Slide Lecture with Audio
This activity is based on a 45-minute slide lecture presented Susan G. Humiston, MD, MPH. This program is available as read only and with accompanying audio.
*Scroll to read lecture and/or follow along with audio.
Slide 1: Welcome to the teleconference, “Adolescent Immunization Update: Opportunities to Prevent Pertussis, Meningococcal Disease, and HPV.” This program is jointly sponsored by Medical Education Collaborative, Inc and Princeton CME, and is supported by an unrestricted educational grant from sanofi pasteur. I am Dr. Sharon Humiston, associate professor of emergency medicine and pediatrics at the University of Rochester Medical Center, and I will be your presenter. Please note that all faculty disclosures for this program are included in the front of your activity booklet.
Slide 2: Please turn now to slide number 2, the one that says, Learning Objectives at the top. I want to go over the learning objectives with you briefly. We are going to summarize the clinical and economic burden of pertussis, meningococcal disease, and HPV in the adolescent population; identify potential barriers to adolescent immunization and review the importance of timely vaccination in this high-risk group; recognize opportunities for vaccine administration in healthy adolescents, particularly among the younger adolescents 11 to 12 years of age; and finally, adopt into clinical practice updated Advisory Committee on Immunization Practices, or ACIP, recommendations for adolescent vaccination. I am going to say that—ACIP—over and over, so I am not going to go through the whole acronym every time. I just want you to remember that ACIP is the group that advises the CDC. So those were our learning objectives.
Please remember that to receive continuing education credit following the conclusion of this activity, each participant must complete the post-test and evaluation form located in the back of the activity booklet. These forms can be easily completed online at www.princetoncme.com. Participants seeking CME credit who successfully complete the post-test and evaluation form online may immediately print their documentation of credit. Participants who mail or fax back their successfully completed post-test and evaluation form for CME credit will receive documentation of credit by mail within 6 weeks. All participants seeking CNE credit—whether post-test and evaluation form are submitted online or via mail or fax—will receive their documentation of credit by mail within 6 weeks.
So thank you again for joining us.
Slide 3: I would like you now to turn to the slide that says at the top, Immunization Practices. As we go through the slides, there is more information on the slides than I am going to get to in the next 40 minutes, but you have the slides to go back and review some of the details that I will miss.
So for our first slide, Immunization Practices. The ACIP recommends immunization against 17 vaccine-preventable diseases across the life span. The routine childhood vaccination with that series, that you see there—which is not the complete 17 by any stretch—prevents an estimated 14 million cases of disease and more than 33,000 deaths in the United States over the lifetime of a child. I think that is pretty exciting. Sometimes we hear from families about too many injections, but when you think about the number of cases of disease and the number of deaths that are prevented, it puts a different light on things.
In 2006, 77% of children 19 to 35 months of age received the recommended series of vaccines. That is what I would consider a mid-C level performance. Not perfect, but much better than we are doing with adolescents.
Slide 4: Let’s look at our next slide, Adolescents: A High-Risk Population. Adolescents are at risk due to waning immunity from childhood vaccines. I think here about pertussis, in particular, because we know that is an inactivated vaccine and that inactivated vaccines tend to wane over time. Missing doses of childhood vaccines; for example, varicella vaccine may have come out just as these kids were at an age when they could have gotten it. So, maybe they missed out on some of the childhood vaccines like that one. Increased exposure to disease via close contact, and here I think about meningococcal disease because people living in barracks, for example, are at increased risk. So, for these reasons, adolescents are at increased risk.
Currently, none of the vaccine-related Healthy People 2010 goals for adolescents 13 to 15 years of age have been achieved, which is not too surprising. The goals include 90% coverage for all recommended vaccines.
Slide 5: So what are the obstacles that keep adolescents from being fully vaccinated?
Adolescents frequently do not seek preventive healthcare. Well, every primary care provider knows that. They tend to be a pretty healthy group of kids, and so they are not coming in except for sports physicals. They often lack insurance or financial coverage, including financial coverage for vaccines. They may visit more than one provider or alternative settings like school-based healthcare centers. So, no one is quite sure who is giving the vaccines.
There are also reasons outside the adolescent group themselves in the way offices are set up and the way the healthcare systems, in general, are set up that are barriers to immunization for adolescents. There is primarily a focus on infant and childhood vaccinations; the ACIP only recently—in the last 3 years—came out with all of these recommendations. And, school requirements often do not exist for adolescents.
Slide 6: Let’s look now at the early adolescent visit. By early adolescent, here, I am talking about 11- and 12-year-olds. There are a number of groups that recommend an early adolescent well visit, and that visit can be used as an opportunity for vaccine administration as well as all of the rest of the great preventive measures that are important in keeping kids healthy and on track. Since 2005, the ACIP has recommended the vaccines we will talk about today: Tdap, the meningococcal vaccine (MCV4), and the HPV vaccine, for females only, of course.
Slide 7: So, it has been since 2005, so this is not exactly new news that we are going to be talking about today. It is just a reminder and a review, but also a statement of the solidity of these recommendations. This is not news. This is pretty much standard practice now. And, you see that reflected, on the next slide, the recommended schedule for persons 7 to 18 years of age. The ACIP has actually come out now and separated out the adolescent immunization schedule from the childhood one just because it is an entity unto itself.
Slide 8: We are going to move into our first disease, pertussis.
Slide 9: This is easily transmitted through respiratory secretions. It is a pretty indiscriminate bug that goes around a classroom quite easily. It starts out in a way that is similar to an upper respiratory infection—just a common cold—and so kids continue to go to school even though they have early signs of pertussis. That is one of the reasons why this disease is so efficient at getting around a classroom. The last bullet on this slide—pertussis is often in adults and adolescents unrecognized and they become the source of the infection for infants who become severely ill and even, unfortunately, end up dying from pertussis.
Slide 10: On our next slide, Pertussis in the United States, 1980-2005, I want to make 2 main points with this: one is that you see that there has actually been a rise in pertussis reporting in recent years, and two, that pertussis is the only vaccine-preventable disease where we know of a rise in the incidence. So that is worrisome. It may be partly because of better reporting, but, in any case, we know that there were at least 25,000 cases of pertussis reported in the United States in 2004. So that is the number reported; we know that there are even more out there. That is worrisome.
Slide 11: If you look at the next slide, Distribution of Pertussis by Age Group, you see that adolescents are the group that has the highest incidence and it is not too surprising. As we said before, they are in close quarters and they are not immune because the childhood vaccine has worn off. So, it is not too surprising that this group is affected.
Slide 12: Our next slide, The Economic Impact of Pertussis. You see, first, the direct medical cost and that varies by age, so that the youngest kids are the ones with the highest direct medical costs—not too surprising given that they are often hospitalized. The indirect costs—what I mean by indirect costs, cost to society, lost work, not being able to perform your normal functions. So those indirect costs are difficult to estimate, but can often be substantial because adults who get the disease are out of work, but also adults who have a child who has been coughing for 100 days end up losing work to take them to the doctor or stay home with them.
Slide 13: Our next slide, Pertussis Among Adolescents. Childhood immunity to pertussis wanes 5 to 10 years after the initial vaccination administration. That is not new news; that has always been known. What is the news here is that now we have a way—because of the licensure of Tdap—that new vaccine makes it so that we can give a booster later in life in a safe and effective way. The complications—again, I will not dwell on this because I think you are already pretty well aware of it—but the persistent cough is the big issue. And, there is a good reason why pertussis is called the 100-day cough. Ninety-seven percent of people will cough for 3 weeks or more, and 47% will cough for 9 weeks or more.
Slide 14: Our next slide, showing that there are 2 different brands of Tdap vaccine, and you see here the trade names are shown and the approval age range which is different for each vaccine. That is important for family medicine or emergency medicine. Emergency medicine, of course, we need to see all age groups.
Slide 15: Our next slide, the ACIP Recommendations for Tdap. Routinely, the CDC says we should be giving Tdap to 11- to 12-year-olds, and catch up for anyone 13 to 18 years of age who did not already receive 1 dose. I will emphasize that 1-dose issue. Currently, both brands of Tdap are licensed only as single-dose administration. They are not currently licensed as routine every-10-year vaccinations, like the Td. There may be a time when that is the way it is licensed; unfortunately, that is not the way it is currently. But, we still have about 7 years for that to come to pass.
Slide 16: Our next slide, Tdap Efficacy in Adolescents and Adults. This slide is only here just to emphasize to you that this vaccine is efficacious against prolonged cough. I will not go through the numbers.
Slide 17: Tdap contraindications; first and foremost, severe allergic reaction to the vaccine or any vaccine component. That is true with all vaccines, of course, that if someone has a severe anaphylactic-type allergy—I am talking hives or respiratory distress after vaccination—that person would not go on to get further doses of that vaccine. The only one that is different for Tdap is this second one: prior encephalopathy within 7 days of administration of a previous pertussis-containing vaccine that was not attributable to another cause. So that is true—remember for your infant formulation, DTaP—that is also true for Tdap.
Slide 18: The next slide, Tdap Precautions. I just want to say a word about what I mean by precautions. Here, these are conditions in a person that make it so that they are at some increased risk of having a side effect from a vaccine. So, now you are in a situation where you need to use clinical judgment before vaccinating the person, and it comes down to, as a clinician, you weigh the risk of the disease versus the risk of the vaccine, and you make an individualized decision, because there is no way for the FDA to make that decision about this individual. So, that is what we mean by precautions throughout the whole talk.
The precautions are shown here, and again I will not go through them, but I just want to emphasize that some of these are the same as the contraindications to the infant formulation for the vaccine. So, for example, progressive neurologic disorder, uncontrolled epilepsy, and progressive encephalopathy would be contraindications for DTaP, but are just precautions for Tdap. So, a little bit different than our infant formulation.
Slide 19: Next slide, Minimum Interval between Td and Tdap. This often comes up because people, like me, wanted to get a pertussis vaccine, but was up-to-date on my Td. And so, my hospital infection control folks were reluctant to give me a Tdap because they said, Well, it has only been 2 years since your last Td. Here, the 5-year interval is encouraged to reduce the chance of a local reaction, but the ACIP does not define an absolute minimum interval.
There was a Canadian study, which Scott Halperin looked at, if there was an increase in adverse effects with vaccination within 2 years of a Td. He showed that there was no increase in side effects. So, again, this is one of those things that comes down to clinical judgment. I think very often if you have an adolescent who is going to be in school or a healthcare provider who is going to be seeing patients—we have had pertussis plenty of times in the emergency department—so I really needed protection. Although there is a 5-year interval recommended, you can bring it down.
Slide 20: Our next slide, DTaP and Tdap Administration Errors. Intuitively, you might think that the DTaP, the infant formulation, would have a lower dose of the antigens because it is for smaller people. In fact, it has a higher dose of the antigens, because it is for immune-naive people. So, by and large, we want to give the infant formulation for infants and the adolescent formulation to adolescents, and not mix and match. That is very important.
What do you do if, lo and behold, you find out there has been an error? First of all, preventing the error is the key, but if you are in a situation where you find out that a vaccine was given in error, what do you do? DTaP administered to a person 7 years of age or older; well basically, you gave a higher dose to someone than they should have gotten. They may have a sore arm, but you count the dose as valid because it was too high a dose.
Next line down. Tdap administered to a child younger than 7 years of age as dose 1, 2, or 3—the primary series. Well, in this case, you gave too low a dose in the primary series, and in that case, you do not count the dose. The person needs to have the DTaP administered as soon as possible. That is a really unfortunate circumstance, you really do not want that to happen; but if it happens, readminister the vaccine so that the person is protected against these 3 important diseases.
And, the third line down, Tdap administered to a child younger than 7 years of age as 1 of the booster doses, dose 4 or 5. In that case, you can count the dose as valid because it was intended to be a booster dose and the lower adolescent antigen level would probably be okay. Again, not ideal, but if it happens, you at least do not have to readminister the vaccine.
Slide 21: Our next slide, Tdap for persons without a history of any prior pertussis vaccination. This may happen because someone has simply lost their vaccine administration records, they came from another country, or when they were young their parents refused to let them have a pertussis vaccine. In summary, the ACIP’s preferred schedule is a single dose of Tdap—and remember we said that it is not licensed to be given over and over, it is just a single-dose licensure right now. So, the second dose as Td at least 4 weeks after that first dose and a second dose of Td at least 6 months after the initial Td dose. So, 3 doses, only 1 of them containing a pertussis portion of the vaccine. So, it is not ideal, but it is the best that we can do under current licensure.
Slide 22: Moving now to meningococcal disease. You see here some of this sequelae and we will get into that.
Slide 23: Meningococcal disease is a terrible disease. You see in the first slide in this section some of the characteristics of the infection and some of the side effects. If you have seen 1 case, you will never forget this.
Slide 24: Our next slide, Clinical and Economic Burden of Meningococcal Disease. It is not a highly common disease—1400 to 2800 cases annually in the United States—but the mortality rate is what stands out: overall, 10% to 14%. Unfortunately, adolescents and young adults have a higher mortality rate than that, it is thought because they have a great immune response and so their own bodies end up working against them to have them end up in circulatory collapse. Eleven to 19% of survivors end up with disease-related complications. You saw in the picture at the beginning of this section, 1 of them is amputations. Often because of infection of the fluid surrounding the brain, you end up with hearing loss. There are some really devastating side effects.
The costs associated with meningococcal disease then are partly due to the direct effects—a prolonged hospitalization. And so, they are quite high for that reason. The costs are also high for the indirect effects. We were talking about earlier with pertussis the cost to society. Here, we have a high loss of life, but also long-term function problems, and so there is a high indirect cost as well.
Slide 25: The next slide, Rates of Meningococcal Disease by Age in the United States. This shows 2 different surveillance systems in the United States. It does not go down to infancy, so you do not see that infant spike, but it does show that through both surveillance systems that there is an adolescent spike. Well, why is that?
Slide 26: The next slide shows you meningococcal disease in adolescents. Increased-risk factors include household crowding, so people who live in dormitories or military barracks would be at increased risk. Smoking, drinking, hanging out at bars, those all put you at increased risk. So, unfortunately, through their behaviors some adolescents are at increased risk.
Eighty percent of meningococcal disease among adolescents is vaccine-preventable. In the United States, we use a vaccine that covers A, C, Y, and W-135. So, 4 different serotypes of the meningococcal disease. So, not all meningococcal disease is covered by our current vaccine, but 80% of adolescent meningococcal disease is covered.
Slide 27: I want to show you something about the vaccines on the next slide. The old vaccine, the pure polysaccharide, is shown on the right-hand side. The MPSV4—that is the polysaccharide—and you see the licensure date was 1978. That is now pretty much just used as an alternate vaccine to the current vaccine, MCV4, which was licensed in 2005. The C stands for conjugate. It means that the polysaccharide—that sugar moiety—is conjugated or joined to a protein moiety, so that when the vaccine comes into the body the antigen presents itself to the T-helper cell. That T-helper cell getting stimulated makes it so that the person ends up with long-term immunity, so that they have memory cells, and it also makes it so that the vaccine works better in younger people. It is also quadrivalent, as the old vaccine was. The FDA indication is 2 to 55 years of age. The CDC recommendation for this vaccine is 11 to 55 years of age. For older people—it is mostly just people who are in specific high-risk conditions, such as having asplenia or working in a laboratory with Neisseria meningitides.
The root of administration though is one of the things I really want to point out, and I will have you circle and highlight. The current vaccine, the conjugate vaccine, is an intramuscular vaccine. That is different than the old vaccine, which was given subcutaneously. So, I am highlighting sometimes for you the areas where it is easy for an office system to make an error. So, putting something in place so everybody knows that the new vaccine is given intramuscularly. You really want it go intramuscular and not subcutaneous because it has an adjuvant in it. The adjuvant stirs up the immune system, and by stirring up the immune system it makes it draw white blood cells to the area. If you put that subcutaneously, you are going to get a big welt. So, we really want it intramuscular.
Slide 28: Our next slide, Immunogenicity of MCV4 in Adolescents. I just want to summarize that slide quickly. It just says that the vaccine is long-lasting.
Slide 29: Our next slide, June 2007: Revised ACIP MCV4 Recommendations around this vaccine. The vaccine recommendations were greatly simplified, just to say that now all individuals 11 to 18 years of age should have 1 dose of this vaccine at the earliest opportunity. It is routine at 11 to 12 years of age, and catch-up from 13 to 18 years of age. So, a lot easier than trying to figure out, well, who is leaving for college this year, who is going to be a freshman, who is entering high school? None of that, just everybody 11 to 18 years of age. Why did they change the recommendations? You will see this in the next slide.
Slide 30: Basically, to simplify it. How much more complicated can the immunization schedule get, after all? And then, also because of the sufficient supply of MCV4 made it so that they could recommend it for everybody. Eventually, we will not need to be giving it to college students, because hopefully they will be having it when they are 11 to 12 years of age. So, that cohort will be fully vaccinated by the time they are reaching college. We had an outbreak of meningococcal disease in a college in New York State recently, and it is always a disaster when that happens.
Slide 31: MCV4 Timing. One of the things the ACIP emphasized in their last statement was that it should be given throughout the year. Do not wait until August so that there is a huge blip in the number of doses needed. Just be giving it all year long. MCV4 and Tdap can be given at the same visit, if both are indicated and available at the same time.
The other thing that the ACIP emphasized in their statement was that the VFC program—the Vaccine for Children program so that people could get free federal vaccine—only goes up to the last day of being 18 years of age. Once you turn 19 years of age, you are no longer eligible for VFC vaccine no matter what your insurance status is. So, for a lot of kids who would have to pay for this vaccine out of pocket if it were not for the federal program, you want to make very sure that they get it before they turn 19 years of age.
Slide 32: Contraindications and Precautions. You see on the next slide, pretty much standard to severe allergy and severe or moderate acute illness. The reason why all of these statements are about moderate-to-severe or acute illness is not because the vaccine will not work if you give it to somebody who has a fever. It is because it is hard then to separate out if someone is severely ill—they have a fever and they look really ill, and then you give them a vaccine and they look more ill; well, is it because their disease is worsening? Or, is it because they have some fever after vaccination? So, it is just to simplify disease management of the disease that was present before the vaccination. It has nothing to do with the efficacy of the vaccine. It has everything to do with not confusing emergency medicine doctors.
Slide 33: Our next slide, GBS and MCV4. Just to summarize, it is very hard to look at rare diseases. If there is an increase in GBS because of meningococcal vaccine, then it is uncommon. Nonetheless, persons with a history of GBS might be at increased risk for post-vaccination GBS. So it is a relative contraindication to receiving the vaccine. Again, here is one of those things where you need to have a clinician who discusses it with the family; your child may have a recurrence of their GBS, but which is better? That or being naive to meningococcal disease? I mean it comes down to that kind of discussion between a clinician and a family.
Slide 34: College students who are going to be freshmen living in a dormitory are at increased risk—4 to 5 times higher than their age-matched population. So, those kids really need the vaccine. Sometimes it is hard to sort out who is in that population. You know what? When we try to get into parsing out high-risk conditions, it is difficult. So, if you just give it to everybody in the age group, 11 to 18 years of age, you are good to go.
Slide 35: Add, then finally, our last disease we are going to talk about is HPV.
Slide 36: Our first slide that talks about HPV is an overview. I just want to emphasize that most infections resolve spontaneously, but this is really, really common, and the few that do not resolve spontaneously may go on to have serious side effects, including cervical cancer. HPV is detected in about 99% of all cervical cancers, so this is, again, one of those infections you really want to prevent.
Slide 37: On the slide that shows the different types and disease associations, you see that there are 2 main groupings: the mucosal/genital type and the nonmucosal type. One of the things that my daughter was worried about was, “I get skin warts. Does that mean I am going to get cervical cancer?” No, skin warts are a different group altogether.
The mucosal HPVs are also divided into 2 main types: the high-risk types, and you see that those are the ones that lead to cancer precursors and genital cancers, and the low-risk types, 6 and 11 are responsible for low-grade cervical abnormalities as well as genital warts and the laryngeal papillomas. The genital warts, of course, are unpleasant and have all kinds of psychological trauma. The laryngeal papillomas are a real problem. Children born through an infected birth canal can end up with these terrible papillomas that make it so that they have difficulty breathing and end up having to have them taken off over and over and over again.
Slide 38: The clinical burden of HPV and cervical cancer. Well, HPV being the most prevalent sexually transmitted infection in the United States, even if a small percent go on to be cervical cancer, then it ends up being a large number of people. So, you see there the estimate from the American Cancer Society. In 2006, they estimated 9700 new cervical cancer cases and 3700 cervical cancer deaths.
Slide 39: The economic burden of HPV in cervical cancer, the costs attributed to the prevention and treatment of HPV conditions, is $4 billion—with a B—annually in the United States. Now, not all of that will go away with the use of HPV vaccine, because we still need to do some cervical screening, but a great deal of it will go away.
Slide 40: Our next slide, HPV infects adolescents as well as older women. I just do not want you to think this is all about older women being infected.
Slide 41: If you turn to your next slide—the percentage of adolescents who have had vaginal sex by gender and age—you see that by 17 years of age, about half of girls and almost half of boys have had vaginal intercourse. Not something that we like to think about, but there it is and so as soon as you are having vaginal intercourse you are at greatly increased risk of HPV infection.
Slide 42: Moving now to the HPV vaccine. I want to say that there are actually 2 vaccines: 1 that is currently licensed is a quadrivalent vaccine against HPV serotypes 6, 11, 16, and 18. There is another one on the horizon; it is not currently licensed. I will not be talking about it or any of the data about it, but it is a bivalent vaccine that covers 2 of the types that cause cervical cancer.
Both vaccines, though, I will say are made in very similar ways. There is this outer capsid protein—this L1 outer capsid protein—and through recombinant technology, they can make lots and lots and lots of replications of this protein. It is a lot like hepatitis B vaccine, actually. The recombinant technology pours out, but what is different and interesting with this is this L1 protein self-assembles into this spear-like thing that ends up like the outer shell of the virus without any inner core. So it is not infectious, there is no DNA in it, it cannot replicate, it is not a living creature. But, it looks like the HPV virus.
Slide 43: HPV Vaccine: Indications. The FDA has approved this for females 9 to 26 years of age, and as we said, this is for the quadrivalent vaccine. Older females and males—it has not currently been licensed. There are studies in place to look at older females and males.
Slide 44: Our next slide, the efficacy for prevention of clinical HPV disease due to HPV 6, 11, 16, and 18. I am just going to highlight the efficacy column to show that against these end points, this vaccine is very efficacious.
Slide 45: Our next slide, Vaccine Efficacy in HPV-Infected Females. If a female is already infected with 1 of these types, the vaccine will not cure that infection. So, it is really important to get the vaccine in before she is infected. So, preferably before she has ever had vaginal intercourse, and we saw that by 17 half of kids will have had intercourse. So, we really want to push this back into early adolescence and remember that you have to have 3 doses in.
Slide 46: ACIP Provisional Recommendations. It is for females, 11 to 12 years of age with 3 doses of quadrivalent vaccine. They say you can start as early as 9 years of age, and I know a lot of offices that are aware that there are 13-year-olds actively having sex, and so to get 3 doses in they want to start at 9 years of age. Catch-up vaccination, up to 26 years of age and sometimes there is some pressure for use of the vaccine later in life—that is off-label use where it has to be discussed between the clinician and the person receiving the vaccine.
Slide 47: HPV Vaccinations Schedule, our next slide. It is a 3-dose series; unfortunately, it is not just one. And, it is given as soon as possible and then, at 2 months after that and 6 months. So, a 0, 2, 6 schedule. The minimum intervals are shown, meaning you do not want to give the vaccine at closer intervals than this; although, it is acceptable as much as 4 days before the minimum interval. As much as you can stick to the recommended, though, it is better, because when you think about how it was tested, it was tested on the routine schedule.
Slide 48: Our next slide, HPV Vaccine Not Yet Licensed for Males. As I mentioned, those studies are in progress now.
Slide 49: Contraindications. Nothing much that you have not already seen: allergy, precaution around moderate-to-severe acute illness. There is no problem with giving this vaccine for people who have had an abnormal or equivocal pap smear or positive HPV in the past. Because, if you think about if they have had 1 form of HPV does not mean that they have had all 4 of the ones that are in the vaccine. So, even if you have 1 infection you can still receive the vaccine, and you can see the others.
Slide 50: Cervical screening is essentially unchanged at this time. There may be a future time when we can back off some on girls who have been vaccinated; but, at this time they say 30% of cervical cancers are caused by HPV types that are not prevented by the quadrivalent vaccine. So, keep doing all of the screening that you are doing.
Slide 51: Improving Adolescent Immunization Rates. So, we move now out of the 3 diseases, and just say, what can we do to increase immunization rates in adolescents? Folks are looking at finding reminder recall systems that will inspire adolescents to come in. One of the things that we know is that at 11 to 12 years of age, you have a much better chance of getting them in than you do when they are 15, 16, or 17 years of age. Distributing vaccine notices to patients and parents at well-child visits—there is also a recommendation now for everyone from 6 months of age to 18 years of age to get an influenza vaccine. We did not talk about that disease, but it is really hard to get adolescents in for that. So, when you have them in for their sports physical in July, and you do not have your flu vaccine in yet, you might want to give them something to remind them that the flu vaccine is recommended for them, too. And, then the last one on this page, utilizing standing orders and provider reminders. You see on your slide an example of a provider reminder. In an office that was still using paper charts, we put this big, hot pink piece of paper on the paper record to remind folks to give the vaccine.
Slide 52: My last slide of the series is the National Immunization Program contact information. I want to tell you this hotline is not just for healthcare providers; it is also for families. So if you have a family that drives you crazy with questions—45 minutes of questions every time they walk through the door—you can give them this hotline. There is an e-mail service that CDC will answer your questions by e-mail, which a lot of people really like because they get hard-copy answers that they can post in the office. There is also a CDC Web site that is pretty good, and there is this CDC Web site on safety that you can give out to families.
Slide 53: So, in summary, we have talked about 3 diseases that have significant clinical and economic burdens on the adolescent population. All 3 of these now being preventable is pretty exciting, I think. Potential barriers to adolescent immunizations are at the patient level, the provider level, and at the healthcare system level with all of the problems with insurance.
We hope that you will be using every opportunity to vaccinate adolescents—all different types of visits—and that you will do it as soon as possible, so that 11- to 12-year-old visit is key. The first step to adopting new practices is to know about them, and so we really thank you for listening in today.
Next >>
