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Adolescent Immunizations

Kathryn S. Brigham, MD^*
Mark A. Goldstein, MD

^* Chief Resident, Massachusetts General Hospital for Children, Boston, Mass
Editorial Board

Abbreviations: AAP: American Academy of Pediatrics • ACIP: Advisory Committee on Immunization Practices • CIN: cervical intraepithelial neoplasia • DTP: diphtheria toxoid, tetanus toxoid, and whole-cell pertussis • DTaP: diphtheria toxoid, tetanus toxoid, and acellular pertussis • FDA: United States Food and Drug Administration • GBS: Guillain Barré syndrome • HAV: hepatitis A virus • HBsAg: hepatitis B surface antigen • HBV: hepatitis B virus • HPV: human papillomavirus • IPV: inactivated poliovirus vaccine • LAIV: live-attenuated influenza vaccine • MCV4: tetravalent meningococcal conjugate vaccine • MPSV4: tetravalent meningococcal polysaccharide vaccine • OPV: oral poliovirus vaccine • PCV7: 7-valent pneumococcal conjugate vaccine • PPV23: 23-valent pneumococcal polysaccharide vaccine • Td: tetanus toxoid and reduced diphtheria toxoid • Tdap: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis • TIV: trivalent inactivated influenza vaccine • VAERS: Vaccine Adverse Events Reporting System

The first 300 words of the full text of this article appear below.

	Objectives

 
After completing this article, readers should be able to:

1. Discuss the rationale for the recent additions to the adolescent vaccination schedule.
   
2. Describe the indications for vaccines in adolescents.
   

	Introduction

 
In the past 5 years, the immunization schedule for adolescents has undergone numerous changes. Several new vaccines have been licensed for use in adolescents. The human papillomavirus (HPV) vaccine is expected to decrease the incidence of genital warts, abnormal cervical cytology, and cervical cancer, thereby reducing significant medical, psychological, and economic burdens for patients and society. A new vaccine against meningococcal disease aims to lower the incidence of that rare infection and its associated significant mortality and morbidity. Although diphtheria and tetanus are very rare occurrences in adolescents, the incidence of pertussis has been increasing in this age group. Fortunately, two new vaccines against pertussis for adolescents should lower the incidence of that illness in this population as well as help to reduce pertussis in the high-risk infant and elderly populations. Finally, although influenza generally is a mild illness in adolescents, new recommendations to immunize all adolescents with an influenza vaccine has the objective of reducing the incidence of the disease and its associated morbidity and mortality in high-risk populations. In addition, for some older vaccines, indications and dosing recommendations have been modified.

Clinicians who provide care for adolescents should be knowledgeable about immunization recommendations because immunizing adolescents with age-appropriate vaccines reduces their disease burden. The recommendations for vaccines in individuals who are immunocompromised are beyond the scope of this article. The Figure shows the current adolescent immunization schedule. Contraindications for vaccines are listed in Table 1, and some adverse effects of vaccines are listed in Table 2.

View larger version (53K):   Figure. Centers for Disease Control and Prevention 2008 adolescent immunization schedule. Available at http://www.cdc.gov/vaccines/recs/schedules/child-schedule.htm#printable.

Table 1. Contraindications to Vaccines^*

Vaccine Contraindication Human papillomavirus (HPV) History of hypersensitivity to yeast Tetravalent meningococcal conjugate vaccine (MCV4) History of severe allergic reaction to diphtheria toxoid or to dry natural rubber latex History of group B Streptococcus (GBS) is a relative contraindication; therefore, clinicians should discuss this with patients prior to administration Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) History of encephalopathy within 7 days of administration of prior dose of pertussis vaccine not attributable to another cause Boostrix® (GlaxoSmithKline Biologicals) should not be given if there is a history of anaphylaxis to latex because the tip and plunger of the needleless syringe contain latex Adacel® (Sanofi Pasteur, Inc) preparations have no latex Trivalent inactivated influenza vaccine (TIV) History of anaphylaxis to eggs Live-attenuated influenza vaccine (LAIV) History of anaphylaxis to eggs Chronic conditions that put the individual at higher risk for complications from influenza (eg, asthma, chronic heart or lung disease, kidney disease, diabetes) Concomitant aspirin therapy Possible immunodeficiency History of GBS Measle, mumps, rubella (MMR) History of anaphylaxis to gelatin or neomycin Known immunodeficiency Pregnancy Varicella History of anaphylaxis to gelatin or neomycin Known immunodeficiency Pregnancy Inactivated poliovirus vaccine (IPV) History of anaphylaxis to streptomycin, neomycin, or polymyxin B

^* A vaccine should not be . . . [Full Text of this Article]

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