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 study published in the August 2008 issue of the American Journal of Preventive Medicine, 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."

"The Promise and Challenge of Adolescent Immunization" by the National Vaccine Advisory Committee.
Corresponding author - Gary L. Freed, MD, MPH.
American Journal of Preventive Medicine, Volume 35, Issue 2 (August 2008) published by Elsevier.
American Journal of Preventive Medicine

National Vaccine Advisory Committee

Gary L. Freed, MD, MPH , Chair, University of Michigan Health Systems
Jon R. Almquist, MD, Virginia Mason Medical Center
Guthrie S. Birkhead, MD, MPH, New York State Department of Health
Cornelia Dekker, MD, Stanford University School of Medicine
Mark Feinberg, MD, Merck & Co., Inc.
Jaime Fergie, MD, FAAP, Driscoll Children's Hospital
Lance K. Gordon, PhD, Vaccine Research & Development Consultant
Alan R. Hinman, MD, The Task Force for Child Survival
Sharon G. Humiston, MD, MPH, Strong Memorial Hospital
Calvin Johnson, MD, MPH, Pennsylvania Department of Health
Jerome O. Klein, MD, Boston University School of Medicine
Mary Beth Koslap-Petraco, MS, CPNP, Department of Health Services for Suffolk County, New York
Charles Lovell, Jr., MD, MACP, York Clinical Research
Trish Parnell, Parents of Kids with Infectious Diseases
Andrew Pavia, MD, University of Utah School of Medicine
Laura E. Riley, MD, Massachusetts General Hospital
Adele E. Young, PhD, George Mason University

About The American Journal Of Preventive Medicine

The American Journal of Preventive Medicine is the official journal of The American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials.

The American Journal of Preventive Medicine is ranked 13th out of 100 Public, Environmental & Occupational Health titles and 17th out of 100 General and Internal Medicine titles according to the 2007 Journal Citation Reports© published by ThomsonReuters.

About Elsevier

Elsevier is a world-leading publisher of scientific, technical and medical information products and services. Working in partnership with the global science and health communities, Elsevier's 7,000 employees in over 70 offices worldwide publish more than 2,000 journals and 1,900 new books per year, in addition to offering a suite of innovative electronic products, such as ScienceDirect , MD Consult, Scopus, bibliographic databases, and online reference works.

Elsevier is a global business headquartered in Amsterdam, The Netherlands and has offices worldwide. Elsevier is part of Reed Elsevier Group plc, a world-leading publisher and information provider. Operating in the science and medical, legal, education and business-to-business sectors, Reed Elsevier provides high-quality and flexible information solutions to users, with increasing emphasis on the Internet as a means of delivery. Reed Elsevier's ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).

Elsevier