Update on Adolescent Immunization: Pertussis Vaccines
Update on Adolescent Immunization: Pertussis Vaccines
Adolescents, who comprise 14% of the US population, are historically resistant to receiving health care. As a result, adolescents have low immunization rates and are becoming more susceptible to diseases that are preventable by vaccine, such as pertussis. The incidence of pertussis has increased during the past 25 years, with a notable shift in incidence from young children to adolescents and young adults. New vaccines that provide protection against pertussis for use in adolescents have been proven to be safe, effective, and cost-beneficial. Regional epidemics among infants and other vulnerable populations can be reduced or eliminated with improved immunity in adolescents.
Fourteen percent of the current population of the United States is composed of adolescents between the ages of 10 and 19 years (US Census Bureau, 2000). Adolescents are generally considered a "healthy" group when compared with children and adults, but in reality, adolescents face unique health care challenges with rising rates of obesity, sexually transmitted infections, diabetes, violence, and substance abuse (Centers for Disease Control and Prevention [CDC], 2004c; Ozer, Park, Paul, Brindis, & Irwin, 2003).
The Guidelines for Adolescent Preventive Services, developed by the American Medical Association's Department of Adolescent Health, recommend that adolescents annually schedule a routine visit with a health care provider (American Medical Association, 1997). Historically, it has been demonstrated that adolescents avoid using the health care system; for example, patients aged 11 to 21 years accounted for only 9.1% of total office visits in 1994 (Ziv, Boulet, & Slap, 1999). Yet in 2001, it was reported that 92% of adolescents had visited a provider during the previous year, although 68% of the visits were for acute illnesses or injuries (Foundation for Accountability, 2001). Primary care providers are more likely to vaccinate during a preventive health visit than during an illness-related visit or follow-up visit (Schaffer, Humiston, Shone, Averhoff, & Szilagyi, 2001), so adolescents may not be receiving currently recommended vaccines.
Determining adolescent immunization rates is challenging, but available data show that the rates have not met the Healthy People 2010 goal, which is to ensure that 90% of adolescents have received all recommended immunizations (US Department of Health and Human Services, 2000). Rickert et al. (2004) reported that in managed care organizations, 64% of adolescents had received two doses of measles-mumps-rubella vaccine (MMR) and only 38% had completed the three-dose hepatitis B vaccine (HepB) series. Similar results were reported from the National Health Interview Survey (MMR, 76%; HepB, 55%), which included tetanus and diphtheria vaccine (Td) coverage (76%) (Dey & Bloom, 2005). The National Committee for Quality Assurance found similar rates (MMR, 72.6%; HepB, 57.5%) among persons with insurance, and even lower rates for persons with Medicaid (MMR, 67.9%; HepB, 47.3%) (National Committee for Quality Assurance, 2003).
Greater challenges for adolescent vaccination lie ahead. The Institute of Medicine (2000) reported that five vaccines (cytomegalovirus, herpes simplex virus, human papillomavirus, parainfluenza, and respiratory syncytial virus) targeted to adolescents are likely to be in development in the near future. Providers, organizations, agencies, and the government may need to consider innovative strategies to help improve the delivery of vaccines to adolescents. Primary care providers should undertake adolescent vaccination strategies as intensely as they do infant vaccination. Two recently approved vaccines for adolescents contain tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) and protect against pertussis. Nurse practitioners need to be knowledgeable about pertussis and the vaccines used to prevent this disease in order to provide adequate protection for their patients. This article reviews the pathophysiology and epidemiology of pertussis and provides practical information about its prevention in adolescents using Tdap.
Abstract and Introduction
Abstract
Adolescents, who comprise 14% of the US population, are historically resistant to receiving health care. As a result, adolescents have low immunization rates and are becoming more susceptible to diseases that are preventable by vaccine, such as pertussis. The incidence of pertussis has increased during the past 25 years, with a notable shift in incidence from young children to adolescents and young adults. New vaccines that provide protection against pertussis for use in adolescents have been proven to be safe, effective, and cost-beneficial. Regional epidemics among infants and other vulnerable populations can be reduced or eliminated with improved immunity in adolescents.
Introduction
Fourteen percent of the current population of the United States is composed of adolescents between the ages of 10 and 19 years (US Census Bureau, 2000). Adolescents are generally considered a "healthy" group when compared with children and adults, but in reality, adolescents face unique health care challenges with rising rates of obesity, sexually transmitted infections, diabetes, violence, and substance abuse (Centers for Disease Control and Prevention [CDC], 2004c; Ozer, Park, Paul, Brindis, & Irwin, 2003).
The Guidelines for Adolescent Preventive Services, developed by the American Medical Association's Department of Adolescent Health, recommend that adolescents annually schedule a routine visit with a health care provider (American Medical Association, 1997). Historically, it has been demonstrated that adolescents avoid using the health care system; for example, patients aged 11 to 21 years accounted for only 9.1% of total office visits in 1994 (Ziv, Boulet, & Slap, 1999). Yet in 2001, it was reported that 92% of adolescents had visited a provider during the previous year, although 68% of the visits were for acute illnesses or injuries (Foundation for Accountability, 2001). Primary care providers are more likely to vaccinate during a preventive health visit than during an illness-related visit or follow-up visit (Schaffer, Humiston, Shone, Averhoff, & Szilagyi, 2001), so adolescents may not be receiving currently recommended vaccines.
Determining adolescent immunization rates is challenging, but available data show that the rates have not met the Healthy People 2010 goal, which is to ensure that 90% of adolescents have received all recommended immunizations (US Department of Health and Human Services, 2000). Rickert et al. (2004) reported that in managed care organizations, 64% of adolescents had received two doses of measles-mumps-rubella vaccine (MMR) and only 38% had completed the three-dose hepatitis B vaccine (HepB) series. Similar results were reported from the National Health Interview Survey (MMR, 76%; HepB, 55%), which included tetanus and diphtheria vaccine (Td) coverage (76%) (Dey & Bloom, 2005). The National Committee for Quality Assurance found similar rates (MMR, 72.6%; HepB, 57.5%) among persons with insurance, and even lower rates for persons with Medicaid (MMR, 67.9%; HepB, 47.3%) (National Committee for Quality Assurance, 2003).
Greater challenges for adolescent vaccination lie ahead. The Institute of Medicine (2000) reported that five vaccines (cytomegalovirus, herpes simplex virus, human papillomavirus, parainfluenza, and respiratory syncytial virus) targeted to adolescents are likely to be in development in the near future. Providers, organizations, agencies, and the government may need to consider innovative strategies to help improve the delivery of vaccines to adolescents. Primary care providers should undertake adolescent vaccination strategies as intensely as they do infant vaccination. Two recently approved vaccines for adolescents contain tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) and protect against pertussis. Nurse practitioners need to be knowledgeable about pertussis and the vaccines used to prevent this disease in order to provide adequate protection for their patients. This article reviews the pathophysiology and epidemiology of pertussis and provides practical information about its prevention in adolescents using Tdap.
