Broward County is located in the southeastern portion of the State of Florida. Broward County’s 2013 population estimate of 1,838,844, represents 9% of the State’s population, and is the second most populous county of the 67 counties in the State of Florida and eighteenth most populous county in the United States (US Census). Its diverse population includes residents representing more than 200 different countries and speaking more than 130 different languages. 31.4% of the residents are foreign-born. Broward County is a minority/majority county demonstrated by its 2013 population by race (Black 28.5%, Asian 3.6%, Hispanic 26.9%, other races 4.1%, more than one race .2%, for a total of 59.5% and White 40.8%).
The Florida Department of Health in Broward County (DOH-Broward) is the official Public Health Agency in Broward County since 1936. It is part of the Integrated Florida Department of Health (DOH) and operates in cooperation with the Broward County Commission under Florida Statute 154. DOH-Broward’s mission is “to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts”. DOH-Broward is the lead agency providing core public health functions and essential services in the county as part of a complex public health system that includes hospitals, clinics, planning agencies, community-based organizations and others. DOH-Broward provides population/community-based services to the county’s 1.8 million residents and over 10 million annual visitors, and is responsible for assessing, maintaining and improving health and safety within the county.
Public Health Issue: According to a CDC analysis (2006-2010), the State of Florida has high rates of HPV-associated cancers. Florida ranks in the top third of States in HPV-associated cervical cancer (8.04-9.54 per 100,000), anal cancer in males (1.13-2.79 per 100,000) and in females (1.86-2.29 per 100,000), oropharyngeal cancer in males (7.11-8.52 per 100,000) and in females (1.60-1.93 per 100,000). Florida ranks in the mid-third of States in HPV-associated penile cancer (0.71-0.85 per 100,000) and vaginal cancer (0.41-0.47 per 100,000).
According to 2013 CDC data, HPV vaccination rates of adolescent girls ages 13-17 in Florida was between 30-37.6%, placing Florida among the lower third in state ranking. The Morbidity and Mortality Weekly Report (MMWR), August 30, 2013/62(34); 685-693, indicates that among females, Florida had the lowest coverage for ≥1 HPV vaccine dose (39.4%) compared to the rest of the States. Because Broward County represents 9% of the State’s population, and is the second most populous county in the State of Florida, it is reasonable to assume that Broward County contributes to Florida’s low HPV vaccination rates.
The goal is to increase HPV vaccination rates in Broward County and the objectives are:
1. Increase awareness of HPV and the HPV vaccine by developing and distributing an HPV palm card and information to the community and providers.
2. Increase HPV vaccination rates in Broward County by providing the HPV vaccine during DOH-Broward’s back to school immunization campaign as a part of routine immunizations.
In 1996, DOH-Broward led the creation of the Broward County Immunization Action Coalition. The mission is to develop, implement, and monitor immunization strategies that further the goals of providing complete protection against, and eventual elimination of, vaccine preventable diseases. DOH-Broward and the Coalition held a community planning meeting on May 11 and 12, 2015 to develop an action plan to increase HPV vaccine rates in Broward County. DOH-Broward representatives presented HPV at the Broward County Pediatric Medical Society’s seminar on May 12, 2015. DOH-Broward conducts an annual back-to-school immunization point of dispensing (POD) that provides over 4,500 vaccines to over 3,000 children. As part of the community action plan, it was agreed to offer HPV vaccine for the first time during back-to-school POD operations in addition to required school immunizations. During the 8/10/15 – 8/25/15 POD, DOH-Broward offered HPV vaccine for the first time during this campaign.
During the POD, 903 HPV vaccines were provided as compared to zero in the prior year. In addition, over 1500 palm cards have been distributed to providers and community.
The success of this process was due to training immunization nurses on how to talk to parents about HPV and the willingness of the nurses to implement these new methods. By making HPV vaccine a part of routine discussion, parents more readily accepted their child receiving this cancer prevention immunization series.
HPV causes 70% (http://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet) of cervical cancer in the United States. By offering HPV education and vaccine during the POD, 903 HPV vaccines were provided.