Vaccines for Teens
By Samuel Katz, MD, and Dennis Clements, MD, PhD

Parents most often think of immunizations for their children in the first 18 months of life and then when they enter school at age 5 or 6. However, a new paradigm is emerging with a focus on teenagers or preteens. At least three new vaccines will soon be available to help protect adolescent health. All will likely be endorsed by the American Academy of Pediatrics, the American Academy of Family Physicians, and the Centers for Disease Control and Prevention.

The first, already licensed earlier in 2005, is a newer, more effective product to prevent meningococcal infection. The three principal groups of organisms responsible for meningitis and severe bloodstream infections in this country are the meningococcus, the pneumococcus, and haemophilus influenza B. Very successful vaccines for the latter two have already been in use for several years; as a result, there has been a striking decrease in those infections. The only vaccine available for the meningococcus, however, has had only limited efficacy.

Two major age groups are most at risk for a meningococcal infection: infants and young children in the first several years of life, and teenagers—particularly those who reside in college dormitories. Both Duke and the University of North Carolina have had instances of meningococcal infections among students. Ten percent of such infections may result in death, while others may cause devastating permanent effects such as mental retardation, loss of limbs, and skin scarring. The vaccine is recommended at age 11 or 12, or at high school entry, as well as to entering college freshmen who will be living in dormitories, travelers to endemic countries, and any other high-risk groups.

The second new vaccine is designed to protect women against the human papillomaviruses (HPV), which are sexually transmitted. Why give this vaccine to teenagers? At least two types of HPV are responsible for more than 75 percent of cervical cancers, which are second only to breast cancer as the most frequent malignancy among women. The viruses cause precancerous changes in the cells lining the cervix of the uterus (which regular Pap tests are recommended to detect).

Studies show that the new HPV vaccine effectively prevents this persistent infection and, therefore, can be expected to dramatically reduce the incidence of cervical cancer. Because HPV transmission begins with the onset of sexual activity, it is logical that the vaccine be administered to young girls before they become sexually active. The vaccine is not yet available, but may be licensed in 2006 or shortly thereafter.

A third infection for which we have immunized infants and children for many years is pertussis—also known as whooping cough. It has recently become apparent that the current vaccines, which have been employed for more than half a century, protect only for five to 10 years. Most children receive their last injection prior to entering school so that 10 years later, as adolescents, they need a booster.

A special vaccine known as dTap has been formulated to boost protection against diphtheria and tetanus as well as pertussis. These vaccines are likely to be licensed within the next months. Pertussis in adolescents or adults does not always feature the disease's characteristic "whoops"--it may appear as only a chronic cough lasting more than two weeks. However, these individuals may transmit the infection to infants too young to have been fully vaccinated. These infants often become severely ill and can even die.

Although hepatitis B vaccination is recommended for infants shortly after birth and throughout the first six months of life, many youngsters reach school without ever having had their hepatitis immunization. Therefore, another aspect of teenage immunization may be a hepatitis “catch-up” at age 11-13 years if a youngster has not previously received a full course of hepatitis B vaccine. Similarly, some children may never have had their second dose of measles-mumps-rubella {MMR} vaccine; that, too, could be administered at an adolescent visit.

The American Academy of Pediatrics has encouraged families to have their children seen at around age 12 for health assessment and management of any problems. Such a visit would be a perfect time at which to check on the need for these new vaccines or for additional doses of the “old” ones. Many children see physicians or other health care workers for examinations prior to participation in sports, camping events, travel, applying to college, and so on. These visits would provide a perfect opportunity to assess the need for any or all of the new vaccines and to initiate them at that time. The new meningococcal vaccine and the new pertussis vaccine require only a single injection. The papillomavirus vaccine, however, may require three, making it necessary to schedule additional visits beyond the initial one.

However these vaccines and schedules work out, the goal is to protect young people against serious, preventable diseases, to assist them in achieving maximum health benefits, and to prevent their spreading infection to others.

Samuel Katz, MD, is the Wilburt Cornell Davison Professor and chairman emeritus of pediatrics at Duke University Medical Center. Dennis Clements, MD, PhD, is interim chair of the Department of Pediatrics at Duke University Medical Center. For more information, visit www.dukehealth.org

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