Challenges and opportunities 
in adolescent immunizations

Special Immunization Section

Vaccines recommended for adolescent patients are underused, leaving this patient population at risk for serious diseases. There are numerous reasons why vaccines are underutilized in adolescent patients, from knowledge gaps to limited provider interactions to cost concerns. Pharmacists can play a substantial role in improving vaccination rates in this patient population by maximizing every opportunity to educate parents and patients, strongly recommending needed vaccines, and administering them as appropriate according to state laws. 


What the stats show


According to the most recent data from the National Immunization Survey–Teen (NIS-Teen), which analyzes vaccination coverage rates among adolescents 13–17 years of age, coverage rates from 2012 to 2013 went from 84.6% to 86.0% for one or more doses of tetanus toxoid, reduced diphtheria toxoid, and tetanus–diphtheria–acellular pertussis (Tdap), from 74.0% to 77.8% for one or more doses of meningococcal conjugate vaccine (MCV4), and from 53.8% to 57.3% for one or more doses of the human papilloma virus (HPV) vaccine among females and from 20.8% to 34.6% among males.1


When the rates for the Tdap, MCV4, and HPV vaccinations were compared with the Healthy People 2020 vaccination target of 80%, many of the individual states fell short of this target. In fact, none of the states met this goal for receipt of the full three-dose HPV series. Although coverage rates were improved from previous years, additional work remains to be done to increase vaccination rates in this patient population. 


Specific challenges


Numerous challenges have been identified for adolescent vaccinations. Some of these challenges include lack of parent and patient knowledge about vaccines, limited provider contact with this patient population, and cost considerations. Both parents and patients may not be fully educated on the recommended vaccines for adolescents and may underestimate the risks associated with vaccine-preventable diseases. In addition, parents and patients may be concerned about the safety of recommended vaccines and the implications of giving select vaccines to their children, such as those designed to prevent sexually transmitted viruses (i.e., HPV). 


Lack of well-care visits in this patient population is another challenge. It is estimated that a little more than one-third of adolescents are seen for health maintenance visits. Therefore, taking advantage of other provider interactions such as visits to the pharmacy and school-located clinics becomes paramount in this patient population to avoid missed opportunities to vaccinate. Lack of insurance coverage coupled with the high cost of vaccines has been identified as another challenge among adolescents.


Overcoming barriers


Providers are encouraged to use every opportunity to review vaccination histories with parents and adolescents. Since many adolescent patients are not being seen for well-care visits as compared with younger children, any interaction with these patients (e.g., sports physicals, visits to the pharmacy) must be viewed as an opportunity to discuss and administer needed vaccinations. In addition, to improve vaccination coverage rates among uninsured adolescents, nontraditional vaccine delivery settings should be considered, such as public health departments, school clinics, and pharmacies. Providers are also encouraged to strongly recommend all needed vaccines, as a strong provider recommendation is one of the best predictors of vaccination. For those who lack insurance, the Affordable Care Act, which provides coverage on preventive care, and the Vaccines for Children (VFC) program may be able to help. The VFC program provides vaccines to eligible, uninsured children who are younger than 19 years of age. 


Education of parents and patients is also essential in terms of the diseases that can be prevented by adolescent vaccines and any potential vaccine safety concerns. Parents may not be familiar with pertussis, meningococcal disease, or HPV and the potential serious complications that can occur in patients who acquire these diseases. For HPV vaccinations, the focus of the conversation should be on the cancer prevention benefits of this vaccine series. Refer parents to educational information available online, such as those on websites such as Vaccine.gov, CDC.gov, and WebMD.com. 


In addition, use of patient reminder and recall systems such as automated postcards, phone calls, and/or text messages may help in increasing the frequency of patient contact to receive needed vaccines. Implementation of standing order policies is another method that may help increase vaccination coverage rates by allowing patients to receive vaccines without a physical examination or individual physician order.


By addressing the various challenges head on, higher immunization rates can be achieved in adolescent patients. Providers should work together to meet the Healthy People 2020 national targets for vaccination coverage rates of 80% for the Tdap, MCV4, and HPV vaccinations.


Reference


  1. MMWR. 2014;63:625–33
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