Opportunity to Increase HPV Vaccination in Rural Washington Starting at Age 9

A Rapid and Practical Quality Improvement Project, Sponsored by the Washington Chapter of the American Academy of Pediatrics

“HPV Vax at 9” works in rural communities! Our first cohort of 5 clinics serving rural Washington had tremendous success implementing workflows to start HPV vaccine at age 9. They found it was easy to implement and vaccination rates increased quickly. We are recruiting an additional 5 clinics serving rural Washington to join the second cohort which runs from June 14, 2023 – December 6, 2023. Maintenance of Certification (MOC) hours will be awarded.

Please reach out directly to DeAnna Dudley, Program Manager at ddudley@wcaap.org if you are interested in learning more about this rapid and practical quality improvement project!

It has been proven that HPV vaccination before age 13 provides powerful protection against 90% of HPV-related cancers (cervical, oropharyngeal, anal, penile, vaginal, vulvar). HPV completion rates in Washington State are well under the Healthy People 2030 Goal of 80%, indicating that many children are at risk of developing cancers in adulthood that could have been prevented. For rural communities this is an even bigger issue; HPV vaccination rates are about 10% lower and HPV-related cancer rates are higher in rural communities. We have an opportunity to make a difference by increasing HPV vaccination rates.

Starting HPV vaccine at age 9 has multiple benefits including a robust immune response, easier conversations with parents, more time to get kids vaccinated by age 13, and most importantly it results in higher rates of on-time vaccination before age 13. Starting at age 9 makes HPV cancer prevention easier!

Starting HPV vaccination at age 9 also complies with current ACIP recommendations and is considered best practice by the Washington State Department of Health, the American Academy of Pediatrics, and National HPV Vaccination Roundtable. As of January 20, 2023, the Washington Immunization Information System (WAIIS) began forecasting for HPV at age 9.

Provider comments from Rural Cohort 1:

  • “This has been an eye-opening experience and a big surprise that parents are welcoming of HPV at age 9/10.”
  • “Wow, I didn’t think it would be this easy” … referring to implementing HPV vax at 9.
  • “This has been a real win compared to how contentious COVID vaccine was.”

Participating clinics will receive training in best practices to promote HPV vaccination in preteens, particularly by starting HPV vaccination at age 9, using strong provider recommendations, and posting a standardized immunization schedule. Clinics will be encouraged to increase well child visits, specifically for age 9-10. Learning will be accomplished through a combination of webinars, cohort meetings and individual clinic coaching sessions (approximately 1-2 hours a month). Clinics will receive training materials such as HPV cue cards, Announcement Approach Pathway, and posters for the exam rooms and lobby.

Baseline data will be collected in June. To assess improvement, we will monitor WAIIS HPV vaccination coverage rates for your clinic and same day HPV vaccine administration at the 9-10 year well child visit monthly.

Forming your Practice QI Team:  To participate, we ask that you assign at least two primary contacts to lead this QI project.

  • Clinical Leader: This person should be a clinician, have a comprehensive understanding of how the clinic operates, and have a strong interest in quality improvement. The clinical leader does not have to be a physician but should have a direct patient care role. Examples: Physician, Nurse Practitioner, Physician Assistant, Registered Nurse.
  • Project Leader: This person will serve as the project manager for this project at your clinic. They will be responsible for data collection, survey completion, and will ensure materials are shared with clinic staff and QI interventions are implemented. The project leader must have experience using the Washington State Immunization Information System (WAIIS) in their clinic. Examples: clinic manager, VFC manager, MA, RN.


Learn more or enroll

For more information and to enroll, contact DeAnna Dudley at ddudley@wcaap.org by June 5, 2023.

Our thanks to Amerigroup for their support of this important work!