Taking Action to Address Critical Gaps in Teen Immunization

Audrey M. Stevenson, PhD, MPH, FNP-BC

You may have heard about vaccine-preventable diseases impacting our nation’s teens, but the problem is larger than many realize. According to recent data from the Centers for Disease Control and Prevention (CDC), millions of Americans aged 13-17 are under-vaccinated against serious infectious diseases.

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Specifically, the CDC recommends all teens receive at least the quadrivalent meningococcal meningitis vaccine (MenACWY)*; human papillomavirus (HPV) vaccine; tetanus, diphtheria and acellular pertussis (Tdap) vaccine; and influenza (flu) vaccine.

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Although there is some good news—we’re seeing incremental year-over-year improvement in vaccination rates overall—the coverage rates for vaccines that need to be administered as multi-dose series remain low.

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For example, in 2016, 82.2% of teens received the first dose MenACWY vaccine, but only 39.1% of teens received the recommended second dose.¹ The data also show less than half of teens (49.5% of girls and 37.5% of boys) completed the HPV vaccination series.

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These gaps in vaccination coverage could have significant health consequences. Meningococcal meningitis, though rare, can cause death in a matter of hours,

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and, more than 31,500 women and men are affected by cancer caused by HPV each year. That equates to a new, potentially preventable case every 20 minutes.⁶

We need to act to help protect more teens, especially when they turn 16. To this end, the CDC recently modified the Childhood and Adolescent Immunization Schedule, calling out a specific 16-year-old immunization visit.⁷ This is a step in the right direction, but rates won’t improve significantly until this visit becomes a standardized platform like the 11- to 12-year-old immunization/preventive services visit. This visit has contributed to vaccination rates for Tdap vaccine and the first dose of MenACWY surpassing Healthy People 2020 goals.

To support this effort, I’m working with a multidisciplinary group of experts specializing in adolescent health and immunization, known as the Adolescent Immunization Initiative (AII). Our mission is specifically focused on firmly establishing a 16-year-old immunization platform. The platform has several potential benefits, such as helping teens catch up on missed immunizations and assessing vaccinations for high-risk conditions. Ultimately, the platform could help improve adolescent preventive health care overall.

As a clinician, you can also make the 16-year-old platform a reality by implementing it in your practice and making it a routine part of older adolescent health. You can find out more about the potential benefits of a 16-year-old visit and the structure of this visit here.

*The serogroup B meningococcal vaccine (MenB) vaccine is also recommended for certain adolescents at increased risk, e.g., students on college campuses that have recently experienced meningococcal B outbreaks.⁸

Contagion^® Editorial Advisory Board member, Audrey M. Stevenson, PhD, MPH, MSN, FNP-BC, holds master of public health and master of nursing degrees and received her doctorate in public health from the University of Utah. She has worked in public health for the past 28 years and is currently Division Director of Family Health Services of the Salt Lake County Health Department in Salt Lake City, Utah. In October 2010, Dr. Stevenson was awarded the American Nurses Association Immunity Award as a result of her efforts to promote the use of tetanus, diphtheria, and acellular pertussis vaccine at public health clinics, resulting in a new protocol at several Utah hospitals to offer the vaccine to postpartum women prior to discharge.

References

1. Walker TY, Elam-Evans LD, Singleton JA, et al. National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13—17 Years—United States, 2016. MMWR Morb Mortal Wkly Rep 2017;66:874–882. DOI: http://dx.doi.org/10.15585/mmwr.mm6633a2.
2. United States Census Bureau. (2013). Age and Sex Composition in the United States. https://www.census.gov/data/tables/2013/demo/age-and-sex/2013-age-sex-composition.html. Updated August 11, 2016. Accessed October 17, 2017.
3. Centers for Disease Control and Prevention (2016). Vaccines for Your Children: Protect Your Child at Every Age — 11 to 12 Years. Retrieved from http://www.cdc.gov/vaccines/parents/protecting-children/years-11-12.html. Updated February 15, 2017. Accessed October 17, 2017.
4. Centers for Disease Control and Prevention. (2016). National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13—17 Years—United States, 2015. Retrieved from http://www.cdc.gov/mmwr/volumes/65/wr/mm6533a4.htm?s_cid=mm6533a4_e.
5. Centers for Disease Control and Prevention. (2017). Meningococcal Disease Signs and Symptoms. Retrieved from https://www.cdc.gov/meningococcal/about/symptoms.html
6. Centers for Disease Control and Prevention (2017). HPV and Cancer. Retrieved from https://www.cdc.gov/cancer/hpv/statistics/cases.htm.
7. Centers for Disease Control and Prevention (2017). Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, UNITED STATES, 2017. Retrieved from https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule-bw.pdf.
8. Centers for Disease Control and Prevention. (2017). Meningococcal Vaccination: What Everyone Should Know. Retrieved from https://www.cdc.gov/vaccines/vpd/mening/public/index.html#should.