Administration Of The Hpv Vaccine In Womens Health Clinics

Administration of the HPV Vaccine in Women’s Health ClinicsJolene Kay Bethune, RN, MSN

PurposePurpose:Educate mothers of adolescent clients about the spread of HPV among teensEducate adolescent clients about the spread of HPV among teens Promote the administration of HPV vaccines

Disease ProcessAccording to the CDC, one in four female adolescents in the United States is infected with:Human Papillomavirus (HPV)ChlamydiaHerpes Simplex VirusTrichomoniasis The most common STI was cancer- and genital wart-associated HPV.

Disease Process40 types of HPVType 16/18 – 70% of cervical cancerTypes 6/11 – 90% of genital wartsType-specific vaccines are proving to be effectiveProtection from vaccines is expected to be long-lastingPap smears will still be necessary to detect certain cancers not prevented by type-specific vaccines

Disease ProcessCondylomataacuminata, also known as genital warts, is associated with certain types of HPV Sites commonly affected include the urinary meatus, labia, vagina, cervix, penis scrotum anus and the perineal area Once exposure occurs, the incubation period is usually two to three months. Initially single, small papillary growths that may grow into large cauliflower-like massesBleeding may occur if the wart is disrupted (Ignativicius & Workman, 2002, p. 1813)They may regress spontaneously or develop into cervical or genital dysplasia or cervical intraepithelial neoplasia (CIN). (Segala, Lea, & Davis, 2003).

Medical and Nursing InterventionsThe goals of medical management:Remove the wartsTreat the symptomsPrevent progression of neoplasiasNo therapy has been shown to completely eradicate HPVThere may be recurrences after treatment

Medical and Nursing InterventionsTreatment includes provider or client applied podophilox 0.5% solutionProvider-provided:CryotherapyPodophyllinTrichloroacetic acidSexual partners must also be treated; and clients must avoid sexual contact until external lesions are healed. (Ignativicius & Workman, 2002)

Medical and Nursing InterventionsDue to the cellular composition of the young cervix, adolescent women are particularly vulnerable to HVP infectionAdolescent immune response to HPV exposure is greater than in adultsAdolescents respond best to vaccines.

Medical and Nursing InterventionsHPV vaccines are now recommended for all women and for girls as young as 11 and 12 years oldDoctors may give it to girls as young as nine years old; the rationale is to vaccinate girls early, before first sexual contact and possible exposure to HPVGiven as a three-dose series; and may be given the same time as other vaccines

Educational InterventionsNursing management focuses on client education about:Mode of transmissionIncubation periodTreatment and complicationsReduction of transmission with the use of condomsPrevention, with the use of vaccines

Project Intervention Poster presentation BrochureShot record with calendar

Cost of VaccineThe HPV vaccine currently on the market:Three doses over six-month period$120 per dose$360 per patient for the series

Cost of VaccineCovered under a federal program available to uninsured and Medicaid eligible childrenAvailable at health departments, public clinics, private doctors’ offices and hospitalsMany large insurance companies will cover the cost of the vaccine because it is recommended by the CDC

Theoretical BasisBandura:Social learning theory (or social cognitive theory)Focuses on how people learn from one anotherEncompasses observational learning, imitation and modeling (McEwen & Wills, 2007, p. 395)Young people acquired behaviors by watching and listening to others who influence themModeled or imitated those behaviors

Theoretical BasisBandura:Chosen because adolescents model behavior of their peers and people they admireA practitioner who is sensitive to the needs of adolescent clients becomes one that is trusted, admired and acceptable by clients The practitioner (and health promotion activities) becomes acceptable to members of the clients’ supportive networks

Theoretical BasisHarper, Callegari, Raine, Blum and Darney (Harper, Callegari, Raine, Blum, & Darney, 2004):Teenagers visiting clinics for contraception often involved others in their contraceptive decision-making (particularly their mothers, male partners and/or friends who the teens reported were supportive)Concluded that pregnancy prevention and counseling programs that integrate supportive networks for teenagers may help adolescents to use effective methodsOther health promotion services offered in the course of clinic visits, like vaccines, (Wells, 2008) could become more acceptable to adolescent clients if the intervention is acceptable to the supportive network.

Review of Relevant LiteratureCDC (CDC, 2008) 26% of adolescent females was infected with STIHPV the most common (18.3%)15% of infected had more than one STI48% of infected were AA; 20% White; 20% MexicanAdolescent girls are at risk for HPVVaccines for HPV 16/18 (responsible for 70% of cervical cancer) and 6/11 (responsible for nearly all genital warts) recommended for 11- and 12-year old girls

Review of Relevant LiteratureTjalma, et al. (Tjalma, Arbyn, Paavonen, Van Waes, & Bogers, 2004) Explanation of HPV/link to CCVaccine strategiesStatus of then terminated Phase II and Phase III trialsStudy results encouragingContinue CC screening for at least a generationCost effectiveness of screening + vaccination

Review of Relevant LiteratureSanfilippo and Lara-Torre (Sanfilippo & Lara-Torre, 2006)Teen Tool Kit developed by ACOGAdolescent-friendly environmentsHPV vaccines the most important new development

Review of Relevant LiteratureQuinn (Quinn, 2007)HPV 16/18 vaccine would have huge impact in reducing CC mortality/morbidityHPV testing/screening should be an adjunct to Pap smear programs

RecommendationsPractice recommendations include:Patient education about HPV infectionPatient education about HPV’s link to genital warts and cervical cancerPatient education about young women’s susceptibility to infectionPatient education is essential to overcoming insufficient knowledge about, and acceptance of HPV vaccine.

RecommendationsPractice recommendations also include:Vaccinating 11- and 12-year old girls before sexual activity commences and puts them at risk for infectionVaccinating women up to 26 years of age if they are infection-freeVaccinating women older than 26 years of age, although not approved by FDAEducating women older than 26 that vaccine is an off-label use for them

ReferencesCenters for Disease Control and Prevention (2008). Prevalence of sexually transmitted infections and bacterial vaginosis among female adolescents in the United States: data from the National Health and Nutritional Examination Survey (NHANES) 2003-2004; oral session, Thursday, March 13, 8:30 am central [oral abstract D4a - Embargo: Tuesday, March 11, 11:30 am central (12:30 pm ET)]. Retrieved April 19, 2009, from http://www.cdc.gov/stdconference/2008/media/summaries-11march2008.pdfEdelman, C. L., & Mandle, C. L. (2006). Health promotion throughout the life span (6 ed.). St. Louis, Missouri: Mosby.Harper, C., Callegari, L., Raine, T., Blum, M., & Darney, P. (2004). Adolescent clinic visits for contraception: support from mothers, male partners and friends. Perspectives on Sexual and Reproductive Health, 36(1), 20-6.Mayeaux, E. J. (2005). Overcoming barriers to HPV vaccine acceptance. The Journal of Family Practice Supplement, 54, 17-22.McEwen, M., & Wills, E. M. (2007). Theoretical Basis for Nursing (2 ed.). Philadelphia, Pennsylvania: Lippincott Williams & Wilkins.

ReferencesPichichero, M. E. (2007). Who should get the HPV vaccine? Journal of Family Practice, 56(3), 197-202.Quinn, M. A. (2007). Should all women be vaccinated against human papillomavirus and what effect will this have on screening programs? Expert Review of Obstetrics and Gynecology, 2, 315-319.Ryan, S., Franzetta, K., & Schelar, E. (2008). Older sexual partners during adolescence: links to reproductive health outcomes in young adulthood. Perspectives on Sexual & Reproductive Health, 40(1), 17-26.Saca-Hazboun, H. (2008). HPV vaccines: are we ready to protect our children? ONS Connect, 23(10), 27.Sanfilippo, J. S., & Lara-Torre, E. (2006). The adolescent gynecology patient. Expert Review of Obstetrics and Gynecology, 1(1), 49-56.Tjalma, W., Arbyn, M., Paavonen, J., Van Waes, T. R., & Bogers, J. (2004). Prophylactic human papillomavirus vaccines: the beginning of the end of cervical cancer. International Journal of Gynecological Cancer, 14, 751-61.

Administration Of The Hpv Vaccine In Womens Health Clinics

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Administration Of The Hpv Vaccine In Womens Health Clinics