Issues Related to Vaccines Issues Related to Vaccines and HIV Testingand HIV Testing

Annual Family ConferenceAnnual Family ConferenceACESACES

October 11, 2007October 11, 2007

Charles H. Woernle, MD, MPHCharles H. Woernle, MD, MPHAlabama Department of Public HealthAlabama Department of Public Health

TopicsTopics

Issues related to vaccinesIssues related to vaccines Human papillomavirus vaccineHuman papillomavirus vaccine Influenza vaccineInfluenza vaccine

Expanded testing for human Expanded testing for human immunodeficiency virus (HIV)immunodeficiency virus (HIV)

Immunization IssuesImmunization Issues

Vaccines—most effective measure to Vaccines—most effective measure to prevent diseaseprevent disease

Four related issues:Four related issues: AcceptanceAcceptance AccessAccess CostCost MandatesMandates

Human Papillomavirus VaccineHuman Papillomavirus Vaccine

Prevents infection from 4 types of Prevents infection from 4 types of HPVHPV Two types cause 90% of genital wartsTwo types cause 90% of genital warts Two types cause 70% of cervical Two types cause 70% of cervical

cancerscancers Vaccine recommended for females 9-Vaccine recommended for females 9-

26 years of age26 years of age

Issues related to HPV VaccineIssues related to HPV Vaccine

CostCost ~$300 vaccine cost for the 3-dose series~$300 vaccine cost for the 3-dose series

PolicyPolicy Societal acceptance—vaccine must be Societal acceptance—vaccine must be

given before onset of sexual activitygiven before onset of sexual activity Question of mandated vaccinationQuestion of mandated vaccination

Objective 4.12Objective 4.12

Increase to 90 percent or more Increase to 90 percent or more influenza immunization coverage influenza immunization coverage among adults aged 65 years or olderamong adults aged 65 years or older

AL baseline (1997) = 62%AL baseline (1997) = 62% US baseline (1995) = 58%US baseline (1995) = 58% AL 2006 = 62%AL 2006 = 62% US 2006 = 69%US 2006 = 69%

Visit www.adph.org/publicationsVisit www.adph.org/publications

Expanded HIV TestingExpanded HIV Testing

~25% of HIV-infected persons do not ~25% of HIV-infected persons do not know they are infected; delay results know they are infected; delay results inin IllnessIllness Spread of infectionSpread of infection

September 2006 CDC guidelinesSeptember 2006 CDC guidelines Offer HIV testing routinely in clinic Offer HIV testing routinely in clinic

settingssettings ““Opt out” instead of “opt in”Opt out” instead of “opt in”

ADPH ActionsADPH Actions

Modifying informed consent to include Modifying informed consent to include reference to HIV as a routine testreference to HIV as a routine test

Modifying HIV laboratory requisition slipModifying HIV laboratory requisition slip Suitable for use in both clinic settings and Suitable for use in both clinic settings and

HIV counseling and testing sitesHIV counseling and testing sites Dual approachDual approach

Individualized consent and pre-test Individualized consent and pre-test counseling in non-clinical settingscounseling in non-clinical settings

Routine testing in clinical settingsRoutine testing in clinical settings

Post-test CounselingPost-test Counseling

Tested individuals should be Tested individuals should be informed of their resultsinformed of their results

Persons with positive results need to Persons with positive results need to be referred for servicesbe referred for services