Carol Mansfield, M.D., M.P.H.Winthrop Pediatrics and Adolescent

Medicine

The Advisory Committee on Immunization Practices recommended that these vaccines be

administered at ages 11-12 years of age, thereby strengthening the “adolescent

platform.”

For HPV, vaccination prior to onset sexual activity improves the efficacy of the vaccine.

Pediatrics, December 2011, volume 128, number 6Adolescent Vaccination Coverage Level in the United

States: 2006-2009

From 2005-2007, three vaccines were added to the adolescent shedule, Tdap, Menactra, and for

girls, Gardasil.

HPV vaccination prior to onset sexual activity maximizes its efficacy

CDC Youth Risk Behavior Surveillance-United States, 2009. Grades 9-12

First Sexual Intercourse before age 13 yrs: Nationwide, 5.9%, white female 2.2%

Ever had sexual intercourse: Nationwide 46% (range from 39% to 61% across state surveys)

Winthrop Pediatrics and Adolescent Medicine embraced the Gardasil vaccination recommendation due to too many ASCUS and LGSIL reports and referrals!

However, providers harbored concerns about duration of immunity, age appropriateness of timing of vaccine administration, parental readiness,

and aggressiveness of advertising by the vaccine maker.

Provider Reactions

Parental Reactions

1. Safety concerns2. Lack of knowledge3. New vaccine4. Not sexually active5. Child does not like shots6. Not needed/necessary7. Too many vaccines at once8. Need to consult with her father/mother, delay tactics9. Expense

Parental Reasons for Not Vaccinating

In the annual National Immunization Survey-Teen (NIS-Teen), among parents of teenagers who had not initiated the HPV series, report of a provider recommendation was significantly associated with vaccination and an intent to vaccinate in the future.

Pediatrics, December 2011, Adolescent Vaccination-Coverage

Levels in the US: 2006-2009

Quality improvement efforts at Winthrop Pediatrics and Adolescent Medicine for Gardasil

1. Providers and staff to recommend Gardasil vaccination starting at age 11 years “to strengthen the adolescent platform,” and annually thereafter, with a very strong push upon entry to high school if not done already. We are patient and sensitive to religious and cultural considerations when parents are not yet ready to embark with the series.

2. Due to 50% no show for subsequent nurse vaccination appointments, we are starting

follow-up phone calls to all no-shows for subsequent Gardasil vaccinations (our present PDSA cycle).

Quality improvement efforts at Winthrop Pediatrics and Adolescent Medicine for Gardasil (continued)

3. Due to problems with scheduling follow-up vaccinations too soon, we are educating all of our staff about the vaccination schedule

4. At every visit, physicals, acute and follow-up, we are printing the patient’s ImmPact vaccination record for the medical assistant and provider to review to reduce any missed vaccine opportunities (previous PDSA cycle.)