Adolescent Immunization Update

Abstract

Since 2005, 3 new vaccines have been added to schedule for routine administration at the 11 to 12-year-old well-child visit. There is also a new recommendation for annual influenza vaccination of all children and adolescents. This update will provide an overview of the vaccines recommended during adolescence: human papillomavirus vaccine (HPV), tetanus and diphtheria toxoid and acellular pertussis vaccine (Tdap), meningococcal conjugate vaccine (MCV4), and influenza vaccine (Table 1). We will also discuss the factors affecting immunization rates, strategies to improve immunization rates, and briefly touch upon recommendations for catch-up vaccinations for this age group (Table 2). HPV is a highly transmissible sexually transmitted infection (STI). Oncogenic HPV types 16 and 18 can lead to vaginal, vulvar, and cervical precancers and cancers, as well as anal, penile, oropharyngeal, and oral cavity cancers. Nononcogenic HPV types 6 and 11 can cause genital warts and recurrent respiratory papillomatosis. Infection often occurs shortly after coitarche. Because approximately one-third of ninth graders have had sexual intercourse and HPV prevalence is around 40% in 14to 19-year-old sexually active females, adolescence is the ideal time to administer this vaccine. There are 2 licensed HPV vaccines (Table 1). The bivalent vaccine (HPV2), Cervarix, protects against the oncogenic HPV types 16 and 18 that cause 70% of cervical cancer, and was licensed in 2009 for administration to females aged 10 to 25 years (Table 2). The quadrivalent vaccine (HPV4), Gardasil, offers protection against HPV types 16 and 18, as well as 2 nononcogenic HPV types, 6 and 11, that cause 90% of genital warts. HPV4 was originally licensed in 2006 for administration to 9to 26-year-old females, and in 2009 received an expanded license for administration to 9to 26-year-old males. The Advisory Committee on Immunization Practices (ACIP) recently provided a permissive recommendation for HPV4 to be given to males, but has not yet recommended routine administration. Pertussis, caused by Bordetella pertussis, is the only vaccine preventable disease that is currently increasing in incidence in the United States. This is, in part, due to waning immunity from childhood vaccines. Infected adolescents and young adults generally have a chronic cough lasting several weeks that can result in lost days of work or school, and in disease transmission to infants. As adolescents and young adults are commonly siblings, parents, or caretakers for young children, achieving adequate vaccination coverage for this age group is an important step in protecting infants from infection. In a study of infants with pertussis, cough illness was reported in a parent or sibling in 28% of cases. For these reasons, in 2006, ACIP began recommending routine Tdap vaccination, in place of the tetanus and diphtheria toxoid vaccine (Td), for 11 to 12 year-olds. There are currently 2 vaccine products that provide added protection against pertussis and tetanus and are recommended for adolescents and young adults—Adacel and Boostrix (Table 1). One Tdap at age 11 years is considered adequate protection against pertussis into adulthood (Table 2); additional tetanus boosters can be given as Td. Tdap can be administered regardless of the interval since the last tetanus and diphtheria toxoid– containing vaccine. Invasive meningococcal infection results in severe disease including pneumonia, meningococcemia, meningitis, and death. While this serious infection occurs rarely, it tends to affect infants and youth aged 11 to 19 years. Adolescents and young adults living in close proximity, such as college dorms or military barracks, are at greater risk for acquiring infection. The meningococcal conjugate vaccines, Menactra and Menveo, provide protection against N. meningitidis serogroups A, C, Y, and W-135 (Table 1). In 2010, the ACIP recommended routine vaccination of 11to 12-year-olds with quadrivalent MCV4 with a booster dose given at age 16 years (Table 2). If not previously vaccinated, ACIP recommends MCV4 vaccination at age 13 to 18 years. Persons who received their first dose at age 13 to 15 years From the *Division of Adolescent Medicine, Department of Pediatrics, Golisano Childrens Hospital at Strong, Rochester, NY; and †Division of Adolescent Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Pediatrics Associates, Buffalo, NY. Reprints: Meera S. Beharry, MD, FAAP, Division of Adolescent Medicine, Department of Pediatrics, Golisano Children’s Hospital at Strong, 601 Elmwood Avenue, Box 690, Rochester, NY 14642. E-mail: meera_beharry@urmc.rochester.edu. Copyright © 2011 by Lippincott Williams & Wilkins ISSN: 0891-3668/11/3009-0787 DOI: 10.1097/INF.0b013e31822d70be CONTENTS Adolescent Immunization