to care, modernize the standards of treatment, and move us closer to curing the disease. The partnership will also lead to creation of a research network and clinical centers of excellence. RRPF’s inspirational tagline, “While we breathe, we hope,” guides its efforts to end the burden of this disease on patients and caregivers.

Presented by the HPV Research Group of the St. Jude Children’s Research Hospital-Washington University in St. Louis Implementation Sciences Collaborative

The HPV Research Group of the St. Jude-Washington University Implementation Sciences Collaborative invites you to explore opportunities for collaborations on implementation science research in the setting of HPV vaccination.

The collaborative brings expertise in implementation sciences from Washington University and Siteman Cancer Center together with childhood cancer care and survivorship resources from St. Jude. The collaborative’s goals are to:

Maximize dissemination and implementation of evidence-based programs
Increase implementation sciences training for St. Jude faculty and fellows
Build collaborative research projects across survivorship, global children’s cancer care and HPV vaccination

The collaborative will host a short conference in 2022 that aims to:

Increase awareness of key HPV vaccination implementation science issues
Identify opportunities for new collaborations on HPV vaccination projects
Share opportunities for involvement in the collaborative

HPV Vaccination in Community Contexts on Thursday, January 27 from Noon–1:30 p.m.
HPV Vaccination in Clinical Contexts on Thursday, February 24 from Noon–1:15 p.m.
HPV Vaccination in Policy Contexts on Thursday, March 31 from Noon–1:15 p.m.
HPV Vaccination: Opportunities and Next Steps on Thursday, April 28 from Noon–1:30 p.m.

The HPV Vaccination Research Group is led by Heather Brandt, PhD, of St. Jude and Lisa Klesges, PhD, of Washington University. For more information, email Carrie Stoll.

The Healthcare Effectiveness Data and Information Set (HEDIS) quality measure for HPV vaccination suggests series completion by the 13th birthday. Various data sources have shown some improvement in meeting this metric, but there is still much room for improvement.

Publicly available HEDIS data for 2019 show HPV vaccination by the 13th birthday was achieved in only 27%– 40% of adolescents. According to 2020 NIS-Teen data, 58.6% of adolescents aged 13–17 years have completed the HPV vaccination series, and fewer have completed the series by their 13th birthdays. HPV vaccination coverage lags behind two other routinely recommended vaccinations for adolescents: the tetanus, diphtheria, acellular pertussis (Tdap) vaccine and the meningococcal conjugate.

While it is important to increase HPV vaccination overall—especially in areas of the U.S with coverage disparities and among groups with lowest coverage—data increasingly support the importance of on-time vaccination for disease prevention.

A recent study published in The Lancet highlights the benefits of HPV vaccination for cancer prevention. An HPV vaccination program introduced in England in 2008 promoted the bivalent HPV vaccination. The authors found a substantial reduction in pre-cancerous lesions and cervical cancers in young women following implementation of this program. This was particularly true for those who were vaccinated at ages 12–13, resulting in hundreds of fewer cases of cervical cancer and more than 17,000 fewer pre-cancerous lesions of the cervix.

The authors conclude: “The HPV immunization program has almost eliminated cervical cancer in women born since September 1, 1995.”

This study follows other studies showing similar results of the importance of age at vaccination based on studies in Scotland and Sweden.

The American Cancer Society and the American Academy of Pediatrics have expressed strong support for initiating HPV vaccination at ages 9–10 to achieve full vaccination by the 13th birthday. Studies have shown that such a schedule leads to increased vaccination coverage and is acceptable to health care providers and systems.

Beginning HPV vaccination at ages 9–10:

Increases the time to achieve series completion by the 13th birthday
Increases likelihood of vaccinating before HPV exposure
Decreases the focus only on vaccinations required for school entry

The St. Jude HPV Cancer Prevention Program is pleased to support the efforts of the National HPV Vaccination Roundtable and its members to convey the evidence associated with starting at ages 9–10 for on-time HPV vaccination. The National HPV Vaccination Roundtable meeting in June 2021 included sessions on starting at this age. Check out the Day 2 recording and resources to learn more.

World Health Organization Honors the Life and Legacy of
Henrietta Lacks

The story of Henrietta Lacks offers valuable lessons, insights and opportunities from which we all may learn.

During her cervical cancer treatment in 1951, Henrietta Lacks' cells were taken without her knowledge or consent. These became the first cells to successfully and continuously grow and divide in a lab. The mass-produced cells became commonly known as “HeLa” cells.

Lacks' cells have made a profound contribution to scientific research and have led to many scientific discoveries, including development of the HPV vaccine, which can prevent six types of HPV cancers including cervical cancer.

Lacks' story is also an example of how such events have contributed to medical distrust. We have an opportunity to improve equitable health outcomes by celebrating her life and legacy while working toward advancements in research participation and protections.

In October 2021, Tedros Adhanom Ghebreyesus, PhD, director general of World Health Organization (WHO), honored Lacks with a WHO Director-General’s Award, recognizing the world-changing legacy.

“In honoring Henrietta Lacks, WHO acknowledges the importance of reckoning with past scientific injustices, and advancing racial equity in health and science,” he said. “It’s also an opportunity to recognize women—particularly women of color—who have made incredible but often unseen contributions to medical science.”

The award was accepted at the WHO office in Geneva by Lacks’ son, Lawrence, who was accompanied by several of her grandchildren, great-grandchildren and other family members.

Seeing Double: Pediatric Advocates for HPV Vaccination

As advocates for childhood immunizations, twin-sister pediatricians Dorothy “Dee” Sinard, MD, and Barb Dentz, MD, will make you think you are seeing double. Both are actively involved in sharing the importance of HPV vaccination in Tennessee and beyond.

Sinard and Dentz understand the important role of trusted messengers to build HPV vaccination confidence. They say health care providers are critical to significantly improving HPV vaccination coverage. Sinard and Dentz see health care providers as champions who are close to the issues related to vaccination confidence and are the first to see HPV cancers in their patients. The sisters support expanding HPV vaccination awareness and education beyond clinical settings to include specialists such as dentists, pharmacists, head and neck doctors, obstetricians, gynecologists and oncologists. They say they hope the collective voices of health care providers across specialties will strengthen efforts to increase HPV vaccination coverage.

Sinard is especially enthusiastic about opportunities to administer the HPV vaccine at ages 9–10. Parents and caregivers may have questions about vaccinating their children at an earlier age. As a result, Sinard emphasizes the importance of delivering a clear safety message supported by sound science. In light of the COVID-19 pandemic, communities are increasingly curious about vaccinations. This offers both unique opportunities and challenges to increase vaccination confidence.

Sinard and Dentz are up for the challenge and will continue to advocate for childhood immunizations across Tennessee.

Charting the Path to Prevention Across the Mid-South

Over the past several months, the HPV Cancer Prevention Program has engaged in HPV vaccination efforts with organizations across the Mid-South. The team participated in the Missouri Immunization Coalition Conference in June and the Arkansas Immunization Summit and the Tennessee Immunization Summit in November.

A common theme across these events was discussion around COVID-19 data, how transmission is affecting various communities, and the importance of prevention through vaccination. COVID-19 vaccinations can be administered with other important vaccines without regard to timing. This means that children and adolescents can receive the COVID-19 and HPV vaccines at the same medical visit.

As a result of the COVID-19 pandemic, we have seen an increase in the number of missed medical visits and a deficit in the number of initiated and completed HPV vaccinations. Now is a critical time to get HPV vaccination rates back on track.

You can find additional summit information, including speaker bios, presentations and resources, on the respective summit webpages.

National Influenza Vaccination Week Extends through December 11

National Influenza Vaccination Week, which runs from December 5 –11, is a time to encourage anyone age 6 months and older to get their annual flu shot. This applies especially to those at highest risk for severe complications and hospitalizations.

Flu remains a significant public health concern. Go online to obtain social media content messages, posters, patient reminder messages, customizable photo frames and social story templates to help share flu vaccination information.

To learn more about National Influenza Vaccination Week or share this important information within your networks, go to the CDC’s National Influenza Vaccination Week website.

Resources for Getting Back on Track with HPV and Other Vaccinations

“Don’t Wait. Vaccinate.” Toolkit

The COVID-19 pandemic has resulted in a steep decline in HPV vaccinations for adolescents who are publicly insured. This represents about 1.4 million missed doses among this group alone.

The St. Jude HPV Cancer Prevention Program is a member and partner of the Unity Consortium focused on increasing adolescent vaccination coverage. According to a June 2021 Unity survey, 1 in 4 parents think that “well visits can wait or are not urgent right now.” As a result, many adolescents are behind on routine vaccinations. This concern prompted Unity, along with Unity Consortium board of directors, officers and members, to share a letter with health care providers urging them to act and help reverse this trend.

Unity's Don't Wait. Vaccinate. Partner Toolkit also provides health care providers with messaging, social media posts, and template letters for parents and caregivers in order to increase adolescent vaccination coverage.

“Let's Play Catch Up” Campaign

The CDC launched the “Let's Play Catch Up” campaign this fall in an effort to include well checks and age-appropriate vaccinations as part of childhood routines that are returning after the COVID-19 pandemic.

This campaign focuses on reaching parents through social media, infographics, newsletter templates and email messaging. Health care providers can use these resources to educate and empower parents to get their children caught up on routinely recommended vaccinations.

What is your favorite food to enjoy during the holiday season?

Many holidays are celebrated around the world during December. Oftentimes, the holidays generate memories from over the years that bring a smile to our faces. The St. Jude HPV Team shares their favorite holiday treats.

“I absolutely love my grandmother’s frappe punch.” – Andrea Stubbs, administrative director

“My mother’s cheese grits are a Christmas breakfast staple, and they ROCK!” – Carol Minor, program coordinator

“I always look forward to sugar cookies and eggnog paired with a classic holiday movie.” – Julia Neely, program coordinator

“Holidays are filled with family and food. My favorite food is Thanksgiving dressing or stuffing to some. It is warm, moist and delicious. Full of flavor, this dish is a staple for my family for both Thanksgiving and Christmas. Add turkey as the protein, and the meal is amazing.” – Contrina Huffman, graduate student assistant

“Belgian waffles with dulce de leche topping and whipped cream from Bryant Park in New York City.” – Duha Magzoub, graduate student assistant

“My mother’s chocolate and lemon cake.” – Ursula LeFlore, administrative specialist

“My mom’s deviled eggs and sugar cookies. I was born to the world's best deviled egg maker and world’s best sugar cookie maker. They are out-of-this-world delicious. For her deviled eggs, I am still working on matching her “by taste and texture” recipe of mayonnaise, mustard, vinegar, sugar and seasonings and always with a little sprinkle of paprika and a green olive cut in half on top. Her sugar cookies shaped like angels, bells, stockings, stars and more melt in your mouth, and I have failed miserably in all instances of attempting to recreate them. I am grateful to still have my mom to make them for me and for everyone to enjoy.” – Heather Brandt, director

Get Free St. Jude HPV Education Materials Today

The St. Jude HPV Cancer Prevention Program has created a series of HPV cancer prevention educational materials. These colorful fact sheets contain essential information about the importance of HPV vaccination as cancer prevention.

There are four versions of the fact sheets to target various audiences: general public, parents, health care providers, and cancer patients and families. The materials emphasize basic information about HPV vaccination and include action steps to prevent HPV cancers.

You can select the versions most appropriate for those you serve. Download the fact sheets online or email PreventHPV@stjude.org to have copies mailed to you.