Vaccine Implementation and Utilization
Adolescent Vaccination
Vaccinating any child or adult presents immense barriers. The most successful regimens are those required for infants. In adolescence and beyond, the ability to immunize is limited by access. Most adolescents do not receive annual health examinations. Hence, immunization opportunities occur during nonroutine visits. The experience with hepatitis B vaccines underscores the difficulty in immunizing adolescents. Clearly, a platform for adolescent immunization similar to that of infant immunizations is needed for the currently recommended vaccines. The Advisory Committee on Immunization Practices, American Medical Association, American Academy of Pediatrics, American Academy of Family Practice, and Society of Adolescent Medicine recommend an early adolescent health care visit at age 11 to 12 years. Vaccinations for tetanus/diphtheria/pertussis booster, hepatitis A, and meningococcal are recommended at this age, and other vaccines (hepatitis B, polio, varicella, measles/mumps/rubella, pneumococcal, influenza) are recommended as catch-up or for special risk groups. This adolescent platform may increase the likelihood of human papillomavirus (HPV) vaccination of girls aged 11 to 12 years. Other venues will be needed to get adequate coverage, including sport physicals, school programs, and acute care visits.
HPV Vaccine Acceptability
Several small studies on HPV vaccine acceptability among young women, parents of adolescents and providers have suggested that overall acceptability for a prophylactic HPV vaccine is high. Multiple factors influenced attitudes. The most salient issues include high efficacy, safety, severity of infection, perceived risk, physician recommendation, and, for providers, professional society recommendation. Acceptability by parents and providers appears to be higher for older adolescents, although one study found that age was not a factor for parents of adolescent children. Some parents expressed concern that a vaccine would increase unsafe sexual behavior, while another study reported that sexual transmission did not affect parental attitudes.
Most parents, young women, and adolescents have minimal knowledge of HPV and its association with cervical cancer. Several studies indicate that vaccine acceptance is improved with increased knowledge. In one study of 575 parents of 10- to 15-year-old children, brief education significantly increased acceptance of an HPV vaccine, particularly for parents who were initially undecided. Results from a randomized intervention study designed to assess the impact of a brief HPV informational brochure (such as provided in doctors' offices) on parental acceptability of HPV vaccines for their 8- to 12-year-old children, however, showed that the observed increase in knowledge related to receipt of the brochure did not result in a significant increase in vaccine acceptability. Attitudes and life experiences appeared to be more important factors. Findings from these acceptability studies are limited by their small sample size and narrow population-based sampling. Many of the authors concluded that education of parents and providers should emphasize the risk of HPV infection in adolescents and the importance of vaccinating children before the onset of sexual activity. Acceptance also may be influenced by whether the vaccine is perceived as a vaccine to reduce the risk of cervical cancer or as a vaccine to prevent a sexually transmitted infection.