As the new school year approaches, adolescents may be seeing their doctor or nurse for a physical. Any medical visit is the perfect time to check that pre-teens' and teens' immunizations are up-to-date. Although most vaccines are delivered during early childhood, several immunizations are recommended for adolescents. Starting at the age of 11 or 12, all adolescents should receive three important vaccines and an annual flu vaccine:¹

• Tetanus, diphtheria, and pertussis vaccine (1 dose): a booster to protect against these three infectious diseases (pertussis is also called "whooping cough");
• Meningococcal conjugate vaccine (2 doses) (MCV4, or MenACWY): an immunization to protect against meningococcal disease (like meningitis or sepsis, a blood infection);
• Human papillomavirus (HPV) vaccine (3 doses) (Cervarix or Gardasil): an immunization recommended for both boys (Gardasil only) and girls (both Cervarix or Gardasil) to protect against many HPV-related cancers;
• Influenza (flu) vaccine (each year): a vaccine (either the flu shot or nasal spray) that is recommended yearly for everyone over 6 months of age to protect against different strains of seasonal influenza.

Time to Catch Up

Adolescents may need to catch-up on vaccines missed when they were younger, or receive boosters of a vaccine that requires more than one dose. To learn more about the vaccines recommended for adolescents, check out this easy-to-use chart from Vaccines.gov which lists the immunizations recommended by the Advisory Committee on Immunization Practices (ACIP) for children and youth ages seven through 18. The U.S. Preventive Services Task Force and all major medical groups adopt the ACIP recommendations.²

Adolescent immunization rates vary by vaccine type, geographical region, and race

• The proportion of adolescents receiving immunizations on time has increased each year between 2006 and 2010. In 2010, coverage rates of the three adolescent-focused vaccines were 69 percent for tetanus, diphtheria, and pertussis, 63 percent for meningitis, and 49 percent for one or more doses of HPV vaccine. By way of comparison, for early childhood vaccines, rates for most long-recommended vaccines are at or above 90 percent.³
• Adolescents living in the Southeastern United States are significantly less likely to receive the three adolescent-targeted vaccines than are teens living in other regions of the country.⁴
• Less than one-third of adolescents received the required three doses of HPV vaccine.⁵ Certain groups of teens are more likely to start, and to finish, the HPV vaccine series: Hispanics and American Indian/Alaskan Natives are more likely than whites to receive at least one dose of the HPV vaccine; however white teens are more likely to receive all three HPV doses than are black or Hispanic teens.⁶

For the most up-to-date data on adolescent immunizations, click here. Also, Vaccines.gov has a widget you can put on your own website to link users to the most up-to-date immunization recommendations.

The HPV Vaccine

The HPV vaccine prevents several types of cancer. Specifically, HPV infection can cause cervical cancer in women, penile cancer in men, and anal or oropharyngeal (throat) cancers in both sexes. In fact, in 2011, HPV may have exceeded smoking as a cause of throat cancer in men.⁷ Gardasil can also protect against genital warts, which are spread by sexual or skin-to-skin contact.⁸ The HPV vaccine is licensed, safe, and effective for females and males ages 9 through 26, and the ACIP recommends that all adolescents begin receiving the vaccine at age 11 or 12. Older adolescents who didn’t begin the series at age 11 or 12 are encouraged to start as soon as possible to “catch up.”  For females, catch-up is recommended up until age 26; for males, catch-up is recommended until age 21 (and until age 26 for males who have sex with other males).⁹ To learn more about why the HPV vaccine is recommended for adolescent boys, click here for a video!

Why so young? For the HPV vaccine to work as it is intended, adolescents should complete all three doses before any sexual activity with another person. The human body produces more antibodies against HPV when given the vaccine at a younger age.¹⁰

Vaccinations and the Affordable Care Act

All youth under age 18 who are enrolled in new group or individual private health plans are eligible to receive the following vaccines without any cost-sharing requirements (when provided by an in-network provider):¹¹

What Communities Can Do

The Guide to Community Preventive Services (Community Guide) has evaluated strategies to increase community vaccination rates. Its recommendations pertinent to adolescent immunizations include:¹²

• Creating requirements. Creating requirements for immunizations prior to entry into child care, school, and college.
• Establishing vaccination programs in community settings. Programs in Women, Infants, and Children (WIC) offices reach many infants and young children with early childhood vaccines, preventing the need for many "catch-up" vaccinations in adolescence.

What Healthcare Providers Can Do

Success in increasing immunization in younger populations is often credited to changes in office practices that view every office visit as an opportunity to update immunizations. Specific evidence-based practices include:¹³

• Set up reminders for you and/or your staff. Reminders, such as prompts in patients’ charts or computer databases, help providers and other clinical staff know when teens are due for vaccinations. In one study, provider reminders increased vaccinations by an average of 18 percentage points.¹⁴
• Set up reminders for patients. Patient reminders involve alerting patients that vaccinations are due or overdue. Reminders can be via telephone, letter, postcard, or system used in your practice.
• Establish standing orders for vaccines. Standing orders authorize nurses, pharmacists, and other healthcare personnel to asses a client’s immunization status and administer vaccinations without the need for examination or direct order from the attending provider. 
• Post recommendations. Providers can also post recommendations and have informational materials available in the office or the practice’s website. Immunization schedules for preteens and teens (ages seven through 18) are available here and print materials are available here.

Many other resources for healthcare providers are available:

• Check out this fact sheet from the CDC, "Information for Health Care Professionals about Adolescent Vaccines," which includes strategies for ensuring that teen patients become fully vaccinated, as well as information on side effects and other details. 
• The print recommendations mentioned above are also available in Spanish, Vietnamese, Korean, and for American Indian/Alaska Native populations. Healthcare providers may also want to post this fact sheet for parents on the risks and responsibilities they face if choosing not to vaccinate their child.
• The CDC has a variety of web-based tools for providers to encourage immunizations. Click here for e-cards and online videos about the importance of vaccinations in adolescence. 

What Parents Can Do

Parents and other caring adults can help protect adolescents against infectious diseases:

• Know the facts. Along with knowing when adolescents should receive immunizations, parents can learn why vaccinations for adolescents are important here, as well as watch this quick video.
• Don’t let cost be a deterrent! The CDC’s Vaccines for Children Program provides vaccines at no cost to over 40 million children under 19 each year. Click here information for parents.
• Stay on track. The interactive Adolescent Immunization Scheduler helps make sure that parents, and teens themselves, never miss an appointment. 
• Document your teen's immunization history. Click here to find out how to access your teen’s vaccination records if you or your doctor do not have them.

 ¹ Centers for Disease Control and Prevention. (2012). 2012 Recommended Immunizations for Children from 7 to 18 years old, Available here.

 ² United States Preventive Services Task Force. Immunizations for Children. Available here.

 ³ Centers for Disease Control and Prevention. (2011). National Immunization Survey-Teen Data - Adolescents/Teens (13-17 years). Available here.

 ⁴ Ibid.

 ⁵ Among females who initiated the HPV vaccine series, 94.3% met the minimum amount of time needed to complete the series before the interview.

 ⁶ Centers for Disease Control and Prevention. (2011). National Immunization Survey-Teen Data - Adolescents/Teens (13-17 years). Available here.

 ⁷ Chaturvedi, A., et al. (2011). Human Papillomavirus and Rising Oropharyngeal Cancer Incidence in the United States. Journal of Clinical Oncology, JCO Nov 10, 2011:4294-4301, available here.

 ⁸ Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases. (2012). Vaccines and Preventable Diseases: HPV Vaccine - Questions & Answers, available here.

 ⁹ Ibid.

 ¹⁰ Ibid.

 ¹¹ The Affordable Care Act and Immunization, available here

 ¹² Guide to Community Preventive Services (2012). Vaccinations to prevent diseases: universally recommended vaccinations. Available here.

 ¹³ Ibid.

 ¹⁴ Ibid.