The Need to Optimize Adolescent Immunization

Abstract

The adolescent period heralds the pediatric patient's transition into adulthood. It is a time of dynamic development during which effective preventive care measures can promote safe behaviors and the development of lifelong health habits. One of the foundations of preventive adolescent health care is timely vaccination, and every visit can be viewed as an opportunity to update and complete an adolescent's immunizations.In the past decade, the adolescent immunization schedule has expanded to include 2 doses of quadrivalent meningococcal conjugate vaccine, 1 dose of tetanus, diphtheria, acellular pertussis, absorbed vaccine, 2 or 3 doses of human papillomavirus vaccine, depending on the child's age, and an annual infl uenza vaccine. In addition, during adolescent visits, health care providers can determine whether catch-up vaccination is needed to meet early childhood recommendations for hepatitis B; hepatitis A; measles, mumps, rubella; poliovirus; and varicella vaccines. New serogroup B meningococcal vaccines are now available for those at increased risk for meningococcal disease; in addition, these serogroup B meningococcal vaccines received a Category B recommendation for healthy adolescents, where individual counseling and risk-benefi t evaluation based on health care provider judgements and patient preferences are indicated. This clinical report focuses on the epidemiology of adolescent vaccine-preventable diseases by reviewing the rationale for the annual universally recommended adolescent immunization schedule of the

A review of the immunogenicity, safety and current recommendations for the meningococcal serogroup B vaccine, MenB‐FHbp

“…Later in 2015, ACIP issued a Category B recommendation for MenB vaccination in individuals aged 16‐23 years, with vaccination preferred between the ages of 16 and 18 years . As indicated by the Category B classification, the decision to vaccinate (or not) will be based on the judgment of the healthcare provider and individual patient/family preference following discussion and evaluation of the risks and benefits of MenB vaccination …”

“…Compared with younger children, older adolescents generally have fewer primary care visits and more visits with specialists, who are less focused on vaccination . There are also a number of potential provider‐related barriers to immunization, including knowledge gaps with respect to vaccine indications and recommendations, and poor communication with parents and/or adolescents . Healthcare policies for vaccination may play a key role in overcoming barriers to vaccination, but until those are widespread, those at the point of care (ie healthcare providers) are the ones who must encourage patient vaccination.…”

“…51 As indicated by the Category B classification, the decision to vaccinate (or not) will be based on the judgment of the healthcare provider and individual patient/family preference following discussion and evaluation of the risks and benefits of MenB vaccination. 81,82 In October 2016, ACIP provided updated recommendations for MenB-FHbp in response to FDA approval earlier that year of both a 2-dose (0 and 6 months) and a modified 3-dose (0, 1-2 and 6 months)…”

“…Despite ACIP recommendations regarding MenB vaccination, there remain a number of barriers to immunization in adolescents and young adults, including cost (real or perceived), supply and a lack of vaccination opportunities. 82 Compared with younger children, older adolescents generally have fewer primary care visits and more visits with specialists, who are less focused on vaccination. 84,85 There are also a number of potential provider-related barriers to immunization, including knowledge gaps with respect to vaccine indications and recommendations, and poor communication with parents and/or adolescents.…”

Missed opportunities for HPV immunization among young adult women

“…These visits are excellent opportunities for providers to encourage patients to receive the HPV immunization because studies have shown that patients are more willing to accept the HPV vaccine when it is viewed as routine or when given with other injections. 33 …”