Texas Department of State Health Services

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Texas Department of State Health Services
Immunization Branch Infectious Disease Control
Unit Updates HPV HBV Mark Ritter, MHA,
PHA Rita Espinoza, MPH June 6, 2007
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Human Papillomavirus (HPV)

• Genital human papillomavirus (HPV) is the most
  common sexually transmitted virus in the US
• There are about 40 types of HPV
• 20 million people are infected in the US
• 6.2 million new infections annually
• Spread through sexual contact
• 10,000 women get cervical cancer in the US
• 3,700 die annually
• 2nd leading cause of cancer deaths among women
  around the world

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HPV Vaccine Timeline

• Gardasil (Merck) is the first HPV vaccine
  licensed in the US (3 dose series)
• Protects against 4 major types of HPV
• Can prevent most genital warts and most cases of
  cervical cancer
• Licensed by the FDA 6/8/2006
• Added to the Federal VFC Program 6/26/2006
• But not funded until 12/2006
• Added to the Texas VFC Program 2/1/2007
• ACIP Recommendations published in MMWR
  3/23/2007

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HPV Vaccine

• Gardasil (Merck)
• Licensed for women 9 -26 years of age
• 3 dose series (est. 120/dose)
• Dose 1 Now
• Dose 2 2 months after dose 1
• Dose 3 6 months after dose 1 (at least 12 weeks
  after the second dose)
• Not recommended for use in pregnancy
• If the vaccine series is interrupted, the series
  does not need to be restarted
• Can prevent most genital warts and most cases of
  cervical cancer

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HPV Vaccination in Texas

• Eligible Groups in Texas for Public Vaccines
• Texas Vaccines For Children (TVFC) eligible
  females 9-18 years of age
• Texas HPV vaccine estimates
• Total females 9-18 years of age 1.7 million
• Total TVFC eligible females 52

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What is VFC?

• Federally funded vaccine supply program
• Distributes free vaccines to private and public
  providers for defined populations
• Serves children birth to 18 years of age who are
• Enrolled in Medicaid
• Uninsured
• Native American/Alaska Native
• Have health insurance, but it does not cover
  immunizations (underinsured). In these cases,
  these children must go to a Federally Qualified
  Health Center (FQHC) or Rural Health Clinic (RHC)
  for immunizations.

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Resources

• CDC website for HPV Vaccine
• http//www.cdc.gov/nip/vaccine/hpv/default.htm
• Merck's website for HPV
• https//www.merckvaccines.com/gardasilProductPage_
  frmst.html

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Hepatitis B Vaccination in HIV and STD Clinic
Settings
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Purpose

• To determine whether providing hepatitis B
  vaccine was feasible in the STD setting
• To offer vaccine to high-risk adult population in
  Texas

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Timeline

• Pilot December 2002 May 2006
• Immunization Division purchased 39,000 doses
• 18 sites volunteered to participate
• Eligibility Persons 19 and older seeking
  testing, treatment, or counseling services
• Continuation April 06 to Present
• One-time funds available from CDC
• Imm Branch, HIV/STD, and IDCU collaboration
• Two-year project
• Expanded to include HIV prevention services
  clinics in addition to STD clinics
• 34 STD clinics (24 lhds)
• 10 HIV clinics (8 agencies)

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Methods

• Doses recorded by age and dose number
• Temperature log
• Inventory monitored on a monthly basis (reports
  due on 7th of each month)
• Vaccine is replenished as needed

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List of Pilot Sites

• Abilene Taylor County Health Dept
• City of Amarillo Public HD
• Austin-Travis county HHSD
• Brazos County HD
• Corpus Christi-Nueces County HD
• Dallas County HHS
• El Paso County HD
• McAllen Clinic Hidalgo County HD
• City of Lubbock

• City of Houston
• Medical Center
• Lyons
• West End
• Milam County HD
• San Antonio Metro HD
• Northeast Texas Public HD (Smith County)
• Texarkana Bowie
• Victoria City-County HD
• Wichita Falls-Wichita County Public HD

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Doses Administered by Dose Number
Pilot7/03-5/06
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Age Distribution of ClientsPilot, 7/03-5/06
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Hepatitis B Vaccine Uptake Pilot, 7/03-5/06
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List of Participating STD Sites

• City of Amarillo Public HD
• Angelina County Cities Health District
• Austin-Travis county HHSD
• Beaumont Public Health District
• Brazos County HD
• Cherokee County
• Collin County Health Dept
• Corpus Christi-Nueces County HD
• Dallas County HHS
• El Paso County HD
• Grayson HD

• Gregg HD
• Hays County HD
• Hidalgo County HD McAllen Clinic
• City of Houston
• Laredo HD
• City of Lubbock
• Milam County HD
• Northeast Texas Public HD
• San Antonio Metro HD
• Victoria City-County HD
• Wichita Falls-Wichita County Public HD
• Williamson County HD

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List of Participating HIV Sites

• AIDS Arms Peabody Health Center
• AIDS services of North Texas
• Denton
• Plano
• AIDS Resources of Rural Texas
• Weatherford
• Abilene

• Permian Basin Community Centers- Basin Asst
  Services
• Health Horizons - Nacogdoches Clinic
• Legacy Houston
• Nelson-Tebedo Health Resource Center
• Valley AIDS Council

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Doses Administered by Dose Number, 7/06-4/07
Data received as of 6/5/07
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Age Distribution of Clients7/06-4/07
Data received as of 6/5/07
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Uptake Estimates

• STD sites
• 16 sites submitted data on number offered first
  dose
• 85 vaccinated with 1st dose
• 31 received the 2nd dose
• HIV sites
• 7 sites submitted data on number offered first
  dose
• 80 vaccinated with 1st dose
• 47 received the 2nd dose

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Resources

• Interpretation of Hepatitis Markers
• http//www.cdc.gov/ncidod/diseases/hepatitis/serol
  ogy/index.htm
• Hepatitis B Vaccination Recommendations
• for Adults
• http//www.cdc.gov/ncidod/diseases/hepatitis/recs/
  index.htm

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Contact Information

• Mark Ritter, MHA
• mark.ritter_at_dshs.state.tx.us
• Ph. [phone] ext. 6432
• Rita Espinoza, MPH
• rita.espinoza_at_dshs.state.tx.us
• Ph. [phone] ext. 6335
• Fax [phone]