What’s New With Adolescent Immunizations

Breena Holmes, MD

Director: Maternal and Child Health

What’s New With Adolescent Immunizations

Objectives

Review current recommendations for adolescent immunization

Factors affecting immunization rates in adolescence

Review and share strategies to improve rates

Recommended Adolescent Immunizations

Tetanus, diptheria, pertussis

Human papillomavirus

Meningococcal

Influenza

Catch up and High risk

Hepatitis A (2 doses)

Hepatitis B (3 doses)

Measles, mumps, rubella (2 doses)

Varicella (2 doses)

Tdap

2006: 11-12 year old booster (waning immunity)

Required for Vermont school entry

Vermont data: any Tdap since age 10= 83%

National data (2009): 56%

Human Papilloma Virus

HPV prevalence = 40% age 14-19 year olds

HPV4 (types 6,11,16,18) licensed for males and

females Vaginal, vulvar, cervical, anal, penile,

oropharyngeal Genital warts

Human Papillomavirus

May 2010 ACIP: males age 9-26 permissive recommendation but not routine Vaccine should either be provided upon

parental request OR proactively offered during office visit

Human Papillomavirus

Vermont data (2010): 50% of adolescent females received at least one dose of HPV 2009: 60% What happened? All 3 doses (2010): 39%

National data (2009): 44% of adolescent females received at least one dose of HPV

Meningococcal

Invasive disease: pneumonia, meningcoccemia, meningitis, death

Adolescents and young adults in close proximity

2010, MCV4 age 11-12 and booster for 16 year olds

Vermont Data (2010): 54% (one dose) National Data (2009): 56% (one dose)

Influenza

2008: routine vaccination to all children age 6 months to 18 years

2010: any one older than 6 months

Vermont data: 38%

Patient-level Barriers

Adolescent Well Visits Vermont data (2010): 46% annual visits

(Medicaid)

Awareness Antivaccine movement

Consent

Provider-level Barriers

Perceived patient behavioral risk Knowledge

Disease risk Prevalence Revised schedule

Patients not coming in (annual visits)

Strategies

Recall and reminder systems: In several studies, clinic staff reminder significantly more effective in lowering no-show rates compared with automated appointment reminder

Teen-friendly setting and hours

Immunizations at Acute Visits Any visit as opportunity

Strategies

Printed info sheets for parents and adolescents

Refusal to vaccinate forms to sign

Review IZ and flag all adolescent charts for Well Exams and Acute Visits

Post IZ schedule in exam roomsCDC campaign: They think meningitis is a

band from the 80s

Strategies

School entry requirements

School-based vaccination programs

Emergency Departments offer Tdap instead of Td

Set up conversation at earlier visit (age 10)

Strategies

Thoughts? Comments? Breena.holmes@state.vt.us