Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?

Abstract

Advances in technology have led to development of new vaccines for adolescents, but these vaccines will be added to a crowded schedule of recommended adolescent clinical preventive services. We reviewed adolescent clinical preventive health care guidelines and patterns of adolescent clinical preventive service delivery and assessed how new adolescent vaccines might affect health care visits and the delivery of other clinical preventive services. Our analysis suggests that new adolescent immunization recommendations are likely to improve adolescent health, both as a "needle" and a "hook." As a needle, the immunization will enhance an adolescent's health by preventing vaccine-preventable diseases during adolescence and adulthood. It also will likely be a hook to bring adolescents (and their parents) into the clinic for adolescent health care visits, during which other clinical preventive services can be provided. We also speculate that new adolescent immunization recommendations might increase the proportion and quality of other clinical preventive services delivered during health care visits. The factor most likely to diminish the positive influence of immunizations on delivery of other clinical preventive services is the additional visit time required for vaccine counseling and administration. Immunizations may "crowd out" delivery of other clinical preventive services during visits or reduce the quality of the clinical preventive service delivery. Complementary strategies to mitigate these effects might include prioritizing clinical preventive services with a strong evidence base for effectiveness, spreading clinical preventive services out over several visits, and withholding selected clinical preventive services during a visit if the prevention activity is effectively covered at the community level. Studies are needed to evaluate the effect of new immunizations on adolescent preventive health care visits, delivery of clinical preventive services, and health outcomes. Pediatricians have a unique opportunity to influence adolescents and their families by helping young people build a strong foundation of good health that will continue into their adult lives.American Academy of Pediatrics (AAP) 1 D ELIVERING PREVENTIVE services to US adolescents* is a public health priority. 2,3 Although most US adolescents are healthy, millions of adolescents initiate behaviors and lifestyles that can adversely affect their immediate and long-term health. 4 Potentially modifiable adolescent behaviors include failure to use seat belts, unsafe operation of motor vehicles, carrying weapons, using alcohol and other drugs, unprotected sex, inactivity, and overeating. These behaviors are directly linked to injuries and death, as well as to sexually transmitted infections (STIs), unintended *The definition of "adolescent" differs across studies and organizations; in this report, an adolescent is a person aged 11 to 18 years, unless otherwise specified.www.pediatrics.org/cgi

Projected Cost-effectiveness of New Vaccines for Adolescents in the United States

“…36 Sixth, the new adolescent vaccines are viewed to strengthen the so-called "adolescent vaccine platform," which means that the routinely recommended vaccines for adolescents may provide a prime opportunity to increase the delivery of other needed clinical preventive services or, in fact, may compete with them for time and other resources. 61 Certainly, there is also the possibility that adolescents will obtain vaccines in venues that cannot offer comprehensive services, but the aim for adolescents, as for children, is to maintain a medical home. 62 …”

A Randomized Trial of the Effect of Centralized Reminder/Recall on Immunizations and Preventive Care Visits for Adolescents

“…These recommendations are primarily based on studies of young children, published before the routine recommendations for adolescent immunization with Tdap, MCV4, and HPV vaccines; these studies noted improved childhood immunization rates due to practice-based reminder/recall. 6,7,10 Because adolescents present infrequently for primary health care visits, 5,12 reminder/recall for adolescent immunizations is attractive in concept. 13,14 Nevertheless, little evidence exists for the effectiveness of practice-based reminder/recall for adolescent immunizations, 15,16 although in one recent study in 4 practices researchers demonstrated increased immunization rates.…”

Interventions to Improve Adolescent Vaccination

“…[12][13][14][15][16][17][18][19][20][21][22][23] This work has laid the foundation for more recent research aimed at developing and evaluating interventions to increase adolescent vaccination. [24][25][26] These studies have centered primarily on HPV and influenza vaccines, given their lower coverage levels.…”