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Happy summer everyone! Katie Conrad has kindly offered to lead our journal club this month. Here is her post to start the club:
There are two articles for you to read. The first article discusses human papillomavirus (HPV) vaccine compliance in the United States. The article focuses on trends noted in the United States regarding HPV K compliance recommendations along with lack of knowledge in high-risk patient population. The second article discusses occupational exposure to HPV for professionals in areas that are prone to aerosolized HPV inducing procedures.
Remember to reply to at least 3 of the 4 prompts on this page and to at least 2 of your peers’ posts.
Here are the links to the articles:
https://cjon.ons.org/cjon/24/3/hpv-knowledge-and-education-report-vaccination-data-national-health-trends-survey
https://oce.ovid.com/article/00006250-202010000-00005/HTML
References
Hoover, R. & Mayer, D. (2020). HPV Knowledge and Education: Report on Vaccination Data from a National Health Trends Survey. Clinical Journal of Oncology Nursing, 24 (3), 257-263. doi: 10.1188/20.CJON.257-263
Harrison, R. & Huh, W. (2020). Occupational Exposure to Human Papillomavirus and Vaccination for Health Care Workers. Obstetrics & Gynecology, 136 (4), 663-665. doi: 10.1097/AOG.0000000000004021.What was the knowledge gained from the article?
I was unaware that HPV associated cancers was more prevalent in oropharyngeal cancers than cervical cancers. I also never thought of the exposure and occupational risks that health care providers were exposed to managing patients with HPV. Knowing this, it makes complete sense that the US Food and Drug Administration and CDC expanded its approval to have adults through age of 45 years to also be vaccinated. I was not aware that the vaccine was even available for this age group or that patients were being asked to receive the vaccine.What other questions does the article raise about current practice?
I question why the adult age for the vaccination is at a limit of 45 years of age and the studies that correlated with that.Do you agree/disagree with the conclusions of the author, why?
I agree with the findings of the Occupational Exposure article and the suggested safety measures to help health care workers limit their exposure. I also agree with the education and encouragement of vaccinations that both articles shared. The benefits of vaccinations has been shown to be far more beneficial against the side effects.I thought age 45 was interesting as well! I was reading a little further into the vaccine and it mentioned the 26 is the cut off for insurance to cover the vaccine d/t less risky of a lifestyle. Here is a quote from Uptodate that might be interesting,
“For adults 27 years and older, catch-up vaccination is not routinely recommended; the ACIP notes that the decision to vaccinate people in this age group should be made on an individual basis. The likelihood of prior exposure to HPV vaccine types increases with age, and thus the population benefit and cost-effectiveness of HPV vaccination is lower among older patients [22]. However, for some individuals in this age group, such as those with no prior sexual experience or with a limited number of prior sexual partners, the risk of prior HPV exposure may be very low. We offer HPV vaccination to such individuals if they are deemed to have a future risk of HPV exposure (eg, expected new sexual partners). Although supporting data are limited, we also suggest HPV vaccination for health care workers who may be at risk for occupational exposure to HPV, even if they are older than 26 years. (See ‘Health care workers at risk for occupational exposure’ below.)
Studies have suggested that HPV vaccination is immunogenic, efficacious, and safe in women older than 25 years [23-26]. However, clinicians and patients should be aware that HPV vaccination of individuals older than 26 years may not be covered by insurance providers or other payers, and this may affect the decision to vaccinate. In the United States, the HPV vaccine is approved through age 45. It is possible that some individuals over the age of 45 years may also benefit from vaccination, but the benefit has not been well studied, and reimbursement for vaccination of such individuals is even less likely.” https://www.uptodate.com/contents/human-papillomavirus-vaccination?search=HPV%20vaccine&source=search_result&selectedTitle=2~95&usage_type=default&display_rank=1
What was the knowledge gained from the article?
These articles were interesting in a few ways. I was intrigued that albeit in small cases surgeons and other OR staff contracted HPV from surgical procedures. I was also surprised to hear that the numbers for the vaccines are that low across the board. I know in other countries (specifically England and Australia) as mentioned in the article they have universal healthcare. This is interesting to me because they were allowed to give vaccines during school for the students. This would be incredibly beneficial for certain populations where they don’t have access to doctor’s offices.Will the research/information in this article change or influence your practice? If so how?
What other questions does the article raise about current practice?
My current questions about this article would be why are we only offering the vaccine to patients under 45 and not more of the population? Are there plans for the vaccine to be studied on the over 45 population since the vaccine wasn’t available to them during the suggested time frame for obtaining the vaccine? Do people who received the initial vaccine need a booster to cover the additional 5 types covered in Guardasil 9? What additional precautions will be taken for staff in procedural areas with the results?Do you agree/disagree with the conclusions of the author, why?
I agree that more of the population should receive the vaccine as it contributes to certain cancers. Anything that can help prevent cancers is a great thing in my opinion. As with any vaccine there will be questions raised and a certain population that won’t want vaccines. As to the how to vaccinate more of the population there is not a good way to do that as of currently.The vaccinating of students in school is a great idea especially to serve those students who would otherwise not have access to the vaccine. I know during COVID time my son’s school was giving vaccines to the students and it was well received by parents, teachers, and students.
What was the knowledge gained?
I, despite having worked in an ENT clinic that biopsied and lasered HPV lesions, was surprised to see that HPV was found in staff performing surgical procedures. It is even more surprising because likely in the OR, a mask was being worn, yet still HPV was found.Questions raised?
Why stop at age 45? People still have sex after the age of 45 and can still pass HPV on. We did a study when I worked at Voice and Swallow (https://doi.org/10.1177/0003489418821695) and we found that vaccinating people, even after they already had HPV lesions on their vocal cords, helped reduce reoccurrence and need for surgery.Agree/disagree with authors conclusions?
I do agree. It is important to educate parents so they are more comfortable with vaccinating their children and making it easier to get the children vaccinated. It is also important to provide vaccinations for healthcare workers, especially those in higher risk settings.CONRAD.369
We found that often the pharmacy part of insurance did not cover those older than 26, but the actual healthcare coverage often would, which makes sense since less surgery is good for the insurance company.Shawver.25
I too wonder if it wouldn’t be a good idea for those who received the original HPV vaccine wouldn’t benefit from getting the updated version since it covers more strains.What was the knowledge gained from the article?
I didn’t know that the U.S. had a goal of 80% HPV vaccination by 2020, but I was not surprised to see that we have not met that goal. I was shocked to learn that there is occupational exposure to HPV from surgical smoke. What!!? This makes me glad I don’t work in the OR. I also was not aware that the HPV vaccine was updated in 2014 to cover 9 strains, and that people can get vaccinated up to age 45. I thought it was still just for teenagers.
Will the research/information in this article change or influence your practice?
If so how? I have always encouraged those of appropriate age to get vaccinated against HPV. Anything we can do to prevent cancer, especially as simple as a vaccination, should be encouraged. Unfortunately, I don’t have many opportunities to encourage vaccination in this age group. I don’t know how I could change my practice much at this point.
Do you agree/disagree with the conclusions of the author, why?
As an adult oncology nurse, I don’t think we have many opportunities to educate about and encourage HPV vaccination. This does fit into our practice since it helps prevent several forms of cancer, but I don’t know many patients who have teenage children. Possibly teenage grandchildren, but then it seems rather far off topic, especially in a busy infusion clinic. I think this would be very important for school nurses, public health nurses, and for public policy advocacy. Since the Covid-19 pandemic, I feel like this nation has a stronger distrust of vaccinations in general. Encouraging any vaccination at higher rates will be very challenging.Hoover, R. & Mayer, D. (2020). HPV Knowledge and Education: Report on Vaccination Data from a National Health Trends Survey. Clinical Journal of Oncology Nursing, 24 (3), 257-263. doi: 10.1188/20.CJON.257-263
Harrison, R. & Huh, W. (2020). Occupational Exposure to Human Papillomavirus and Vaccination for Health Care Workers. Obstetrics & Gynecology, 136 (4), 663-665. doi: 10.1097/AOG.0000000000004021.
Jeff and Stephanie-
I too was intrigued by the idea of schools giving vaccinations to teenagers, especially at no cost. I don’t know how well this would be received in the US though, given how many parents opt out of sex education at school for their teenage children. The current political climate with anti-vaccination beliefs and general distrust of medicine could combine for a dangerous situation. Parents are getting upset over different subjects being taught in school- I can’t imagine how emotional they would get at the idea of vaccinations given at school.
Holly-
Thanks for letting us know that people vaccinated that already had HPV reduced recurrence and need for surgery. With the regulations regarding vaccination, I also wondered why to stop at age 45? Why not give it to everyone? The article was not clear what would happen if the vaccine was given to someone who had already been exposed to HPV.
What was the knowledge gained from the article?
Article 1: I was very shocked at how little information people have on HPV and the vaccine. I also didn’t know that the U.S had a vaccine goal of 80%, I’m not surprised that we didn’t hit that goal.
Article 2: I didn’t know that in 2010, oropharyngeal cancers surpassed cervical cancers as the most common HPV-associated cancer. I’m surprised. I also learned that the smoke generated in the OR is how practitioners are exposed to the virus.
What other questions does the article raise about current practice?
Article 1: Why are we not doing more to education patients and especially parents on the importance of getting the HPV vaccine? Once a child becomes age appropriate, or even the year before, we need to start educating families on HPV and the vaccine. We wait until it’s too late or when the patient is seen for cervical cancer. Sometimes if we’re lucky, we catch it at CIN1-3.
Article 2: What are we doing to protect our providers? Other than being vaccinated, is there additional PPE they can wear if operating on an HPV positive patient? I also wonder if providers really know their risks with these patients.Do you agree/disagree with the conclusions of the author, why?
Article 1: I agree that there are multiple barriers that need to be addressed regarding the HPV vaccine. There are multiple teaching moments for both the doctors, nurse practitioners and nurses that we need to start taking advantage of and educating our patients.
Article 2: I agree that we should encourage providers to be vaccinated. Especially with their occupational risk, if they perform multiple surgeries a day they are at higher risk. Not only should we educate our patients on the virus, providers need to be educated as well, especially if they are at an increased risk of exposure and infectionThanks for responding Greg! I agree it is a difficult time to gain trust regarding vaccines. It was mentioned that other countries focus on vaccinating children in the school setting and that has resulted in higher outcomes. Hoping at some point we a country can get there. Does anyone with older kids know if schools offer vaccine clinics for things other than flu or COVID? Also, I have seen commercials recently encouraging HPV vaccinations. Hopefully the topic will gain more attention.
Stephanie- what kind of vaccines were the schools doing during Covid times? Was this something the school had to send out information regardless of if kids received the vaccines or not? I could see so many hoops a school would have to jump through to make this actually happen. I know in other countries (with more rural areas) it would make the most sense to include vaccines into school.
Greg- do you think HPV vaccines would have to be included in a sex education type setting IF it were to ever catch on in schools? Where parents could opt to for both or do you see other variables that would limit this scenario from ever happening (especially given the state of vaccines and how they are viewed)?
Katelyn- I have seen numerous commercials on HPV as well. I am by no means comparing lung cancer to cervical or any of the other types of cancer mentioned in the articles. In my time working in the thoracic clinic I learned that there was a minimal amount of research for newer treatments until the last 10-15 years… so maybe HPV research and facts may be comparable and now that it’s making the news and commercials more research may be completed on it.
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