C. Robinette Curtis

National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13-17 Years — United States, 2014

The Advisory Committee on Immunization Practices (ACIP) recommends that adolescents aged 11-12 years routinely receive vaccines to prevent diseases, including human papillomavirus (HPV)-associated cancers, pertussis, and meningococcal disease (1). To assess vaccination coverage among adolescents in the United States, CDC analyzed data collected regarding 21,875 adolescents through the 2015 National Immunization Survey-Teen (NIS-Teen).* During 2014-2015, coverage among adolescents aged 13-17 years increased for each HPV vaccine dose among males, including ≥1 HPV vaccine dose (from 41.7% to 49.8%), and increased modestly for ≥1 HPV vaccine dose among females (from 60.0% to 62.8%) and ≥1 quadrivalent meningococcal conjugate vaccine (MenACWY) dose (from 79.3% to 81.3%). Coverage with ≥1 HPV vaccine dose was higher among adolescents living in households below the poverty level, compared with adolescents in households at or above the poverty level.(†) HPV vaccination coverage (≥1, ≥2, or ≥3 doses) increased in 28 states/local areas among males and in seven states among females. Despite limited progress, HPV vaccination coverage remained lower than MenACWY and tetanus, diphtheria, and acellular pertussis vaccine (Tdap) coverage, indicating continued missed opportunities for HPV-associated cancer prevention.

Adolescent Immunization Delivery in School-Based Health Centers: A National Survey

PURPOSE Vaccinating adolescents in a variety of settings may be needed to achieve high vaccination coverage. School-based health centers (SBHCs) provide a wide range of health services, but little is known about immunization delivery in SBHCs. The objective of this investigation was to assess, in a national random sample of SBHCs, adolescent immunization practices and perceived barriers to vaccination. METHODS One thousand SBHCs were randomly selected from a national database. Surveys were conducted between November 2007 and March 2008 by Internet and standard mail. RESULTS Of 815 survey-eligible SBHCs, 521 (64%) responded. Of the SBHCs, 84% reported vaccinating adolescents, with most offering tetanus-diphtheria-acellular pertussis, meningococcal conjugate, and human papillomavirus vaccines. Among SBHCs that vaccinated adolescents, 96% vaccinated Medicaid-insured and 98% vaccinated uninsured students. Although 93% of vaccinating SBHCs participated in the Vaccines for Children program, only 39% billed private insurance for vaccines given. A total of 69% used an electronic database or registry to track vaccines given, and 83% sent reminders to adolescents and/or their parents if immunizations were needed. For SBHCs that did not offer vaccines, difficulty billing private insurance was the most frequently cited barrier to vaccination. CONCLUSIONS Most SBHCs appear to be fully involved in immunization delivery to adolescents, offering newly recommended vaccines and performing interventions such as reminder/recall to improve immunization rates. Although the number of SBHCs is relatively small, with roughly 2000 nationally, SBHCs appear to be an important vaccination resource, particularly for low income and uninsured adolescents who may have more limited access to vaccination elsewhere.

Surveillance for transmission and antibiotic adverse events among neonates and adults exposed to a healthcare worker with pertussis.

BACKGROUND During a hospital obstetric rotation, a medical student demonstrated classic symptoms of pertussis. The diagnosis was confirmed by isolation of Bordetella pertussis. Because this exposure occurred in a high-risk hospital setting, control measures were undertaken to prevent transmission and illness. OBJECTIVES To identify secondary cases of pertussis, to determine compliance with chemoprophylaxis recommendations, and to monitor for adverse events associated with chemoprophylaxis following a hospital exposure to pertussis. PATIENTS More than 500 individuals were potentially exposed, including 168 neonates; antimicrobial chemoprophylaxis was administered to 281 individuals. Fifty-eight neonates and 194 adults began azithromycin chemoprophylaxis; 18 neonates and 2 adults began erythromycin chemoprophylaxis. METHODS Active surveillance was instituted for (1) secondary cases of pertussis among healthcare coworkers, obstetric patients, their neonates, and labor companions and (2) antibiotic compliance and tolerance. RESULTS No secondary cases of pertussis were confirmed by laboratory tests; however, 26 suspected cases and 5 clinically compatible cases were identified. Antibiotic courses were completed by 95% of the individuals who initiated therapy. Neonates taking azithromycin had statistically significantly less gastrointestinal distress compared with neonates taking erythromycin (12% vs 50%; P = .002); there were no cases of infantile hypertrophic pyloric stenosis. CONCLUSIONS Although it was not possible to assess the effectiveness of the antibiotic regimens, the lack of laboratory-confirmed secondary cases suggests control measures were successful. Data from the 58 neonates who received azithromycin suggest it may be well tolerated in this age group.

Preventing cervical cancer

Three federal programs with the potential to reduce cervical cancer incidence, morbidity, and mortality, especially among underserved populations, are administered by the Centers for Disease Control and Prevention (CDC): the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), the Vaccines for Children (VFC) Program, and the Section 317 immunization grant program. The NBCCEDP provides breast and cervical cancer screening and diagnostic services to uninsured and underinsured women. The VFC program and the Section 317 immunization grant program provide vaccines, including human papillomavirus (HPV) vaccine, to targeted populations at no cost for these vaccines. This article describes the programs, their histories, populations served, services offered, and roles in preventing cervical cancer through HPV vaccination and cervical cancer screening. Potential long‐term reduction in healthcare costs resulting from HPV vaccination is also discussed. As an example of an initiative to vaccinate uninsured women aged 19‐26 years through a cancer services program, a state‐based effort that was recently launched in New York, is highlighted. Cancer 2008;113:(10 suppl):3004–12. Published 2008 by the American Cancer Society.

Limited Awareness of Vaccines Recommended for Adolescents and Other Results from Two National Consumer Health Surveys in the United States

PURPOSE This study describes the vaccine-related knowledge and attitudes of adolescents aged 11-18 years and parents of adolescents aged 11-18 years. METHODS We analyzed the 2007 HealthStyles and YouthStyles surveys related to vaccine knowledge and attitudes of parents (n = 1,208) and adolescents (n = 1,087). RESULTS In all, 21% of parents and 11% of adolescents correctly identified the three vaccines recommended at the time of the survey for adolescents. Regarding the hypothetical scenario that minor adolescents should be allowed to consent to vaccination without parental knowledge, 70% of parents and 72% of adolescents disagreed. The majority of parents and adolescents recognized the importance of vaccines in protecting an adolescents health yet a substantial minority of both groups also reported concerns about vaccine safety. CONCLUSIONS Many parents and adolescents surveyed were not aware of all vaccine recommendations for adolescents and did not support adolescents receiving vaccinations independent of parental knowledge and/or consent.

Increasing Adolescent Immunization Rates in Primary Care Strategies Physicians Use and Would Consider Implementing

Strategies to increase adolescent immunization rates have been suggested, but little is documented about which strategies clinicians actually use or would consider. In spring 2010, we surveyed primary care physicians from 2 practice-based research networks (PBRNs): Greater Rochester PBRN (GR-PBRN) and national pediatric COntinuity Research NETwork (CORNET). Network clinicians received mailed or online surveys (response rate 76%, n = 148). The GR-PBRN patient population (51% suburban, 33% rural, and 16% urban) differed from that served by CORNET (85% urban). For nonseasonal vaccines recommended for adolescents, many GR-PBRN and CORNET practices reported using nurse prompts to providers at preventive visits (61% and 52%, respectively), physician education (53% and 53%), and scheduled vaccine-only visits (91% and 82%). Strategies not used that clinicians frequently indicated they would consider included patient reminder/recall and prompts to providers via nurses or electronic health records. As preventive visits and immunization recommendations grow more complex, using technology to support immunization delivery to adolescents might be effective.

Adolescents’ Perspectives on Vaccination Outside the Traditional Medical Home A Survey of Urban Middle and High School Students

Eleventh- and 6th-grade students from an urban public school district were surveyed concerning vaccination outside the traditional medical home. Survey response rates were 50% for 11th- and 73% for 6th-grade students. Seventy-two percent of 11th-grade students reported that public health clinics were definitely or probably acceptable locations for vaccination; 70% reported this for emergency departments, 65% for school-based health centers, 55% for family planning clinics, and 44% for obstetrics/gynecology clinics. Corresponding percentages for 6th-grade students were 60% for public health clinics, 49% for emergency departments, 39% for school-based health centers, and 36% for family planning clinics. Sixth-grade students were not asked about obstetrics/gynecology clinics. Forty-seven percent of respondents identified a doctor’s office as the “best” setting to receive vaccines, more than identified any other setting. We concluded that vaccination in one or more settings outside the traditional medical home was acceptable to most adolescents.

Successful Use of Interventions in Combination to Improve Human Papillomavirus Vaccination Coverage Rates Among Adolescents—Chicago, 2013 to 2015

In 2013, National Immunization Survey-Teen data indicated that >40% of female adolescents had not initiated the human papillomavirus (HPV) vaccine series and >60% had not completed the series, documenting vaccination rates much lower than those for other vaccines recommended for adolescents. The Chicago Department of Public Health (CDPH) was 1 of 22 jurisdictions nationwide to receive a Prevention and Public Health Fund award through the Centers for Disease Control and Prevention to improve HPV vaccination rates among adolescents. The CDPH implemented 5 interventions targeting the public, clinicians and their staff, and diverse immunization and cancer prevention stakeholders. Compared with 2013 jurisdiction-specific HPV vaccination rates among all adolescents, Chicagos HPV vaccination rates were increased significantly in 2014 and 2015. This article details the methods and results of Chicagos successful interventions, the particular strengths as well as barriers encountered, and future steps necessary for sustaining improvement.