Taking Action to Address Critical Gaps in Teen Immunization

Oct 10, 2018 | Kim Rodgers

Immunization data has revealed significant gaps in vaccination coverage among adolescents, especially those 16-to-18 years of age. There is a significant need to ensure that these adolescents receive timely immunization to prevent the threat of significant health consequences. To support this effort, the Adolescent Immunization Initiative (AII) was formed to establish an immunization platform for adolescents at 16 years of age.

According to recent data from the Centers for Disease Control and Prevention (CDC), millions of Americans aged 13-17 are under-vaccinated against serious infectious diseases. Specifically, the CDC recommends all teens receive at least the quadrivalent meningococcal meningitis vaccine (MenACWY)*; human papillomavirus (HPV) vaccine; tetanus, diphtheria and acellular pertussis (Tdap) vaccine; and influenza (flu) vaccine. Though we’re seeing incremental year-over-year improvement in vaccination rates overall—the coverage rates for vaccines that need to be administered as multi-dose series remain low. For example, in 2016, 82.2% of teens received the first dose MenACWY vaccine, but only 39.1% of teens received the recommended second dose. The data also show less than half of teens (49.5% of girls and 37.5% of boys) completed the HPV vaccination series. Meningococcal meningitis, though rare, can cause death in a matter of hours, and more than 31,500 women and men are affected by cancer caused by HPV each year.

We need to act to help protect more teens, especially when they turn 16! To this end, the CDC recently modified the Childhood and Adolescent Immunization Schedule, calling out a specific 16-year-old immunization visit. This is a step in the right direction, but rates won’t improve significantly until this visit becomes a standardized platform like the 11- to 12-year-old immunization/preventive services visit. This visit has contributed to vaccination rates for Tdap vaccine and the first dose of MenACWY surpassing Healthy People 2020 goals.

To support this effort, a multidisciplinary group of experts specializing in adolescent health and immunization, known as the Adolescent Immunization Initiative (AII) focus primarily on immunization of older adolescents, 16 - through 18 – years of age. AII’s mission is to increase those rates by collaborating with stakeholders to establish an immunization platform at 16 years of age. The Adolescent Immunization Initiative (AII) is a multidisciplinary group of experts in adolescent health and immunization, including pediatricians, adolescent medicine specialists, family physicians, nursing professionals, infectious disease experts, public health advocates, and pharmacy professionals. AII aims to raise awareness about the 16-year column on the ACIP schedule and its significance and help health care providers implement an immunization and preventive services visit for 16-year-olds in their practice.

The 16 – year old immunization platform has several potential benefits, such as helping teens catch up on missed immunizations and assessing vaccinations for high-risk conditions. Ultimately, the platform could help improve adolescent preventive health care overall. As a clinician, healthcare providers can also make the 16-year-old platform a reality by implementing it in practice and making it a routine part of older adolescent health. Elevating the importance of the 16-year-old visit would make clinicians and families more aware of, and motivated to comply with, preventive health recommendations for adolescents. Ideally, such a visit would stimulate a lifelong preventive care mindset in adolescents, with immunizations providing a solid foundation. To further assist adolescent healthcare providers in implementing best practices, and understanding the potential benefits of the 16-year old visit the AII’s partners developed a white paper, Rationale for An Immunization Platform at 16 Years of Age.

There is a lack of awareness among health care providers about the new 16-year age column on the ACIP schedule. In addition, health care providers tend to overestimate their practice’s immunization rates and therefore may not recognize the need for a plan of improvement. Firmly establishing the 16-year-old immunization platform in practice will require widespread recognition among health care providers that 16 years is a priority age for a preventive health visit and that vaccination is an important intervention during the visit.

Implementing the platform requires a proactive approach, such as identifying 16-year-olds who are due for their annual immunization and preventive health visit and reaching out to them rather than waiting for them to come in to the medical office on their own. Healthcare practices are encouraged to implement the 16-year old immunization visit:

  • Measure adolescent immunization rates to get a baseline and set goals for improvement.
  • Identify and reach out to vaccine-eligible patients (e.g., remind and recall).
  • Adopt a team approach and a routine vaccination workflow (e.g., use standing orders), and designate a vaccine champion to lead the practice’s immunization efforts.
  • Capitalize on opportunities to immunize (check immunization status at every patient visit).
  • Foster a culture of prevention, including scheduling annual preventive health visits for all teens.
  • Educate families about the 16-year-old visit far in advance (as early as the 11- to 12-year-old immunization visit).

For more information, please access the following tools and resources on adolescent immunization and the 16 year-old platform visit:

Journal articles that include a focus on age 16

Klein J, Tan L, Zimet GD. Improving adolescent immunization coverage: the time to act is now.
J Adolesc Health
. 2017;61(5):541-543.

Clark SJ, Cowan AE, Wells KB. Public health opportunities to improve late-adolescent immunization. J Public Health Manag Pract. 2018 Mar 1. doi: 10.1097/PHH.0000000000000792. [Epubahead of print].

(Also SAHM’s position statement as noted under SAHM entry on page 2)

Adolescent Immunization Initiative (AII)

Rationale for an Immunization Platform at 16 Years of Age (February 2017)

Implementing the Adolescent 16-Year-Old Immunization Platform in Your Practice (May 2018)

AII fact sheets (forthcoming, July 2018): The Importance and Potential of the 16-Year-Old Immunization Visit and Implementing the 16-Year-Old Immunization Visit: A How-To Tool for Health Care Practices

American Academy of Family Physicians (AAFP) Foundation

Highlight on VACCINATIONS 4 TEENS (HOV4T) Resource Library, http://www.aafpfoundation.org/vaccinations4teens

American Academy of Pediatrics (AAP)

Companion articles in Pediatrics (March 2017) on adolescent immunization:
Practical Approaches to Optimize Adolescent Immunization and The Need to Optimize Adolescent Immunization: http://pediatrics.aappublications.org/content/139/3/e20164187 and http://pediatrics.aappublications.org/content/early/2017/02/02/peds.2016-4186

Association of Immunization Managers (AIM)

Adolescent Immunization Toolkit, including resource guide, program practices database and interviews,
and resource library, http://www.immunizationmanagers.org/adolescents

Centers for Disease Control and Prevention (CDC)

Preteen and Teen Vaccine Resources, http://www.cdc.gov/vaccines/parents/resources/teen.html

Immunization Action Coalition (IAC)

Adolescent immunization update and the 16-year-old platform. (Webinar), http://www.immunize.org/webinars/atkinson2

PowerPoint slide sets: http://www.immunize.org/resources/res_powerpoint.asp

Technically Speaking (February 2017): New “16-year-old Vaccination Platform” Highlighted in 2017 U.S. Child/Teen Immunization Schedule, http://www.immunize.org/technically-speaking/20170222.asp

MenACWY: You’re Not Done If You Give Just One; Give 2 Doses to Strengthen Protection, http://www.Give2MenACWY.org

Top 10 Ways to Improve Adolescent Immunization Rates, http://www.give2menacwy.org/improve-your-rates/top-10

Vaccineinformation.org; includes personal testimonials from teens, http://www.vaccineinformation.org/teens/

IAC and the Society for Adolescent Health and Medicine (SAHM)

You’re 16…We Recommend These Vaccines for You! (Patient handout)

National Association of School Nurses (NASN)

Stats4Vax: Improving teen vaccination rates one school nurse at a time (resource library)

National Foundation for Infectious Diseases (NFID)


Call to Action: Addressing New and Ongoing Adolescent Vaccination Challenges (March 2016)

Infographic: Adolescents Can Be Protected from 14 Deadly Diseases

Parents of Kids with Infectious Diseases (PKIDS)

http://www.pkids.org; not specific to adolescent immunization but includes pertinent material, including videos of adolescent patient stories (http://www.pkids.org/meningitis/videos.html)

Society for Adolescent Health and Medicine (SAHM)

Position statement: Establishing an Immunization Platform for 16-Year-Olds in the United States http://www.adolescenthealth.org/SAHM_Main/media/2017-Speaker-Handouts/Auslander-et-al-SAHM-16-year-old-Platform-J-Adolesc-Health-2017.pdf

(Also patient handout done jointly with IAC, as listed at top of page)

UNITY (United for adolescent vaccination)

Vax@16: Missed opportunities guide, resources for parents and teens, infographics, http://www.unity4teenvax.org/home/resources/vax16/

Adolescent Immunization: Understanding Challenges and Framing Solutions for Healthcare Providers (May 2017)

Phone app Thrive—Teen/Young Adult Health Resources, Information & Vaccine Education http://www.unity4teenvax.org/resources/thrive-app/

Pursuit of the Three C’s: Confident, Concise, and Consistent Healthcare Provider Recommendations for Adolescent Vaccines (video series) and Adolescent Health and Immunization Poll findings: http://www.unity4teenvax.org/unity-projects/

The Vaccine Handbook (The Purple Book)

Table and accompanying description on immunization platforms, including late adolescent

National Alliance to Advance Adolescent Health

Got Transition – practice tools to improve the transition from pediatric to adult health care, http://www.gottransition.org

Voices of Meningitis
http://www.voicesofmeningitis.org; includes video library of patient stories


About Kim Rodgers

Pronouns: She/Her

Kim Rodgers is the Communications Manager at NACCHO.

More posts by Kim Rodgers

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