Appropriate strategies have been called for to get new
vaccines to the adolescent population in US.
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 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
School-entry requirements, or mandates, have proven to be an
effective mechanism to raise immunization rates among children in the U.S. But as
school entry requirements are under the purview of individual states, there is
no federal legislative role in this process.
As it stands the US healthcare system is not very
effective in getting vaccines to them, says a study published in the August
2008 issue of the American Journal of Preventive Medicine
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.
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 the 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, it is felt. 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.
According to lead author Gary L. Freed, 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."