Jonathan Miller, MD, discusses early HPV vaccination in children at PAS 2023

Contemporary OB/GYN®:

Well, thank you so much for joining me today. My name is Morgan Petrocelli with Contemporary OBGYN and Contemporary Pediatrics.

Jonathan Miller, MD:

Hi, my name is Dr. Jonathan Miller. I'm a general pediatrician and chief of primary care, pediatrics, at Nemours Children's Health in the Delaware Valley.

Contemporary OB/GYN®:

Awesome. Well, thank you so much, again, for joining me today. So I kind of want to talk about your abstract that's gonna be presented at the Pediatric Academic Societies. Um, so can you kind of tell me a little bit more about the subject that your abstract is on? And why you chose this topic?

Jonathan Miller, MD:

So as a primary care pediatrician, we're really interested in prevention of disease. And one of the diseases that we can prevent now with a vaccine is certain types of cancer that are related to human papillomavirus (HPV). And so we have the HPV vaccine available to us. And it is recommended for all children to get that vaccine, typically at 11 years old. And we are interested in it, it's allowed to be given as early as 9 years. And we're really interested in seeing if we can increase the percentage of our patients that are interested in getting that vaccine and that actually do get that vaccine by trying to start it a little bit earlier, because other folks have had had some success at getting increased uptake of the vaccine when starting at 9 years old. So that's what our project was about.

Contemporary OB/GYN®:

Can you tell me a little bit more about the results?

Jonathan Miller, MD:

Absolutely. So we were looking at two main outcomes. The national HPV vaccine metric specifically looks at what percentage of 13 year old kids are fully vaccinated for HPV. So that was our ultimate goal was looking at 13 year olds. But our project was really about starting the vaccine early. So our initial goal was initiation of the vaccine prior to 11. And when we really when we started this, about 12% of our patients were starting HPV prior to 11 years old. And by the end of our project, which we did over several years, we now have over 42% of our patients starting before 11 years old. So it was a massive increase over what our baseline was. And that led to significant improvements. In the national metric, the 13 year old metric, we started at about 47% of our patients were fully vaccinated for HPV by 13 years old. And by the end of this now we're over 60%. And we're doing better than some national benchmarks. And so we're really proud of this work. And I really do believe that, that early initiation of the vaccine is a major game changer, as far as this is concerned. And that really should, you know, looking forward to thinking about our conclusions. You know, this really should inform the CDC and the Advisory Committee for Immunization Practices recommendations for when we start the vaccines right now, it's recommended to start at 11 years. But you can start it at 9 years, I think these types of studies will eventually lead to us having a recommendation for starting at 9 years.

Contemporary OB/GYN®:

And what did you find the most interesting about the results?

Jonathan Miller, MD:

My primary care network has 20 primary care practices that take care of over 126,000 kids. This is a really large network. And we started with a lot of variability within practices, as well as in providers in how they were recommending the HPV vaccine. In the past, people recommended the vaccine really talking about HPV as a sexually transmitted disease and the implications of that. But now we're really changing to speaking about this as something that's about preventing cancer. And that conversation actually became a little bit easier when you were doing it at 9 and 10 years old than at 11 and 12. Because I think a lot of parents used to say, you know, having this conversation as their child was approaching, you know, sexual activity. And we've sort of been able to take that part out of the conversation, which makes it a little bit more meaningful for parents. I think,

Contemporary OB/GYN®:

I know you kind of discussed opening up conversation with parents, do you personally have any clinical pearls when it comes to opening up that conversation with parents about getting their children vaccinated against HPV? Especially, a lot of people assume it's just girls who get vaccinated, but it's also available for boys.

Jonathan Miller, MD:

Yeah, so this is a vaccine that has been shown to prevent cancer in both men and women. So, it prevents cervical cancer in women, but clearly does a really good job of preventing all types of cancer and throat cancers, for instance, in men are also something that is going to be protected by getting this vaccine. And so what I find is that a lot my patients, they, you know, they have trust in me as their physician, and so that if I have a strong recommendation that their child will really benefit from this, a lot of families are listening to that. And so part of this project was teaching providers to make strong recommendations around this vaccine, to do it at earlier ages, to focus on discussion of cancer. And, we really had excellent results, you know, in making those changes.

Contemporary OB/GYN®:

And do you have any top takeaways from this abstract that you think people should walk away with when they kind of look at it and digest the information?

Jonathan Miller, MD:

Yeah, well, for our practices, one of the changes that we made that was the most successful was updating our electronic medical record, to start to notify us that a child was behind on this vaccine at nine years old instead of 11. And so it was triggering that reminder for all of our providers to say, well, you know, this is a child who's now due for a vaccine where it didn't used to say until 11 years old, that was probably the single biggest factor that allowed us to be successful at doing this. And so, what I would recommend to other pediatricians as they consider something like this, is really think about how you can use your technology to work for you. If you can make those EMR changes, it's going to sort of be built into your system. And that's what leads to change in culture.