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What’s New With Adolescent Immunizations

What’s New With Adolescent Immunizations. Breena Holmes, MD Director: Maternal and Child Health. Objectives. Review current recommendations for adolescent immunization Factors affecting immunization rates in adolescence Review and share strategies to improve rates.

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What’s New With Adolescent Immunizations

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  1. What’s New With Adolescent Immunizations Breena Holmes, MD Director: Maternal and Child Health

  2. Objectives Review current recommendations for adolescent immunization Factors affecting immunization rates in adolescence Review and share strategies to improve rates

  3. Recommended Adolescent Immunizations Tetanus, diptheria, pertussis Human papillomavirus Meningococcal Influenza

  4. Catch up and High risk Hepatitis A (2 doses) Hepatitis B (3 doses) Measles, mumps, rubella (2 doses) Varicella (2 doses)

  5. Tdap 2006: 11-12 year old booster (waning immunity) Required for Vermont school entry Vermont data: any Tdap since age 10= 83% National data (2009): 56%

  6. Human Papilloma Virus HPV prevalence = 40% age 14-19 year olds HPV4 (types 6,11,16,18) licensed for males and females Vaginal, vulvar, cervical, anal, penile, oropharyngeal Genital warts

  7. Human Papillomavirus May 2010 ACIP: males age 9-26 permissive recommendation but not routine Vaccine should either be provided upon parental request OR proactively offered during office visit

  8. Human Papillomavirus Vermont data (2010): 50% of adolescent females received at least one dose of HPV 2009: 60% What happened? All 3 doses (2010): 39% National data (2009): 44% of adolescent females received at least one dose of HPV

  9. Meningococcal Invasive disease: pneumonia, meningcoccemia, meningitis, death Adolescents and young adults in close proximity 2010, MCV4 age 11-12 and booster for 16 year olds Vermont Data (2010): 54% (one dose) National Data (2009): 56% (one dose)

  10. Influenza 2008: routine vaccination to all children age 6 months to 18 years 2010: any one older than 6 months Vermont data: 38%

  11. Patient-level Barriers Adolescent Well Visits Vermont data (2010): 46% annual visits (Medicaid) Awareness Antivaccine movement Consent

  12. Provider-level Barriers Perceived patient behavioral risk Knowledge Disease risk Prevalence Revised schedule Patients not coming in (annual visits)

  13. Strategies Recall and reminder systems: In several studies, clinic staff reminder significantly more effective in lowering no-show rates compared with automated appointment reminder Teen-friendly setting and hours Immunizations at Acute Visits Any visit as opportunity

  14. Strategies Printed info sheets for parents and adolescents Refusal to vaccinate forms to sign Review IZ and flag all adolescent charts for Well Exams and Acute Visits Post IZ schedule in exam rooms CDC campaign: They think meningitis is a band from the 80s

  15. Strategies School entry requirements School-based vaccination programs Emergency Departments offer Tdap instead of Td Set up conversation at earlier visit (age 10)

  16. Strategies Thoughts? Comments? Breena.holmes@state.vt.us

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