patient care perspectives

The Need to Optimize Adolescent Immunization

by Mark H. Sawyer, MD, FAAP, FIDSA

Overview

Every patient encounter can be viewed as an opportunity to update and complete an adolescent’s immunizations, and the influenza vaccine is no exception. Our featured expert discusses how to address the need to optimize immunization in the adolescent population.

Expert Commentary

Mark H. Sawyer, MD, FAAP, FIDSA

Professor of Clinical Pediatrics
Division of Infectious Diseases
University of California, San Diego, School of Medicine
Rady Children’s Hospital-San Diego
San Diego, CA

“For me, the challenge is not about a crowded adolescent vaccination schedule, but rather the mistaken perception that adolescents are not at significant risk from influenza.”

Mark H. Sawyer, MD, FAAP, FIDSA

During normal times, one of the biggest obstacles to achieving high adolescent influenza vaccine coverage is that adolescents are adolescents, and I do not mean that in a disparaging way. They are busy, and getting them into a physician’s office for any vaccine can be a challenge. While some argue that overcrowding in the adolescent immunization schedule is an obstacle to achieving high vaccine coverage rates, it is difficult for me to agree. Most adolescents require only the following 4 vaccines: the HPV, Tdap, meningococcal, and influenza vaccines—few in comparison with the number of vaccines required for 1- and 2-year-old children. For me, the challenge is not about a crowded adolescent vaccination schedule, but about the mistaken perception that adolescents are not at significant risk from influenza. Last year, an adolescent from San Diego County died from influenza. It does happen, and we need to make people realize that this is a very real problem with very serious potential outcomes. I work part-time with our health department, so I approach this issue from a public health perspective—never miss an opportunity to immunize. There is a camp that advocates for more flexibility in the schedule, allowing more vaccinations to be deferred for a subsequent visit, but I personally think that it is a mistake to miss an opportunity to administer all of the appropriate vaccines at any given visit. Sometimes it may simply be a case of an adolescent winning a battle for control with the parent (eg, “Mom, I don’t want all 4 right now—it hurts too much”). We do not give 2-month-old babies that choice, so why are some parents giving it to their 12-year-old adolescents? Some parents may overestimate the ease with which they will be able to get their adolescent back to receive the skipped vaccinations. 

School-based immunization programs are helpful, and, while some exist in the United States, they are far less common than in other countries (eg, Canada, the United Kingdom). Pharmacy-based immunization is also quite helpful here, and I think that we should be encouraging the use of pharmacies to achieve our goal of getting adolescents all of their vaccines, including the influenza vaccine. If we had robust school-based immunization programs and were more supportive of pharmacy-based immunization, I think that our influenza vaccination rates would be much higher and achieved more efficiently.

References

Bernstein HH, Bocchini JA Jr; AAP Committee on Infectious Diseases. Practical approaches to optimize adolescent immunization. Pediatrics. 2017;139(3):pii: e20164187.

Bernstein HH, Bocchini JA Jr; AAP Committee on Infectious Diseases. The need to optimize adolescent immunization. Pediatrics. 2017;139(3):pii: e20164186.

Centers for Disease Control and Prevention. FluView Interactive. Influenza-associated pediatric mortality. https://gis.cdc.gov/GRASP/Fluview/PedFluDeath.html. Accessed May 7, 2020.

Centers for Disease Control and Prevention. Immunization schedules. Table 1. Recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2020. https://bit.ly/2TBsPqf. Accessed May 7, 2020.

Shang M, Blanton L, Brammer L, Olsen SJ, Fry AM. Influenza-associated pediatric deaths in the United States, 2010-2016. Pediatrics. 2018;141(4): pii: e20172918.

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