Challenges to vaccinating adolescents - Vaccine implementation issues
Challenges to vaccinating adolescents - Vaccine implementation issues
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DOI：
10.1097/01.inf.0000166161.12087.94
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发表时间：
2005-06-01
影响因子：
3.6
通讯作者：
Rosenthal, SL
中科院分区：
文献类型：
--
作者：
Humiston, SG;Rosenthal, SL
背景：青少年免疫是一个不断发展的领域，许多新疫苗正在开发中，新的或扩大的免疫建议即将出现。方法：讨论了青少年的特征及其卫生保健，特别关注在青春期早期或中期将破伤风白喉-无细胞百日咳疫苗替代破伤风-白喉类毒素的潜在建议纳入常规预防保健的一部分所面临的挑战。利用疾病控制和预防中心社区预防服务工作组创建的框架，审查了疫苗干预机会的三个重叠层面：（1）医疗保健系统（增强获得疫苗接种服务的机会）； (2) 卫生保健提供者（基于提供者的干预措施）； (3) 患者和家庭（“不断增加的社区需求”）。结果：疫苗的实施存在一些障碍，这使得在青少年中实现高免疫覆盖率成为一项挑战。在医疗保健系统层面提高疫苗接种率的有前景的干预措施包括减少自付费用、扩大免疫接种范围以及在学校实施疫苗接种计划。基于提供者的提高疫苗接种率的干预措施包括定期评估免疫率并向所有办公室人员提供反馈、提供者提醒和常规命令。客户回忆和提醒、教育和入学要求可以有助于“增加社区对疫苗接种的需求”，因为它们可以激励父母和青少年完成免疫接种。结论：青少年与其他人群相比是独特的。由于免疫接种成为青少年卫生保健中更加突出的问题，因此需要在该年龄组中测试先前研究的干预措施。
Background: Adolescent immunization is a growing field, with many new vaccines in development and new or expanded immunization recommendations on the horizon.Methods: Characteristics of adolescents and their health care are discussed, focusing specifically on the challenges of incorporating a potential recommendation to replace tetanus-diphtheria toxoid with tetanus-diphtheria-acellular pertussis vaccine during early or middle adolescence as part of routine preventive care. Using the framework created by the Centers for Disease Control and Prevention's Task Force on Community Preventive Services, three overlapping levels at which there are opportunities for vaccine intervention are reviewed: (1) health care systems (enhancing access to vaccination services); (2) health care providers (provider-based interventions); and (3) patients and families ("increasing community demand").Results: There are several barriers to vaccine implementation that make achieving high immunization coverage rates among adolescents a challenge. Promising interventions for improving vaccination rates at the health care system level include reducing out-of-pocket costs, expanding access to immunizations, and implementing vaccination programs in schools. Provider-based interventions for improving vaccination rates include regular assessments of immunization rate with feedback to all office personnel, provider reminders, and standing orders. Client recall and reminders, education, and requirements for school entry can assist in "increasing community demand" for vaccinations in that they motivate parents and adolescents to follow through with immunizations.Conclusions: Adolescents are unique from other populations. Previously studied interventions need to be tested in this age group as immunization becomes a more salient issue in adolescent health care.