July 8, 2008 Vaccinating infants and toddlers is an almost universal practice in the United States. Vaccines to prevent flu are a regular part of medical care for senior citizens and at-risk patients. But, according to a new study, the US healthcare system is not very effective in getting vaccines to the adolescent population.
In response to a request from the Assistant Secretary for Health, the Adolescent Working Group of the National Vaccine Advisory Committee (NVAC) conducted an assessment of the current state of adolescent immunizations and identified issues that will require national attention in the coming months and years if current and future recommended adolescent immunizations will be used to their potential.
There are three new vaccines available and recommended for adolescents that prevent a total of five diseases that can have a range of devastating health consequences. Individual vaccines protect against meningococcal meningitis and human papillomavirus and a combined vaccine protects against tetanus, diphtheria, and pertussis. All three vaccines have been shown to be safe and effective.
The authors cite six topics with unique applications to adolescent immunization. There are venues for vaccine administration, consent for immunizations, communication, financing, surveillance, and the potential for school mandates.
The traditional role of the primary care physician to administer vaccines may not be effective for adolescents, who tend to enter the healthcare system only for acute problems. Additional healthcare settings that can provide additional access include pharmacies, family planning and sexually transmitted infection clinics, obstetrician--gynecologist offices, emergency departments, teen clinics and health departments.
The ability of adolescents to consent for health care--including vaccinations--differs substantially by state and by health condition. This variability could have a major impact on our nation's ability to achieve immunization coverage in this age group. Significant and potentially controversial issues arise upon making a vaccination available to adolescents -- especially in nontraditional settings.
Convincing adolescents and young adults to engage in preventive behaviors is difficult. Current programs have not been successful in immunizing a major portion of adolescents with the tetanus booster. Without a new approach to communication and new communications materials, the public, providers, parents, and the adolescents themselves may not understand the need and the appropriate timing of these vaccinations.
These new vaccines for adolescents are among the most expensive vaccines recommended today for any age group. Their aggregate estimated price per adolescent in the private sector is approximately $500. This has the potential to put a considerable strain on both the public and private financing sectors. These costs, when combined with the fact that fewer adolescents have insurance coverage for preventive services, must be addressed.
Surveillance is important to effective implementation and evaluation of public health programs. U.S. surveillance systems have limited capacity to yield data related to disease burden, vaccination coverage, and vaccination impact among adolescents. For surveillance systems to work, many healthcare providers will require education regarding the importance of disease reporting, adverse event reporting, and participating in immunization information systems.
School-entry requirements, or mandates, have proven to be an effective mechanism to raise immunization rates among children in the U.S. Because some of these new vaccines differ from older vaccines with regard to the nature of transmission of the disease they prevent, they raise novel legal and policy issues that must be addressed to determine if a school mandate strategy should be implemented. As school entry requirements are under the purview of individual states, there is no federal legislative role in this process.
According to lead author Gary L. Freed, MD, MPH, University of Michigan, "Our nation is in a new position regarding the healthcare of adolescents. With increasing challenges to their health, including obesity, diabetes, sexually transmitted infections and mental health issues, adolescents are vulnerable as they grow into adults. With three new vaccines available to combat five serious diseases there is an opportunity to prevent these specific illnesses, to help adolescents increase their healthcare access and to support their growth and development to productive adults. There is also unique opportunity to establish a culture of immunization among adolescents that may lead them to pursue immunization as adults as well as eventually for their own children in greater numbers. Our nation must find the ways to ensure the promise of these new preventive measures are fulfilled. Some of these issues raised will require additional information to determine the best course of action. For the future of our nation, the time to begin this process is now."
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- The Promise and Challenge of Adolescent Immunization. American Journal of Preventive Medicine, Volume 35, Issue 2 (August 2008)
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