Overcoming the Challenge of Adolescent Immunization
Treating adolescents requires an approach that combines pediatrics with behavioral health and internal medicine to manage a wide range of conditions, including attention deficit-hyperactivity disorder, mood and anxiety problems, sports injuries, sexual and gynecological conditions, and drug and alcohol abuse, in addition to hypertension, lipid disorders, and other “adult” diseases and conditions. With the advent of new vaccines and recent recommendations from the ACIP, adolescents also represent a new age group for immunizations. In addition to annual vaccination with the influenza vaccine and catch-up vaccinations with vaccines initially dosed in childhood, the ACIP currently recommends routine vaccination at the preventive health visit at age 11 to 12 years with 3 vaccines: the MCV4 vaccine, the HPV vaccine, and a booster of the Tdap vaccine.[3,6] Catch-up vaccination is recommended for these vaccines for those 11 to 18 years of age (MCV4 and Tdap) and females 13 to 26 years of age (HPV).[1,2,4] Adolescent recommendations for these 3 vaccines, however, have only been in place for at most 4 years, and coverage rates in adolescents are correspondingly low at around 37% to 42% (see US Adolescent Immunization Strategy section).[5,47] In addition to the issues of parental concern with vaccine safety and other barriers encountered with infant and childhood immunizations, vaccinating adolescents presents a distinct and different set of challenges, some of which are related to the unique concerns of this age group as well as to a lack of awareness of updated vaccination recommendations.
Barriers to Vaccinating Adolescents
Opportunities to immunize adolescents are frequently missed. One large US survey of adolescents enrolled in Harvard Pilgrim Health Care (N = 23,987) in 1997-2004 found an average of 5 missed opportunities to vaccinate occurred for each adolescent who was eligible to receive an immunization and had contact with the healthcare system. Although every point of contact with a healthcare provider represents an opportunity to vaccinate, adolescents are most likely to be vaccinated during preventive care visits, when providers are most likely to review immunization records. The highest vaccination rates for the tetanus/diphtheria vaccine, for example, in the Harvard Pilgrim study were in adolescents who had used preventive care services (Figure 11). Pediatricians and family practitioners are far less likely to review immunization records when adolescents visit the office for acute health complaints, and fewer still use these opportunities to administer vaccines.[48,49] Although the likelihood of adolescents receiving vaccines at health maintenance visits is increased, most surveys at the US national and state level indicate adolescents frequently do not receive recommended preventive care interventions regardless of their reason for visiting the clinic. Physicians cite lack of time and patient interest, as well as compensation and confidentiality/patient privacy issues as reasons for this deficiency.
Funding by Novartis – heavily invested in the vaccine industry