A program of the

International Association of Immunization Managers

Peer-to-Peer ExchangeHPV Vaccination in Ireland

Dr. Brenda Corcoran for Molly Howell, MPH

Immunization Program ManagerAssistant Director of Disease ControlNorth Dakota Department of Health

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Human Papillomavirus (HPV) in the United States• Every 20 minutes, someone in the U.S. is diagnosed

with an HPV-related cancer.• About 79 million Americans are currently infected

with HPV. • About 14 million people become newly infected

each year (mostly in teens and early 20s). • For each year the U.S. stays at 30% coverage for

HPV vaccine instead of achieving 80% 4,400 future cervical cancer cases and 1,400 cervical cancer deaths will occur annually.

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HPV Vaccine Recommendations in the U.S.• HPV vaccine is administered as a 3-dose series. • 0, 1-2, and 6 months

• HPV vaccines are routinely recommended by ACIP for 11 and 12 year-old girls and boys. • The vaccine series can be started beginning at age 9. • Female recommendation: 2007• Male recommendation: 2010

• Catch-up vaccination is routinely recommended for 13 – 26 year-olds.

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North Dakota

• North Dakota is located in the north-central portion of the U.S.• Population:723,393• Conservative, rural, agricultural state that is currently experiencing an “oil

boom” and significant population increase• Historically, high rates of immunization• All recommended vaccines required for childcare or school entry, with

the exception of HPV and influenza.IAIM Inaugural Conference, March 3 - 4, 2015,

Istanbul, Turkey 4

North Dakota Adolescent (13-17) Immunization Rates (NIS)

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2008 2009 2010 2011 2012 20130

10

20

30

40

50

60

70

80

90

100

47.8

71.6

83.187.5

89.5

95

47.4

66

76.8

84.288.1

93.7

28.7

45.141.7

51.2

60.357.5

15.9

31.7

26.3 27.8

40.9 41.1

18.6

36.1

TdapMCV4HPV1-FHPV3-FHPV1-M2 VAR

North Dakota vs. U.S. HPV Vaccination Rates (2013 NIS)

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HPV1 - Female HPV3 - Female HPV1 - Male HPV3 - Male0

10

20

30

40

50

60

70

57.3

37.634.6

13.9

57.5

41.1

36.1

18.4

USND

Peer-to-Peer Exchange: HPV Vaccination Objectives• Be able to describe strategies used to implement and achieve high rates

of HPV vaccination amongst adolescents, including, school located clinics, communication initiatives, educational materials, insurance coverage, healthcare provider education, etc.

• Understand mandatory (or lack there of) school immunization requirements

• Determine the process used by another country to assess immunization coverage, including the use of immunization information systems

• Understand barriers to immunization and strategies used to combat barriers in another country

• Be able to summarize the healthcare structure of the country and possible differences that may impact immunization coverage rates

• Determine opportunities for implementation of learned strategies in North Dakota

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Peer-to-Peer Exchange: Ireland• Population: 4.595 million• Mixture of cities and very rural areas• 84.2% Catholic

• Universal childhood immunization programs• General Practitioners vaccinate infants• Local vaccination teams visit primary and second

level schools.• No school immunization requirements (mandates)

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Peer-to-Peer Exchange: Ireland• Dublin, Ireland• September 8 – September 11, 2014• Peer Supporter: Dr. Brenda Corcoran, Ireland

National Immunization Office (NIO), Health Service Executive (HSE)• Agenda:• Met with NIO staff• Attended three school immunization clinics• Met with surveillance and communications staff within

the HSE

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Peer-to-Peer Exchange: Ireland• In April 2008, the National Immunization Advisory

Committee (NIAC) (similar to ACIP in the U.S.) recommended HPV vaccine for all girls at age 12.• Three-dose schedule

• Ireland supplies 100% recommended vaccines (very limited private purchase).• Government agreed funding Sept 2008• Deferred due to economic situation• Funding not agreed until January 2010

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HPV Vaccine Program – Ireland2010/2011• Vaccine procured – HPV4• Training program developed• Information materials tested• Vaccinated all girls entering second level school

(“7th grade” age 12-13) 2010/2011 and 2009/2010 (double cohort)• No national IT system so manual recording of

uptake (target 80%)

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HPV Vaccine Program- Ireland 2010/2011

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HPV Vaccine Program – Ireland2011/2012• Routine program continued • Catch-up program for all girls in last year of second

level school (“seniors” age 17-18)• minors can consent for themselves (no parental consent

needed) at age 16• target 60%

• IT system developed• tracks consent, demographics, vaccine etc.

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HPV Vaccine Program – IrelandAge 12-13

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2011/2012 2012/2013

• Over 80% uptake achieved for 3 dose schedule• >96% girls who started dose 1 completed dose 3

HPV Vaccine Program – IrelandAge 17-18

2011/2012 2012/2013

• Over 60% uptake achieved for 3 dose schedule• Over 93% girls who started dose 1 completed dose 3• Some girls may have already received HPV vaccine

HPV Vaccine Program -Ireland2014 – 2015 • Changed to a two-dose HPV vaccine schedule• 0 and 6 months • First dose administered with Tdap• Second dose administered with new booster of

Meningococcal C (MenC) vaccine

• Tdap and MenC vaccines administered to boys

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Lessons Learned from Ireland• Delay in funding for HPV vaccine caused increased

demand for the vaccine.• Parents and general public demanded that the Irish

Government provide HPV vaccine after funding stopped.• Created positive media attention for HPV vaccine

• United Kingdom TV reality star, Jade Goody, died of cervical cancer at age 27 in March 2009.• Created positive media attention for HPV vaccine

• Catholic Church mostly silent on HPV vaccine

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Lessons Learned from Ireland• School-located clinics are an effective way to vaccinate.

• Convenience• Parents in Ireland are familiar with school based vaccinations

because primary school entry vaccines are given there.• Persistent and passionate school teams contact parents of children

who missed school clinics.• NIO has a close relationship with the Department of Education.• One-time consent in Ireland makes school vaccinations easier.

• The government funds 100% of the vaccine cost and administration; no billing of insurance.• If girls do not get the vaccine at school or “mop-up clinic,” then the

family may have to pay out-of-pocket later.

• The public trusts information from Irish health authorities.

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Lessons Learned from Ireland

•People know HPV vaccine as the “cancer vaccine.”

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Possible Applications for North Dakota• Pilot school clinics with local public health units or

mass vaccinators in North Dakota• Conduct a media/educational campaign with focus

on preventing cancer• Focus on the need for vaccination prior to exposure.• Educate physicians/nurses about how to communicate

with parents about the vaccine.

• Use trusted sources for HPV promotion/information• Local physicians• North Dakota residents impacted by HPV

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Thank You!

• International Association of Immunization Managers• Dr. Brenda Corcoran, National Immunization Office

in Ireland• Ireland HSE staff • North Dakota Department of Health

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