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National Vaccine Advisory Committee recommends increased adolescent immunization
July 08, 2008Vaccinating 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."
Elsevier Health Sciences
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."
Elsevier Health Sciences
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Marking its tenth anniversary year, the PATH Malaria Vaccine Initiative (MVI) today unveiled a new strategy that sets the stage for an aggressive push targeting the long-term goal of eliminating and eradicating malaria. Malaria is one of the world's deadliest infectious diseases, killing nearly 900,000 people a year, most of them children in sub-Saharan Africa.
Progress made on group B streptococcus vaccine
Scientists supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, have completed a Phase II clinical study that indicates a vaccine to prevent Group B Streptococcus (GBS) infection is possible.
Pandemic flu vaccine campaigns may be undermined by coincidental medical events
The effectiveness of pandemic flu vaccination campaigns - like that now underway for H1N1 - could be undermined by the public incorrectly associating coincidental and unrelated health events with the vaccines.
Older Patients with Dementia at Increased Risk for Flu Mortality
An epidemiological study on pneumonia and influenza (P&I) in adults age 65 and over reports that patients with dementia are diagnosed with flu less frequently, have shorter hospital stays, and have a fifty percent higher rate of death than those without dementia.
Flu shots not to be sneezed at
Two in five at-risk American adults who would benefit from vaccination against seasonal flu are missing out on the protective shots because they believe they do not need them and are not inclined to be vaccinated.
MedImmune to present data on RSV and influenza at 2009 AAP National Conference and Exhibition
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Outfoxing pox: Developing a new class of vaccine candidates
In the annals of medicine, Edward Jenner's 1796 vaccination of a young boy against smallpox, using fluid from cowpox blisters, remains a landmark case. In a new study, Kathryn Sykes, a researcher at Arizona State University's Biodesign Institute and her colleagues have taken a fresh look at cowpox.
African cattle to be protected from killer disease
Millions of African families could be saved from destitution thanks to a much-needed vaccine that is being mass-produced in a drive to protect cattle against a deadly parasite.
Protect Children First With H1N1 Flu Vaccine, Says UAB-Based National Pediatric Disease Expert
The optimal way to control swine flu, the new H1N1 virus that emerged as a global threat in 2009, is to vaccinate children with the planned H1N1 flu shot, says the co-director of the University of Alabama at Birmingham (UAB) Division of Pediatric Infectious Diseases.
Pregnant women need flu shots
Pregnant women should be sure to get all their flu shots as soon as the vaccines become available this year to protect them against both the seasonal flu and the H1N1 (swine) flu, according to eight leading national maternal and infant health organizations.
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