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

The NIS-Teen 2022 adolescent vaccination data were published in Morbidity and Mortality Weekly Report (MMWR) on August 24. In our Path to Prevention newsletter, since the launch of our program in March 2021, we have discussed concerning drops in HPV vaccination coverage due to the COVID-19 pandemic and determinants, like vaccination hesitancy, that have exerted escalating influence. However, until the last few weeks, NIS-Teen, the primary national data source for monitoring HPV vaccination in the United States, had not aligned with other data sources showing declines, such as well child visits, Vaccines for Children (VFC) program ordering data, and state immunization information systems, during the pandemic.

So what did we learn from the 2022 NIS-Teen data?

The NIS-Teen adolescent vaccination data show that for the first time since 2013, one or more doses of HPV vaccination (>1 dose) did not increase (76.9% in 2021 to 76.0% in 2022), thus potentially pointing to the effects of the pandemic in this cross-sectional data source. HPV up-to-date (HPV UTD) increased slightly by 0.9%, which was a lower percent increase from previous years (61.7% in 2021 to 62.6% in 2022). Birth cohort data showed HPV vaccination coverage nearly 4-6% lower among the 2008 birth cohort as compared to the 2007 class.

HPV vaccination initiation declined among adolescents who were publicly insured (Medicaid) and continued to remain lowest among adolescents who are uninsured. The VFC program is critical to ensure coverage among adolescents who represent underserved populations. The figure below shows the declines in coverage among adolescents who are publicly insured and uninsured.

Geographic variation in HPV coverage persisted. Adolescents living in rural areas continued to have lower HPV vaccination coverage as compared to adolescents in more urban areas. Coverage with ≥1 ranged from 61.0% in Mississippi to 94.6% in Rhode Island, and the percentage of adolescents HPV UTD vaccination ranged from 38.5% in Mississippi to 85.2% in Rhode Island.

What do we make of these data? How do we move forward to ensure children are protected today from HPV cancers they may develop in the future?

We hope you will join us for “Digging Deeper into HPV Vaccination Data, A Virtual Training Experience” on September 13 from 11 a.m.-12:30 p.m. CT. Cassandra (Sandy) Pingali, Centers for Disease Control and Prevention and lead author of the MMWR publication, will present on the NIS-Teen data with Courtnay Londo of the American Immunization Registry Association and Casey Daniel, PhD of the university of South Alabama presenting on HPV vaccination data sources nationally and regionally. Register for this interactive training experience.

This month, our program is also releasing an updated analysis of public policy decisions and factors driving HPV vaccination coverage in the United States. The updated analysis focuses on key policy recommendations for cost-savings and also for reducing the burden of disease.

Figure: HPV Vaccination Coverage among Adolescents by Health Insurance Status

The St. Jude HPV Cancer Prevention Program partnered with FTI Consulting to conduct an updated examination of public policy decisions and other factors that drive HPV vaccination coverage across the United States. The analysis examined the relation between HPV vaccination initiation and series completion regarding nine factors. Using CDC data and peer-reviewed literature, FTI Consulting performed a cost savings analysis that projected that the increased HPV vaccination series initiation and reduced HPV cancer incidence that would result from addressing four of these factors could reduce national direct health care spending by nearly $19 million. In addition, the increased HPV vaccination series completion and reduced HPV cancer incidence could reduce the two-year national direct health care spending by more than $24 million as shown in the figure below.

Using the results of the quantitative analysis along with insights from interviews and focus groups, FTI Consulting developed five policy recommendations to improve HPV vaccination coverage:

Leverage meningococcal conjugate vaccination as a model for HPV vaccination education and recommendations
Expand health care provider and practice staff education and training related to HPV vaccination and strengthen HPV vaccination recommendations for parents and caregivers
Improve efforts to recruit and enroll various types of health care providers in the federal Vaccines for Children (VFC) program
Expand the resources available to improve HPV vaccination data collection and reporting through state immunization information systems (IISs)
Engage in efforts to preserve and expand eligibility for Medicaid

Increasing HPV vaccination coverage will reduce the incidence of HPV cancers and save millions of dollars for our nation’s health care system. To realize the full potential and promise of the HPV vaccine, we must pursue policy change to address systemic barriers to HPV vaccination coverage in the United States.

Access the full report and fact sheet for the updated analysis at stjude.org/hpv-policy-summary.

Figure: Total National Cost Savings from HPV Vaccine Initiation and HPV Vaccine Series Completion

Since 2021, September has been designated as Childhood Cancer Awareness Month to honor children and survivors affected by pediatric cancers. What better way to honor them than by offering vaccination to safeguard them from six different types of cancers in adulthood?

The five-year survival rate for childhood cancer survivors has reached up to 85% in the United States. The significant increase in survival rates of childhood cancers is mainly due to the development of innovative therapies, which has resulted in more than 840,000 childhood cancer survivors in the United States. However, childhood cancer survivors are at an elevated risk for developing new HPV infections and cancers as adults primarily due to cancer-directed therapy, which weakens their immune systems. Both male (oropharyngeal, anal, penile cancer) and female (cervical, oropharyngeal, anal, vaginal, vulvar cancer) childhood cancer survivors are at risk of developing HPV secondary cancers as adults.

The CDC routinely recommends HPV vaccination for ages 9-26 and for some individuals ages 27-45. CDC’s Advisory Committee on Immunization Practices (ACIP) recommends two-doses of HPV vaccine in children who start the series before their 15th birthday and three-doses among those who start it on or after their 15th birthday and individuals with immunocompromised conditions. The Children’s Oncology Group (COG) Survivorship Guidelines for HPV vaccination are to follow the current CDC recommendations beginning six months after the completion of cancer-directed therapy. Though this recommendation has been in effect for several years, coupled with research showing HPV immunogenicity and safety in childhood cancer survivors and the majority of the HPV cancers are prevented through HPV vaccination, the coverage is substantially lower in childhood cancer survivors compared to the general populations (23.8% vs. 40.5%, respectively).

Some reasons for lower HPV vaccination coverage in childhood cancer survivors are vaccine hesitancy, vaccine-related information deficits, safety concerns, and lack of strong healthcare provider recommendations. Lower HPV vaccination coverage among these vulnerable and highly susceptible childhood cancer survivors is concerning. Research shows that more children get the vaccine when healthcare providers recommend it. Childhood cancer survivors trust and prefer to regularly visit their oncology teams even after the completion of their cancer treatment for follow-up care. Focusing on appropriate communication and implementation to improve on-time HPV vaccination among childhood cancer survivors following their cancer-directed therapy is necessary to reduce the additional burden of new HPV-related infections and cancers.

Learn more about why HPV vaccination is important for childhood cancer survivors at together.stjude.org and in a fact sheet developed specifically for childhood cancer survivors.

According to a recently released report from the World Health Organization, global childhood vaccinations edge closer to pre-pandemic levels. Global childhood vaccination coverage has nearly rebounded to pre-pandemic levels, with 4 million more children receiving full vaccinations in 2022 compared to 2021.

One bright spot in the report was HPV vaccination data, which contrasted with the recently released NIS-Teen data evaluating coverage among 13-17 year olds in the United States. HPV vaccination rates surpassed pre-pandemic levels to reach 21% of girls globally in 2022, compared with 19% in 2019. HPV vaccine rates have a long way to go to achieve the United Nation’s goal of reaching 90% of girls worldwide by 2030.

Cervical cancer survivor and thriver, Karla Chavez, answered a few questions this month, which also is Gynecological Cancer Awareness Month. Karla Chavez is from Honduras and she is a civil engineer and amigurumi enthusiast. Karla is a 4-year cervical and thyroid cancer survivor and a proud ostomate. She is a Cervivor Ambassador, a 2019 Cervivor School graduate, and Co-leader of the Cervivor Espanol community. Karla was awarded the 2020 Britanny Wagner Social Media Advocacy Award Recipient and was named named the 2022 Cervivor Champion Award. Karla also participated in the 2022 HPV Cancer Survivors School hosted by the St. Jude HPV Cancer Prevention Program and powered by Cervivor, Inc.

In this article series, we have been taking time to explore reasons why HPV vaccination is lower in rural areas and also, importantly, to identify solutions that ensure people living in rural areas are protected from HPV cancers too. In this month’s Wide Open Spaces article, we reached out to a few people who currently live or grew up in a rural area to share their thoughts on HPV vaccination. Their perspectives provide us with much to consider about why they have chosen rural living and also point to potential solutions. Our panelists included:

Jason, married father of three adult children
Erin, mother of two children under 5
Mindy, married mother
Susan, married grandmother of three middle schoolers

Learn more here

We invite guest contributors to share information on how they are working to improve HPV vaccination in rural areas. If you are interested in contributing or learning more about our efforts to improve HPV vaccination with rural communities, please email us at PreventHPV@stjude.org.

September 13 | Digging Deeper into HPV Vaccination Data: A Virtual Training Experience

The HPV Vaccination Roundtable of the Southeast will host “Digging Deeper into HPV Vaccination Data: A Virtual Training Experience” from 11 a.m. to 12:30 p.m. CT on September 13.

HPV vaccination data are a valuable resource to guide efforts to improve coverage and prevent HPV cancers.

What are the latest data available on HPV vaccination in the U.S.?
How do we work with the data that are available?
How can we advocate for data we need?

This interactive training experience will include presentations, facilitated breakout room discussions, and large group sharing.

November 15 | Navigating Conversations: Effective Communication Strategies for HPV Vaccination in the Southeast

Register for the second training experience hosted by the HPV Vaccination Roundtable of the Southeast on 11 a.m. to 12:30 p.m. CT on November 15. The focus of this second training experience will be on addressing misinformation and practical messaging to promote HPV vaccination in the southeastern United States. Register to join live or access the recording following the conclusion of the training.

January 22-23, 2024: In-person Meeting of the HPV Vaccination Roundtable of the Southeast

Save the date for the inaugural conference of the HPV Vaccination Roundtable of the Southeast on January 22-23, 2024 in Memphis, Tennessee. The HPV Vaccination Roundtable of the Southeast will bring together people working in southeastern states to improve HPV vaccination coverage. This conference is an opportunity for you to share successes and challenges, generate ideas, and promote action to improve HPV vaccination in the southeastern U.S. through identification of strategies for collective impact. Registration will be open soon.

Visit the HPV Vaccination Roundtable of the Southeast website at stjude.org/southeast-roundtable, sign up here to receive the latest information about the roundtable, and email PreventHPV@stjude.org with any questions.

The National Cancer Institute’s Division of Cancer Control & Population Sciences (DCCPS) invites you to join the upcoming HPV Cancer Center Consortium webinar series.

The first webinar in the series will be on September 29 from 2-3 p.m. ET. “HPV Age 9 Webinar: Emerging Evidence on HPV Vaccination at Age 9” will feature Debbie Saslow, PhD, American Cancer Society; Kristin Oliver, MD, MHS, Icahn School of Medicine at Mount Sinai; Tamera Coyne-Beasley, MD, MPH, University of Alabama at Birmingham; and Robert A. Bednarczyk, PhD, Emory University.

Access resources to start HPV vaccination at age 9 through the National HPV Vaccination Roundtable and a special issue of Human Vaccines and Immunotherapeutics dedicated to evidence supporting HPV vaccination at age 9.

The second webinar in the series will be on November 2 and focus on catch-up HPV vaccination. Register here.

Direct any inquiries about the HPV Cancer Center Consortium and webinar series to hpvvaxcancercenter@icf.com.

The American Cancer Society released its 2022-2023 HPV Vaccination Impact Report last month. In the report, several accomplishments were noted, including growing partnerships, patient reach, and HPV vaccination impact, as well as advancing cervical cancer elimination. Activities were implemented with health partnerships, national roundtables (HPV Vaccination Roundtable and newly formed Cervical Cancer Roundtable), state and coalition engagement, public awareness, and through research. Notably, HPV vaccination initiation increased 3% overall among 9-13 -year -olds and more than 4% specifically in 9-10- –year -olds and 11-12 –year olds. The American Cancer Society is critical to efforts across the United States and globally to prevent HPV cancers.

VAX 2 STOP CANCER, a nonprofit organization with a mission to prevent cancer by expanding the use of the human papillomavirus (HPV) vaccine through education, public awareness, and advocacy, is pleased to offer new training for dental providers. This free, online, on-demand Dental Provider Education Program is available NOW for dentists, pediatric dentists, and hygienists. Utilizing methods endorsed by the National Cancer Institute and materials from the University of North Carolina and the National HPV Vaccination Roundtable, the training presents the best method for recommending the HPV vaccine to patients ages 9-26. Oropharyngeal cancer is now the most frequently diagnosed HPV-associated cancer, surpassing cervical cancer diagnoses. HPV causes 14,800 cases of oropharyngeal cancer each year in the US. The HPV vaccine recommendation is critical to reducing the devastating effects of oropharyngeal cancer and dental providers have a vital role in protecting their patients from these cancers. Research shows that parents feel comfortable having discussions about HPV and the vaccine in the dental setting, especially with dentists. See the attached flyer for details. If you have any questions or need more information, email info@vax2stopcancer.org

Immunize Arkansas hosted their annual Immunization Summit educational event for immunization leaders and health care providers from Arkansas and the surrounding region who want to address and improve vaccination issues. This year's event was on August 4 at the Wyndham Hotel in North Little Rock, Ar. The event featured content experts Jennifer Dillaha, MD, Director and State Health officer; Anne Santifer, Director of the Office of Health Information Technology; Rachel Odom, BSN, Arkansas IIS Manager; Ben Rowley, PhD, Associate Professor, University of Central Arkansas; Allie Staton, PharmD Vaccine Confidence Strategist Immunize Arkansas; and Robert H. Hopkins, Jr., MD, Professor of Internal Medicine and Pediatrics, UAMS COM. The St. Jude HPV Cancer Prevention team were sponsors at the event and were able to engage with attendees about the importance of the HPV vaccination.

The West Region of Tennessee Cancer Coalition (TC2) is under new leadership with Chair Carla Baker, Memphis Breast Cancer Consortium; Co-Chair Elizabeth Newman, Kirkland Cancer Center; and Secretary Nicole Russell, STAR Center. This team puts the state’s cancer plan into action, which provides ways to lower the chances of getting cancer that are based on good evidence, like getting HPV vaccination.

As the West TC2 region grows, new members are filling the gap for cancer survivors in West Tennessee. Carol Collins, a breast cancer survivor, had nowhere to turn in the small town of Brighton during her cancer journey. That led her to fill a void for all Tipton County cancer survivors, as she started Courage in Cancer for any cancer survivor, recognizing the strength of those with a common bond.

TC2 continues to monitor the State of Tennessee Cancer Plan with updates due for 2023-2027. Once completed, each of the three TC2 regions will have a chance to carry out new evidence-based initiatives, from HPV immunization to health equity and cancer disparities in Tennessee. Also, TC2 will offer new work groups in January 2024 to allow members an opportunity to work on cancer-related topics that match their interests. For more information, go to Tennessee Cancer Coalition.

September 19: 3rd Annual BBQ, HPV Vaccination & You Roundtable

The 3rd Annual Meeting of the Memphis and Shelby County HPV Cancer Prevention Roundtable is September 19, from 8:30 a.m.-3:30 p.m. at the Memphis Botanic Garden. The event will promote learning and updates for members and partners eager to impact HPV vaccination and cancer prevention in Memphis and Shelby County. We have planned a robust schedule of presentations that will build local context and capacity to improve HPV vaccination coverage and prevent HPV cancers. Register today.

For more information about the Memphis and Shelby County HPV Cancer Prevention Roundtable, please visit stjude.org/memphis-roundtable or email Carol.Minor@stjude.org or PreventHPV@stjude.org.

Back-to-School Immunization Drive

The first two immunization events of the 2023 Back-to-School Immunization Drive in Memphis and Shelby County took place on July 29 and August 5 at the Teaching & Learning Academy in Memphis, TennN. These events are the product of a collaboration between the St. Jude HPV Cancer Prevention Program, the Shelby County Health Department, Le Bonheur Children's Hospital, Memphis-Shelby County Schools, the University of Tennessee Health Science Center, and Shot RX.

The Shelby County Health Department reported immunizing 567 students in the first two back-to-school events, and 138 received the HPV vaccination. The HPV team distributed 525 backpacks to students, each containing a lunch bag and a Path to a Bright Future back-to-school activity book. During the event, HPV educators engaged with parents and caregivers in important conversations (some in Spanish) about the HPV vaccine and cancer prevention.

One of the best stories from the August 5 event was learning that two Hispanic families who attended the first event when we provided HPV vaccination education returned exclusively to receive this vaccine. In the words of Ms. Rodriguez-Briceño, "As parents, we do everything in our power to keep our children safe and healthy. Why would a responsible parent pass up this free opportunity to protect their children from cancer?"

The third immunization event in this back-to-school series is on September 30. Volunteers are still need for the event. If you are interested, sign up here to volunteer.

September is self-awareness month. Self-awareness is vital for mental health and well-being and, when we are truly in tune with ourselves, we can shape our lives. What are some steps that you are taking to improve your overall well-being?

"I have started getting up earlier every morning to have some quiet for myself before my family wakes up. This quiet time gives me a chance to set my tone for the day.” – Karlisa Cryer, medical content writer

"To improve my overall well-being, other than my regular work routine, I try to connect with my family and friends, keep myself active, eat good food, and drink enough water.” – Pragya Gautam Poudel, postdoctoral fellow

"I’m beginning to live in the moment and relax more.” – Portia Knowlton, program coordinator

"Online shopping helps me relax. Discovering sales helps improve my overall well-being and my budget." – Ursula Leflore, administrative specialist

"Some steps I am taking to improve my overall well-being is learning to spend more time in nature and being outdoors! " – Duha Magzoub, program coordinator

“I want to be still and enjoy more peaceful moments." – Carol Minor, program coordinator

“I prioritize activities that are unplugged, outdoors, and allow me to disconnect from school and work. Running, cooking, and reading are all activities that make me a happier person. I also incorporate small daily rituals to look forward to that add pockets of joy and mindfulness throughout my day. “ - – Kasia Mitchell, graduate student assistant

"Prior to the pandemic, my friends and I used to have weekly game nights or dinners. Those were great ways for us to laugh a lot and for me to invest in my overall well-being. We have started to establish a regular rhythm of gathering again and it feels great." – Andrea Stubbs, administrative director

"I think exercising and being emotionally connected to the people in my life are crucial for my well-being. Thus, I've picked up bicycle riding a few days a week and am trying to spend more quality time with my family." – Cristobal Valdebenito, program coordinator

"I try to take time every day just for me – whether that is exercising, reading, watching television, or just plain sitting still for a few minutes to catch my breath." – Heather Brandt, director

The St. Jude HPV Cancer Prevention Program’s Path to a Bright Future campaign spotlights the benefits of on-time HPV vaccination to prevent cancer in children ages 9–12. The campaign also raises awareness of the dangers of HPV pre-cancers and cancers.

Join us:

Get your child vaccinated against HPV by their 13th birthday: If you or your child is in the recommended age range (ages 9–26 and possibly until age 45), get vaccinated.
Encourage others to get their children vaccinated: Normalize HPV vaccination as cancer prevention.
Share the facts: HPV vaccination is safe, effective, and durable. It prevents 6 types of cancer.

Learn more and join the campaign.