1. Adolescent Vaccines

2. Educational Learning Objectives
At the conclusion of this presentation, the participant should be able to:
Discuss the indications and recommendations for the most current immunization schedules for childhood, adolescent, and adult populations
Respond to frequently encountered questions and situations during patient discussions including safety, efficacy, and possible misinformation
Implement strategies for improving immunization rates within one’s clinical practice, taking into account current immunization schedules and guidelines

3. Definition of ‘Adolescent’
7th birthday until the 19th birthday
Per CDC adolescent immunization schedule
Society of Adolescent Medicine defines adolescent as yrs

4. 2010 ACIP Adolescent Immunization Schedule
Minimum age 9 years
ACIP Schedules. Accessed Jan 2010.

5. Adolescent Catch-up Schedule
ACIP Schedules. Accessed Jan 2010.

6. Adolescent (13–17 yrs) Vaccination Coverage, United States 2007–2008
100 90
2007 N = 2947
2008 N = 17,835 80 70 60
Vaccination Coverage (%) 50 40 30 20 10
MMR
Hepatitis B
Varicella
Varicella
Td or Tdap
Tdap
MCV4
HPV4*
HPV4*
≥ 2 Doses
≥ 3 Doses
≥ 1 Dose
≥ 2 Doses
≥ 1 Dose
≥ 1 Dose
≥ 1 Dose
≥ 1 Dose
≥ 3 Doses
* Percentages for females only
CDC. MMWR Morb Mortal Wkly Rep. 2009;58(36):

7. Tdap Boostrix Adacel Approved for use ages 10-64 years
---
recommended
catch-up
Boostrix
Approved for use
ages years
Adacel
Approved for use
ages years
Two FDA-approved Tdap vaccines available
Both contain the same acellular pertussis component as their respective DTaP products
FDA recommended one-time use of Tdap only
For year olds, replaces Td booster if no previous Tdap
Catch-up for yrs (5-year interval from last Td encouraged)
MCV4 contains diphtheria conjugate protein carrier
If both are indicated, administer MCV4 and Tdap simultaneously
CDC. MMWR Recomm Rep. 2006;55(RR03):1-34.

8. Tdap 10 to 18 years of age 19 to 64 years of age
Replaces Td booster for 11­12-year-olds
Catch-up for yrs (5-year interval from Td encouraged)
If no previous DPT series, give as 1 Tdap + 2 Td
Give with MCV4 if both vaccines are indicated
Replaces Td booster; wound management*
2-year interval from Td for adults in contact with infants; health care workers
Anyone who wants to decrease risk of disease
The safety and effectiveness of Tdap have not been established in pregnant women
If overall risk/benefit is favorable, discount risk of local rxns and immunize
Note: Give MCV4 and Tdap simultaneously if both are indicated; carrier protein for MCV4 is diphtheria toxoid, avoid injection site reactions from sequential vaccination.
* Only if no previous Tdap received
CDC. MMWR Recomm Rep. 2006;55(RR3):1-34.
CDC. MMWR Recomm Rep. 2006;55(RR17):1-33.
CDC. MMWR Morb Mortal Wkly Rep. 2009;58(14):

9. Available HPV Vaccines
Quadrivalent
Merck - Gardasil®
Bivalent
GSK - Cervarix®
Licensed in the US
2006
2009
Virus-like Particle Types
HPV 6, 11, 16, 18
HPV 16, 18
Protection against HPV 16/18 related CIN2+
≥ 98%
≥ 93%
Protection against HPV 6/11 related genital lesions
~99%
---
Hypersensitivity-related contraindication
Yeast
Latex
Age ranges
Routine 11 or 12 yrs, as young as 9 yrs;
catch-up yrs
Routine 11 or 12 yrs,
as young as 10 years;
catch-up yrs
Schedule
0, 2, 6 months
0, 1, 6 months
CIN2+: cervical intraepithelial neoplasia grade 2 or higher and adenocarcinoma in situ
Markowitz L. ACIP Meeting Oct Accessed Oct 2009.

10. HPV – ACIP Recommendations Quadrivalent HPV (HPV4) and Bivalent HPV (HPV2)
Routine vaccination of females aged years with 3 doses of HPV vaccine
Catch-up yrs (HPV4); yrs (HPV2)
ACIP: no preference for either vaccine
HPV4 or HPV2 vaccination for prevention of HPV 16/18-related cervical cancers, precancers and dysplastic lesions
Vaccination with HPV4 for additional prevention against genital warts
Monitor patients for 15 minutes following vaccination for syncopal episodes
ACIP Schedules. Accessed Jan 2010.

11. HPV Vaccination and Pregnancy
HPV vaccines are not recommended for use in pregnant women
Initiation of the vaccine series should be delayed until after completion of pregnancy
If a woman is found to be pregnant after initiating the vaccination series, delay remaining doses until after the pregnancy
If a vaccine dose has been administered during pregnancy, there is no indication for intervention
Two vaccine in pregnancy registries have been established. Patients and health care providers should report:
Quadrivalent HPV vaccine/pregnancy:
Bivalent HPV vaccine/pregnancy:
CDC.
Accessed March 2010.

12. HPV Quadrivalent Vaccine in Males
FDA approved quadrivalent HPV vaccine for prevention of genital warts due to HPV types 6 and 11 in boys and men ages 9 through 26
ACIP: Permissive HPV vaccine for males
Cost effectiveness
Priority vaccinating females to reduce overall disease/cancer burden
Quadrivalent HPV vaccine most effective when given before exposure to HPV through sexual contact
FDA News Release.
Accessed Oct 2009.
Dunne E. ACIP Meeting Oct 2009.

13. Avg Annual Incidence (#)
HPV-associated* Invasive Squamous Cell Carcinomas in Women and Men, 1998–2003
Anatomic Area
Avg Annual Incidence (#)
Incidence (per 100,000)
95% CI
Cervix
10,846
8.9
8.9,9.0
Vagina
601
0.5
0.4,0.5
Vulva
2266
1.7
1.7,1.7
Anus/Rectum
1935
1.5
1.5,1.5
Oropharynx/OC
1702
1.3
1.3,1.4
Total Females
17,350
14.0
13.8,14.0
Penis
828
0.8
0.8,0.8
1083
1.0
1.0,1.0
5658
5.2
5.1,5.2
Total Males
7568
7.0
6.9,7.0
*Defined by histology and anatomic site
Watson M, et al. Cancer. 2008;113(10suppl):
Data source: National Program of Cancer Registries and SEER, covering 83% coverage of US population.
ACIP Meeting February Accessed Oct 2009.

14. HPV Vaccine Parental Concerns
Many parents uncomfortable addressing subjects related to child sexuality, especially at such young ages
Be sensitive to discussing this issue
Communicate the importance of completing the 6-month immunization series before the adolescent becomes sexually active
Vaccination does not imply current sexual activity, nor will it encourage it
Protection against HPV acquired by involuntary sexual intercourse
Improved immunogenicity at younger ages
Educate parents and adolescents regarding the ubiquitous nature of HPV and its association with cervical dysplasia and cancer
Parents who received education on human papillomavirus and HPV vaccine more likely to accept vaccination of their child than those who received no educational intervention
Communicate the universality of the vaccine recommendation to avoid feelings of being stigmatized/singled out
Rosenthal SL. J Adolesc Health. 2005;37:

15. HPV Postlicensure Safety Data- VAERS
Review of 12,424 adverse event reports following immunization (AEFI) with quadrivalent HPV Vaccine from the Vaccine Adverse Event Reporting System (VAERS): 6/31/06 through 12/31/08
Disproportional reporting of syncope and venous thromboembolism
Increased risk among teens yrs
Serious injuries have resulted
Providers should strongly consider observing patients for 15 minutes after they are vaccinated
Quadrivalent HPV was the only vaccine administered in:
74% of syncope/vasovagal reports
73% of dizziness reports
78% of nausea reports
Slade BA, et al. JAMA. 2009;302(7):
Calugar A. Oct 2008 ACIP meeting.
Accessed Oct 2009.

16. Meningococcal Conjugate Vaccines
Recommended for adolescents aged years and others at increased risk for meningococcal disease
MCV4-D (Menactra®, Sanofi): licensed for persons 2-55 years; Serogroups A, C, Y, W-135; diphtheria toxoid conjugate
MenACWY-CRM197 (Menveo®, Novartis): licensed for persons years; Serogroups A, C, Y, W-135; diphtheria CRM197 conjugate
Revaccination for Persons at Increased Risk
Previous vaccination (meningococcal conjugate vaccine or MPSV4) at 2-6 years, revaccinate 3 years after initial meningococcal vaccine
Previous vaccination (meningococcal conjugate vaccine or MPSV4) at ≥ 7 years, revaccinate 5 years after initial meningococcal vaccine
This includes:
Persons with persistent complement component deficiencies
Persons with anatomic or functional asplenia
Microbiologists who are routinely exposed to isolates of N. meningitidis
Frequent travelers to or people living in areas with high rates of meningococcal disease (African meningitis belt)
Meissner HC. Accessed March 2010.
CDC. MMWR Morb Mortal Wkly Rep. 2009;58(37):

17. Annual Influenza Vaccine is Recommended for:
All people age 6 months and older!
According to the Advisory Committee on Immunization Practices (ACIP) of the US Centers for Disease Control and Prevention (CDC), several groups of people should be primary targets for vaccination during the influenza season. These are groups who are at high risk of morbidity or mortality due to influenza.
CDC. Accessed March 2010. 17

18. Trivalent Inactivated Virus (TIV) versus Live Attenuated Influenza Virus (LAIV) Vaccines
Licensed for use in persons age ≥6 mos
Intramuscular injection
TIV contains purified viral particles that have been chemically inactivated
Purified components from 3 WHO-recommended annual strains
Immunity developed against disrupted/denatured viral proteins, not against intact virus
LAIV
Licensed for use among nonpregnant persons aged 2-49 years
Administered by nasal spray
LAIV contains intact virus that has been propogated in eggs at 25ºC
Cold-adaptation results in restricted replication at body temp
More mild flu symptoms
Contains same 3 WHO-recommended annual strains as TIV
CDC. MMWR Recomm Rep. 2009;58(RR8):1-52.
Flumist Prescribing Information. Accessed Oct 2009.

19. 2009–2010 Seasonal Influenza Vaccines
2009–2010 seasonal influenza vaccine formulation:
A/Brisbane/59/2007(H1N1)-like virus
A/Brisbane/10/2007 (H3N2)-like virus
B/Brisbane/60/2008-like antigens
Vaccines
Trivalent Inactivated, Injectable Influenza Vaccine
Fluzone® (sanofi): age ≥ 6 months
Fluvirin® (Novartis): age ≥ 4 years
Fluarix® (GSK): age ≥ 3 years
FluLaval™ (ID Biomedical/GSK): age ≥ 18 years
Afluria® (CSL): age ≥ 6 months
Live Attenuated, Nasal Spray Influenza Vaccine
FluMist® (MedImmune): age 2 through 49 years (healthy, non-pregnant)
Seasonal 2009 influenza vaccine does not protect against 2009 (pandemic) H1N1 influenza
CDC. MMWR Recomm Rep. 2009;58(RR8):1-52.
CDC.
Accessed March 2010.

20. 2009 H1N1 (Pandemic) Influenza Vaccines
As of November 11, 2009: 4 monovalent inactivated vaccines approved
CSL Limited
Age 6-35 mos: Two 0.25 mL IM doses (4 wk interval)
Age 36 mos to 9 yrs: Two 0.5 mL IM doses (4 wk interval)
Age ≥ 10 yrs: Single 0.5 mL IM injection
Adults ≥ 18 yrs: Single 0.5 mL IM injection
Novartis Vaccines and Diagnostics Limited
Age 4-9 yrs: Two 0.5 mL IM doses (4 wk interval)
Age yrs: Single 0.5 mL IM injection
Age ≥18 yrs: Single 0.5 mL IM injection
Sanofi Pasteur, Inc.
Age ≥10 yrs: Single 0.5 mL IM injection
ID Biomedical/GSK
1 live attenuated (nasal administration)
MedImmune LLC
Age 2-9 yrs: Two 0.2 mL doses (0.1 mL per nostril), 4 week interval
Age yrs: Single 0.2 mL dose (0.1 mL per nostril)
Prescribing information available at: Accessed December 2009.

21. 2010–2011 Influenza Season Universal Influenza Vaccination
All people 6 months and older are now recommended to receive annual influenza vaccination
Trivalent Influenza Vaccines
A/California/7/2009(H1N1)-like virus
Same strain as in the 2009 H1N1 monovalent vaccine
A/Perth/16/2009(H3N2)-like virus
New strain for northern hemisphere vaccine
Same strain as 2010 southern hemisphere seasonal strain
B/Brisbane/60/2008-like virus
No change
Current information from the CDC and FDA
CDC. March 2010.
CDC. Accessed June 2010.
FDA. Accessed June 2010.

22. 2010–2011 Influenza Season Continued Emphasis on High-risk Groups:
Children aged 6 months through 4 years
Adults ≥ 50 years
Women who will be pregnant during the influenza season
Persons who have chronic pulmonary, cardiovascular, renal, hepatic, neurological, neuromuscular, hematological or metabolic disorders
Persons who have immunosuppression (including caused by medication or HIV)
Residents of nursing homes and other chronic-care facilities
Health care personnel
Household contacts and caregivers of children aged < 5 year and adults aged ≥ 50 years, with particular emphasis on vaccinating contacts of children < 6 months
Household contacts and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza
CDC. Accessed March 2010.

23. PPSV23 Single dose recommended for:
7–10 years
11-12 years
13–18 years
for certain high-risk groups
Single dose recommended for:
All ≥ 65 years
2–64 years: chronic cardiovascular disease, chronic pulmonary disease, diabetes, alcoholism, chronic liver disease, CSF leaks, asplenia, cochlear implants
>2 years and immunocompromised
Asthmatics and smokers age years
Proposed language for one-time revaccination:
“A second dose of PPSV23 is recommended 5 years after the first dose of PPSV23 for persons aged >2 years who are immunocompromised, have sickle cell disease, or functional or anatomic asplenia”
ACIP Summary Recommendations. Accessed Oct 2009.
ACIP Provisional Recommendations. Accessed Oct 2009.

24. PPSV23 and Alaskan Natives, American Indians
“Routine use of PPSV23 is not recommended for Alaska Native or American Indian persons younger than 65 years old unless they have underlying medical conditions that are PPSV23 indications.
However, in special situations, public health authorities may recommend PPSV23 for Alaska Natives and American Indians aged 50 through 64 years who are living in areas in which the risk of invasive pneumococcal disease is increased."
ACIP Provisional Recommendations.
Accessed Oct 2009.

25. HepA Routine vaccination recommended for all children ages 12-23 mos
7–10 years
11-12 years
13–18 years
for certain high-risk groups
Routine vaccination recommended for all children ages mos
In areas without existing Hep A vaccination programs, catch-up of unvaccinated children 2-18 yrs old may be considered
Recommendations for age ≥2 yrs depend on risk and vary according to state programs
Dosing:
VAQTA®
For all persons age ≥12 mos
2 doses at 0 and 6-18 mos
HAVRIX®
2 doses at 0 and 6-12 mos
CDC. MMWR Morb Mortal Wkly Rep. 2006;55(RR7):1-23.
CDC Resolution No. 06/07-1.
Accessed Oct 2009.

26. Hepatitis A Vaccine International Travel
For healthy persons 40 years of age or younger
2 doses 6 months apart prior to departure
The first dose of Hepatitis A vaccine should be administered as soon as travel is considered
1 dose of single-antigen vaccine administered at any time before departure
Consider both HAV and Ig for
Persons age > 40 with chronic illness traveling in less than 2 weeks and only receiving one dose of HAV
Persons at risk of severe disease from hepatitis A virus planning to travel in 2 weeks or sooner
CDC. MMWR Morb Mortal Wkly Rep. 2007;56(41):

27. Hepatitis A Postexposure Prophylaxis
For healthy persons 12 months through 40 years of age who have not previously received HepA vaccine
Take into account patient characteristics, including chronic liver disease
Immunoglobulin and/or single-antigen hepatitis A vaccine should be administered as soon as possible after exposure
Vaccine preferred for those of age 12 mos to 40 yrs
Ig preferred for age <12 mos, those with vaccine allergies, or those with immunosuppression or liver disease
Ig preferred for age >40 but vaccine may be used if Ig unavailable
HepA and Ig may be administered simultaneously
Efficacy of Ig or HepA when administered >2 weeks postexposure is unknown
CDC. MMWR Morb Mortal Wkly Rep. 2007;56(41):
CDC. MMWR Morb Mortal Wkly Rep. 2009;58(36):

28. Hepatitis A: Families of International Adoptees
Hepatitis A vaccination is recommended for all previously unvaccinated persons who anticipate close personal contact with an international adoptee from countries of high or intermediate endemicity during the first 60 days following arrival in the US.
The first dose of hepatitis A vaccine should be administered as soon as adoption is planned. Ideally, the first dose of hepatitis A vaccine should be administered at least two weeks prior to the arrival of the adoptee.
CDC. MMWR Morb Mortal Wkly Rep. 2009;58(36):

29. HepB Multiple schedules
7–10 years
11-12 years
13–18 years
catch-up
Multiple schedules
Children 1-10 yrs
0, 1, and 6 mos
0, 2, and 4 mos
0, 1, 2, and 12 mos
Adolescents yrs
0, 1, and 4 mos*
0, 2, and 4 mos*
0, 12, and 24 mos*
0 and 4-6 mos (2 dose schedule uses adult 10ug formulation, Recombivax-HB)**
No combination HepB vaccines approved for use in ages yrs
* These schedules provide equivalent seroprotection in adolescents
**No long-term data are available for antibody persistence- when second dose is to be administered at age >15 yrs, consider switching to a 3-dose schedule using pediatric formulation
CDC. MMWR Recomm Rep. 2005;54(RR16):1-23.

30. HepA-HepB Combination Vaccine (Twinrix)
Approved for persons 18 years and older
Combination HepA vaccine (pediatric dose) and HepB (adult dose)
First licensed schedule: 0, 1, and 6 months
Alternate schedule 2007: Doses at 0, 7, days and a booster dose at 12 months
The first 3 doses of the new schedule provide equivalent protection to:
The first dose in the standard single-antigen adult hepatitis A vaccine series
The first 2 doses in the standard adult hepatitis B vaccine series
Seroconversion is nearly 100% after either 3 doses of the combination vaccine on the new schedule or a single dose of single-antigen adult hepatitis A vaccine
Duration of protection 4 yrs against HepA
No increased benefit of the new schedule for the hepatitis B component compared to administration of 2 hepatitis B vaccine doses 1 to 2 months apart
CDC. MMWR Morb Mortal Wkly Rep. 2007;56(40):1057.

31. Varicella Universal recommendation for routine vaccination is 2 doses
7–10 years
11-12 years
13–18 years
catch-up
Universal recommendation for routine vaccination is 2 doses
Given 3 months apart for those under 13 years old
4 to 8 weeks apart for those ≥ 13 years old
Second dose is still valid if >8 week interval
Formulations
Varivax licensed ages 12 mos and older
Proquad (Combination MMRV) not licensed ≥13 years
CDC. MMWR Recomm Rep. 2007;56(RR04):1-40.

32. Adolescent Immunization: Goals and Objectives
Effective adolescent vaccine delivery and monitoring are critical
Adolescents lag far behind preschoolers in immunization coverage
Healthy People 2010 objective for adolescents aged years is 90% coverage with the following:
3 or more doses of hepatitis B vaccine
2 or more doses of MMR vaccine
1 or more doses of Td* vaccine
1 or more doses of varicella vaccine
*Healthy People 2010 objectives were set prior to licensure of Tdap, meningococcal, and HPV vaccines. 32

33. Strategies for Improving Adolescent Immunization Rates

34. Healthy People 2010 Adolescent Immunization Goals
Increase the proportion of young children and adolescents who receive all vaccines that have been recommended for universal administration for at least 5 years
Increase routine vaccination coverage levels for adolescents
For yrs olds, 90% coverage rates for ≥ 3 hepatitis B, ≥ 2 MMR, ≥ 1 varicella, ≥ 1 TD
Flu vaccine recommendation is new; no specific goal established
Healthy People
14-27.htm. Accessed September 2009.

35. Parents Are a Key Influence
Parental perception of vaccination is an important factor in adolescents’ vaccination decisions1,2
Parents influence adolescent acceptance
Providers influence parental acceptance
Parental consent for immunization is the most cited barrier to immunizing students at school-based vaccination initiatives3,4
Rosenthal SL, et al. J Adolesc Health. 1995;17:
Rosenthal SL. J Adolesc Health. 2005;37:
Guajardo AD, et al. J Sch Health. 2002;72:
Deeks SL, Johnson IL. Can J Public Health. 1998;89:

36. Patient and Provider Factors That Influence Adolescent Immunization
Education/
Knowledge
Self-Efficacy
Patient
Provider
Insurance/
Reimbursement
Time
Provider likelihood to administer
immunization
Patient likelihood to access immunization
ADOLESCENT IMMUNIZATION
Middleman AB. J Adolesc Health. 2007;41:

37. Available Reimbursement for Adolescent Vaccination
Public funding for eligible children up to but not including the 19th birthday
Vaccines for Children Program (VFC)
Many insurers follow VFC lead
State Children’s Health Insurance Program (SCHIP)
Funding for adolescents > 19 years:
Federal Vaccination Assistance Act, Section 317
Inadequate for large-scale immunization strategies

38. Establishing Adolescent Immunization Platforms
Need exists for standard immunization visits during adolescence
ACIP recommendations geared to 11- to 12-year-old age group
Younger adolescents have higher rates of accessing preventive health care than older adolescents
Rand CM, et al. J Adolesc Health. 2005;37:87-93.

39. Establishing Adolescent Immunization Platforms (cont)
Society for Adolescent Medicine position statement
11- to 12-year visit: primary immunization platform
14- to 15-year visit: catch up on missed vaccines or complete multidose regimens
17- to 18-year visit: update vaccinations that were missed or are newly recommended
Middleman AB, et al. J Adolesc Health. 2006;38:
IDSA. Clin Infect Dis. 2007;44:e104-e108.

40. Advantages of Building an Adolescent Immunization Platform Structure
Puts focus on disease prevention among this age group
Presents opportunities for improved comprehensive care that includes other health issues (eg, screening and prevention of risk behaviors)
Creates parental and provider expectation of compliance with established adolescent immunization visits
IDSA. Clin Infect Dis. 2007;44:e104-e108.

41. Adolescent Vaccination Coverage: Who Is Measuring?
The National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) update:
NCQA eliminated measures in 2008; Web site indicates development of updated measures for 2009
National Immunization Survey (NIS) 2006: First year of data collection for adolescents 13 to 17 years of age
NIS-Teen:
Includes provider-reported information
HPV not reported (recommended in 2007)
Now conducted annually

42. NIS-Teen Results Vaccine Coverage 2006+ 2007^ 2008*
≥ 1 dose Tdap after 10 years of age
10.8%
30.4%
40.8%
≥ 1 dose Td/Tdap after 10 years of age
60.1%
72.3%
72.2%
≥ 3 doses HepB vaccine
81.3%
87.6%
87.9%
≥ 2 doses MMR vaccine
86.9%
88.9%
89.3%
≥ 1 dose of Varicella vaccine (no disease history)
65.5%
75.7%
81.9%
≥ 2 doses of Varicella vaccine (no disease history) –
18.8%
34.1%
MCV4 vaccine
11.7%
32.4%
41.8%
HPV 4 ≥ 1 dose
25.1%
37.2%
+n = adolescents
^n = 2947 adolescents
*n = 17,835 adolescents
CDC. MMWR Morb Mortal Wkly Rep. 2008;57(40):
CDC. MMWR Morb Mortal Wkly Rep. 2009;58(36):

43. Adolescent Immunization Rates: Strategies to Hit the Target
Public Policy
Providers
National
State
Education re immunizations
Use of recall systems
Education
re: provision of preventive care for adolescents
Use of standing orders
Mandates for school entry
Development of standard immunization platforms by ACIP, professional organizations
Use of immunization information systems
Development of specific vaccination
“quick visits” if other services not needed
Use of screening tools
Bull’s-eye!
Shots in
Adolescent
Arms
State review of “consent” procedures
Attend vaccination “quick visits” if other preventive services not required
Education
re need for preventive care of adolescents
Reimbursement/
funding (currently SCHIP)
Use of alternative site
if no medical home or if need to complete a series of vaccinations
Reimbursement/
funding
(currently VFC, 317)
Enrollment in immunization information systems
Education re: immunizations
Funding and support for immunization information systems
Patients
Funding and support for immunization information systems
State legislation allowing immunization at alternative sites
Insurance reform
Middleman AB. J Adoles Health. 2007;41:

44. Benefits of Using a Computerized Immunization Information System (IIS)
Recommended by National Vaccine Advisory Committee (NVAC) and National Immunization Program (NIP)
Consolidates fragmented records
Keeps track of patients needing recommended or catch-up vaccination
Provides automated reminder and recall
Assists in management of vaccine supply
Generates vaccination records for parents, schools, other
Yawn BP, et al. Am J Manag Care. 1998;4:
Glazner JE, et al. Ambul Pediatr. 2004;4:34-40.

45. Are Providers Seeing Adolescents?
HEDIS data: 34% of adolescents who participate in health plans have annual preventive visits1
NCHS (CDC) data: 86% of 6- to 17-year-olds and 76% of 18- to 24-year-olds report at least one doctor’s office, ED, or home visit within past year2
88–92% of adolescents report having an identified source of primary care3,4
HEDIS = Health Plan Employer Data and Information Set; NCHS = National Center for Health Statistics
McInerny TK, et al. Pediatrics. 2005;115:
National Center for Health Statistics. Health, United States, 2005.
Klein JD, et al. Arch Pediatr Adolesc Med. 1998;152:
Klein JD, et al. J Adolesc Health. 1999;25:

46. Provider-based Strategies to Improve Adolescent Immunization Rates
Standing orders
Recommended by CDC (strong evidence) to increase adult immunization
Would likely decrease missed vaccination opportunities in adolescents
Screening tools (NVAC recommends annual review)
Reminder/recall systems (often with IIS)
Recommended (strong evidence) by CDC to increase adult, adolescent, and childhood immunizations
Complex for adolescents (eg, changing phone numbers, waning effect of calls)
Vaccination “quick visits”
Understanding other adolescent issues/care
IIS: immunization information systems
The Community Guide. Accessed September 2009.
Szilagyi PG, et al. Arch Pediatr Adolesc Med. 2006;160:

47. The Goal: To Increase the Adolescent Immunization Rate
Healthy People 2010
Adolescent immunization coverage goal: 90%
Increase number of providers who measure vaccination coverage level every 2 years among children in their practice
Free assistance from public health departments (CoCASA software)
Vaccines for Children quality improvement activities (eg, AFIX)
Healthy People 2010 Immunization and Infectious Disease. Accessed Oct 2009.
CoCASA. Accessed Oct 2009.
AFIX. Accessed Oct 2009.

48. Standing Orders Are Among the Most Effective Strategies
Nonphysicians offer and administer vaccinations
No direct MD involvement at the time of the visit
Established with physician approved policies and protocols
Locations:
Clinics and hospitals
CDC. Accessed September 2009.
McKibbin LJ, et al. MMWR Recomm Rep. 2000;49 (RR1):15-26.

49. Success of Standing Orders as Part of a Multifaceted Program
Influenza Vaccination Rates for Elderly Patients in General Medicine Clinics
Standing
Orders
Education
Nichol KL. Am J Med. 1998;105:

50. Resources

51. PROTECTTM Website: http://www.francefoundation.com/protect/

52. Resources for Patients and Parents
Guide to evaluating information on the web
CDC Vaccine Information Statements (VISs)
Vaccine Safety
National Network for Immunization Information (NNII)
Allied Vaccine Group
Immunization Action Coalition (IAC)
Vaccine Education Center at CHOP
TCH Center for Vaccine Awareness and Research

53. Resources for Providers
Immunization Schedules
ACIP recommendations & provisional recommendations
The Guide to Community Preventive Services. Vaccine recommendations
Assessment, Feedback, Incentives, and Exchange (AFIX)
National Foundation for Infectious Diseases
Centers for Medicare & Medicaid Services

54. Resources for Providers, Parents, and Patients
The Immunization Action Coalition: vaccine information for the public and health professionals
The Immunization Action Coalition: directory of immunization coalitions