There's a lot going on in adolescence, including trying to complete additional recommended vaccines. There's been a bigger emphasis on completing newer immunization series recommended for adolescents, the most controversial being HPV. We will review some of the barriers and recommendations to address this.
Materials for this week:
- Case discussion
- Delivering adolescent vaccinations in the medical home – Szilagyi et al, Pediatrics 2008
- Recommended 2017 vaccine schedule and a parent version for children ages 7-18
Key take-home points:
- What types of practice settings do adolescents use? Most teenagers do have a medical home in the US and >90% of adolescent vaccinations are received in a pediatric, family medicine or community health clinic. A few receive vaccines in school clinics, internal medicine and OB-GYN settings.
- What are adolescent immunization rates in the US? The 2014 National Immunization Survey results showed that vaccination rates among adolescents ages 13-17 are improving, but are still consistently lower than among young children. Coverage rates in 2014 were: Tdap -88% coverage, quadrivalent meningococcal conjugate vaccine or MCV4-79%, and HPV vaccine Girls:>1 dose [60%], 3 doses [40%]; Boys: >1 dose [42%], 3 doses [22%].
- What are the recommended vaccines for pre-teens and adolescents? Starting at age 11, we recommend a 2-dose meningococcal series, single dose of Tdap, 2-dose HPV vaccine series (2 doses if started before age 15; 3 doses if started at 15+ yo), and an annual influenza vaccine.
- What are common barriers to adolescent immunizations? Provider/clinic factors include not offering vaccines at acute visits, and not having follow-up visits; and family factors include not coming for annual wellness visits. There has been particular parental concern about the HPV vaccine safety and need for it at a younger age. The HPV vaccine is only effective against HPV strains before exposure to the strains. Even before teens start intercourse, they may be at risk for HPV related disease. In fact, HPV DNA has been detected in cervicovaginal swabs from girls who report never having had sexual intercourse, so the virus is also transmitted through other forms of sexual contact. Some data suggest better immunogenicity to the vaccine when given at a younger age.
- What are ways we can help increase vaccination rates? A strong provider recommendation is one of the most important factors that positively affects vaccination, as has been shown in several studies for the HPV vaccine. Other strategies are to review immunization records at every visit, offer immunizations at each visit, and schedule follow-up visits for the next vaccine due.