In 2013, the Philadelphia Department of Public Health was one of 11 health departments awarded a $500,000 grant from the U.S. Centers for Disease Control and Prevention (CDC) to increase adolescent HPV immunization rates. this project ended on June 30, 2015.
In 2012 the data showed that adolescent females in Philadelphia were receiving the first dose of HPV vaccine at rates higher than the national average, but they were not completing the three-dose series. The city was also struggling to vaccinate adolescent boys, who had immunization rates far lower than females.
The Health Department and CDC developed a five-point strategy to increase and improve HPV immunization rates:
- Organize a diverse stakeholder committee
- Offer Continuing Medical Education (CME) for pediatric healthcare providers
- Develop and disseminate a marketing campaign targeting parents of teenagers
- Mail vaccine reminder and recall postcards directly to parents of teens
- Conduct adolescent AFIX visits
Local stakeholders included representation from:
- Access Matters
- Pennsylvania Academy of Family Physicians Foundation
- Pennsylvania Chapter, American Academy of Pediatrics
- Pennsylvania Department of Health, Cancer Prevention
- Pennsylvania Coalition of Nurse Practitioners
- Pennsylvania Immunization Coalition Greater
- Philadelphia Health Action, Inc.
- The Philadelphia School District
- Children’s Hospital of Philadelphia
- St. Christopher’s Hospital for Children
- Thomas Jefferson University Hospitals
The Philadelphia Department of Public Health worked in collaboration with the Health Federation of Philadelphia for the provider education component of this project.
Providers were offered Continuing Medical Education (CME) credits for attending a presentation about HPV and the HPV vaccine. Education included medical information, ACIP recommendations, local epidemiology, and tips for how to communicate with patients and parents.
The opportunity for CME credits were advertised through the Philadelphia Vaccines For Children (VFC) Program. Education was offered in peer-to-peer meetings, grand rounds, professional meetings, and webinars.
The project educated 731 healthcare workers in the city of Philadelphia: 146 physicians, 71 nurse practitioners, 221 registered nurses, and 293 others including medical assistants.
The marketing campaign had three main messages to deliver to parents of Philadelphia teens:
- The HPV vaccine is recommended for both boys and girls
- The HPV vaccine is given in three doses
- Adolescents should start the three-dose series at 11-12 years of age
The Philadelphia Department of Public Health identified the first message as a priority. This was because of the low immunization rates among Philadelphia adolescent males, and the common misconception among parents that only females should receive the vaccine.
Marketing included CDC-developed materials, and creative developed by the Philadelphia Department of Public Health. Media was purchased for TV, radio, billboards, SEPTA buses, Internet radio, online news, and Facebook. Ads were purchased in both English and Spanish.
The Philadelphia Department of Public Health conducted a centralized reminder/recall campaign through the KIDS Plus Immunization Information System. This campaign followed CDC guidance for the HPV project.
From February to August 2014 the Philadelphia Department of Public Health mailed 93,247 postcards to parents of teenagers aged 11 through 17 who were due to receive the HPV vaccine. In August, 57,975 robocalls were made as follow-up reminders. Finally, an additional 50,000 recall postcards were mailed in November and December of 2014. In total, 143,247 postcards were mailed with a 7% return rate.
The Philadelphia Department of Public Health also partnered with Greater Philadelphia Health Action, Inc. (GPHA) to produce and mail Vietnamese and Chinese language postcards for the city’s non-native English speaking population.
Adolescent AFIX Visits
AFIX stands for Assessment Feedback Incentive and eXchange.
AFIX is a quality improvement program used to raise immunization coverage levels, reduce missed opportunities to vaccinate, and improve standards of practice at the provider level.
Adolescent AFIX was new in 2014, and conducted at any Philadelphia VFC provider with >10 adolescent patients. A total of 122 adolescent AFIX visits were completed.
Philadelphia HPV Immunization Rates
Below is a toolkit for Philadelphia immunization providers. You can also view the CDC’s toolkit here.
Talking to Patients and Parents
- CDC Tips for Talking with Parents about HPV Vaccine
- AAP Tips for Talking to Your Parents about HPV Vaccine
- Addressing Common Concerns about Preteen Vaccines
- Give a Strong Recommendation for HPV Vaccine
Handouts for Patients and Parents
Handouts for Providers
- HPV Facts for Philadelphia Providers
- Importance of HPV Vaccine – Kristen’s Story
- Vaccine Safety: 10 Facts for Medical Assistants
- Vaccine Information Statement: Gardasil
- Vaccine Information Statement: Gardasil-9
- Vaccine Information Statement: Cervarix
Funding provided by the U.S. Centers for Disease Control and Prevention.