Adolescent vaccination strategies
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1 Adolescent vaccination strategies Gregory Hussey Vaccines for Africa Initiative Institute of Infectious Diseases & Molecular Medicine University of Cape Town
2 Outline Why vaccinate adolescents? What vaccines are recommended? Strategies to vaccinate adolescents? Policies Issues of concern.
3 Immunization is one of the most cost effective public health interventions. Globally, an estimated 3m child deaths and adult deaths are prevented annually
4 Population pyramid - SA 18%
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6 WHO recommendations for immunization Universal recommendations BCG Polio DTP H influenzae type b Hepatitis B Pneumococcal conjugate Rotavirus Measles Rubella Human papilloma virus Regional / at risk recommendations Meningococcal conjugate MenA, MenC, MenACYW Hepatitis A Yellow fever Japanese encephalitis Tick borne encephalitis Rabies Dengue Typhoid Cholera Mumps Influenza Varicella
7 Why vaccinate adolescents?
8 Adolescent vaccine preventable disease burden 75% of new HPV infections occur in year olds globally. In the US, 1 in 3 whooping cough cases occur in adolescents age years. 20 % of RSA meningococcal disease cases occur in the age group years.
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11 Why vaccinate in adolescents. At risk for vaccine preventable disease. Waning infant vaccine induced immunity results in cases occurring later in childhood / adolescents.
12 Protection after Two Doses of Measles Vaccine Is Independent of Interval between Doses De Serres et al. JID 1999;180 (July)
13 Why vaccinate adolescents? At risk for vaccine preventable disease. Adolescents are a common source for transmitting infection to the community. Adolescents are a common source for transmitting infection to the community.
14 Aust Fam Physician Jan 2007
15 Prevalence (%) Meningococcal carriage rates are low during infancy and peak at 19 Years of Age 1 Young adults are the most common source of transmission to the community 2 Up to 10% of adolescents and adults are asymptomatic transient carriers Meta-analysis of 89 Studies in 28 Countries 1 Fitted data Range of 95% CI Age 1 Christensen H. Lancet Infect Dis. 2010;10(12):853; 2 Pelton SI. Pediatr Infect Dis J. 2009;28(4):329; 3 CDC. In: Epidemiology and Prevention of Vaccine-Preventable Diseases. (The Pink Book.) 12th ed
16 Why vaccinate in adolescents. At risk for vaccine preventable disease. Adolescents are a common source for transmitting infection to the community. Waning infant vaccine induced immunity results in cases occurring in adolescents. Provide catch up vaccines for those not fully immunized. Vaccinate high risk adolescent groups eg military cadets, lab workers, HIV + etc
17 POLICY Immunizing school-age children and adolescents: Experience from low- and middle-income countries
18 Vaccines for routine administration to adolescents Influenza (1 dose annually) Meningococcal conjugate vaccine (1 primary and 1 booster dose) Tetanus, diphtheria and acellular pertussis (1 booster dose) WHO Td booster 9-15 years of age * Human papillomavirus * (2 or 3 dose primary series) * WHO recommendation
19 Catch-up vaccines for adolescents not fully immunized Hepatitis B * Polio OPV * or IPV Measles * or MMR Varicella Hepatitis A * WHO recommendation
20 Vaccines for adolescents at higher risk of disease or complications Pneumococcal polysaccharide Hepatitis A Varicella Rabies Typhoid Cholera Japanese encephalitis
21 ttps://
22 Vaccines recommended during pregnancy Tetanus Influenza Acellular pertussis (Tdap)
23 Vaccine delivery strategies Clinic based Community outreach (supplemental) School based
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29 ISSUES / CONCERNS ISSUES / CONCERNS ISSUES / CONCERNS ISSUES / CONCERNS ISSUES / CONCERNS ISSUES / CONCERNS ISSUES / CONCERNS ISSUES / CONCERNS
30 Cost of vaccines in SA; SEP per dose ex VAT, PBB, May R500
31 MANAGED CARE July 2010
32 tshot2nded_eng_2015.pdf
33 Vaccinating adolescents and young adults - problems with coincidental pathologies and safety assessments
34 Importance of background rates of disease in understanding vaccine adverse events Black et al Lancet December 19; 374(9707):
35 Unseen and neglected Photograph: Photofusion/Rex, Courtesy The Guadian, UK
36 Options for linking health interventions for adolescents with HPV vaccination
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38 @ 9 years HPV Tdap
39 Don t procrastinate - vaccinate
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