AAP Urges Improvement in Teen Vaccination Rates

​Immunization is a key preventive cornerstone of pediatric care but efforts often fall short with adolescents

Adolescents are less likely than younger children to receive all the recommended vaccines, threatening their long-term health.

Two new AAP clinical reports, "The Need to Optimize Adolescent Immunization" and "Practical Approaches to Optimize Adolescent Immunization," will be published in the March 2017 issue of Pediatrics (published online 5 p.m. ET Monday, Feb. 6).

The publication of the two reports coincides with newly updated immunization schedules for children and adolescents, which are revised every February. The schedules are recommended by the American Academy of Pediatrics, the American Academy of Family Physicians and the Centers for Disease Control and Prevention.

"Parents understandably have questions, especially about immunizations that didn't exist when they were growing up," said Henry H. Bernstein, DO, MHCM, FAAP, a lead author of the two clinical reports. "When physicians take time to explain how the vaccines work to prevent disease, they often find families are receptive. For instance, some are surprised to learn that the HPV vaccine prevents cervical cancer."

In the two clinical reports and the immunization schedules, the AAP officially endorses a 2-dose schedule for HPV vaccine for teens who begin the vaccine series between ages 9 and 14. The 2-dose schedule was recommended by the CDC Advisory Committee on Immunization Practices in October 2016. Three doses of HPV vaccine continue to be recommended for teens who start the vaccination series on or after their 15^th birthday and for those with certain immunocompromising conditions.

Over the past decade, the vaccines recommended for adolescents have expanded to include:

• Two doses of quadrivalent meningococcal conjugate vaccine (a dose at ages 11 or 12, and a booster dose at age 16)

• Serogroup B meningococcal vaccine for those at increased risk for meningococcal disease (dosing varies; given at age 16 to 18) and for healthy adolescents, as a Category B recommendation, where individual counseling and risk-benefit evaluation based upon health provider judgements and patient preferences are indicated

• One dose of tetanus, diphtheria, acellular pertussis (Tdap) vaccine (at age 11 or 12)

• Two to three doses of human papillomavirus vaccine (HPV), depending on the child's age (preferably beginning age 11 or 12)

• An annual influenza vaccine

Other catch-up vaccinations may be recommended to meet early childhood recommendations, as well.

​"We often find that teenagers don't visit their doctors as regularly as they did as when they were younger, and they may be late or even miss important immunizations recommended to keep them healthy," said Joseph A. Bocchini, Jr., MD, FAAP, co-author on the AAP clinical reports and former chair of the AAP Committee on Infectious Diseases. "We hope to improve teenage vaccination rates by working more closely with families, and helping parents understand the health benefits of staying up-to-date with immunizations."

Nationally, adolescent vaccination rates lag well below the targeted threshold of 80% or greater for the HPV and influenza vaccines. Vaccination rates also vary considerably by vaccine and by state. During the 2015-16 influenza season, only 46.8% of adolescents ages 13 through 17 were vaccinated against the flu. And while HPV vaccination rates are improving slowly, only 40% of girls and 22% of boys had completed the then-recommended three-dose series of the HPV vaccine in 2014.

The American Academy of Pediatrics offers an interactive map that allows users to compare immunization rates by state and type of vaccine. The map includes the percentages of adolescents, divided by gender, who have received at least one dose of the HPV vaccine.

One challenge to improving vaccination rates among adolescents is the fact they are less likely to visit the doctor for preventive care as they get older. One study showed that children ages 11 to 14 visited a physician's office for preventive care three times more often than older teens.

Healthcare provider recommendations are strong indicators of whether or not parents choose to vaccinate their children. The AAP offers practical strategies physicians can use to improve adolescent vaccination rates, including how to answer questions from patients and parents, and how to provide timely reminders about recommended vaccines and needed doses.

The AAP also recommends a portion of the adolescent visit should be between the health care provider and patient, without the presence of a parent.

​​"We want to help teens feel comfortable sharing their own perspectives, and adolescence is a time when they should begin to take responsibility for their own health and wellness," said Dr. Bernstein. "An important part of that is making sure they have the vaccines that will protect them as they enter adulthood."