1. Contact: Anuradha Bhatt, MPH abhatt@immunizationmanagers.org
Common Practices, Program Priorities and Awardee Perspectives on Increasing Older Adolescent Coverage Rates
Anuradha Bhatt, MPH, Katelyn Wells, Ph.D
Association of Immunization Managers
Background
Survey Results
Change in Activities from 2016 to 2017: (see figure 3)
The top three most common activities all focused on educating providers about adolescent vaccines. The most common activity was providing guidance on the definition of the clinical decision recommendation for MenB (44 of 54). This was also true in 2016.
Awardees increased participation in targeting older adolescents (OA) with through social media, communicating about the older adolescent platform using newsletters to providers, and informing providers of resources about MCV4.
Awardees decreased participation in partnering with community vaccinators, including older adolescents in school assessments and promoting clinics at high schools.
Focus Group Results
Increasing vaccination rates in the older adolescent (aged yrs) population is a matter of critical importance:
40% of eligible adolescents received the recommended second dose of meningococcal vaccine in 2016
47% of 17 year-olds were up to date on HPV vaccine in 2016
>50% received influenza vaccine during the flu season.
In 2017, the Advisory Committee on Immunization Practices updated the Childhood and Adolescent Immunization Schedule to include a specific 16 year-old-column to replace the year-old column. This change encourages routine assessment and vaccination at age 16 and makes it easier for parents and providers to understand the appropriate timing of adolescent vaccinations. Several groups have expressed support for an immunization platform at aged 16 years.
IP ROLE: SUPPORTING PROVIDERS
Potential Strategies for Improvement: Adolescent Well Visit
Consider sending notices about school immunization requirements in early spring or throughout the year instead of the end of the school year.
Sending adolescent reminder/recall notices throughout the year may increase awareness about the 16-year-old platform.
Potential Strategies for Improvement: Immunizations and Non-Traditional Providers
Share materials with provider organizations for inclusion in their newsletters to educate providers about adolescent immunization and the new 16-year-old platform.
Work with internal partners in dental health and STD prevention to expand the reach of adolescent immunization promotion beyond primary care providers.
IP ROLE: TRACKING ADOLESCENT VACCINATION RATES
Potential Strategy for Improvement: State-Level Adolescent Immunization Records
Encourage CDC partners to expand NIS-Teen to measure MCV booster dose coverage at age 16 on a state by state basis.
Share local coverage rate estimates to encourage reporting of adolescent data and heighten visibility of adolescent immunization, including the 16-year-old platform.
IP ROLE: EDUCATING THE PUBLIC
Potential Strategy for Improvement: Educational Materials for Older Teens
Develop information packets to address transition to early adulthood; emphasize their responsibility for their own health care and the importance of receiving immunizations while still covered by VFC or parents’ insurance.
Keep the audience in mind when creating information packets by using content and images relevant to older teens, eg, sports physicals, or driver licensing.
Potential Strategy for Improvement: Limited Budgets
Use digital advertisements at high school sporting events to promote immunization in this demographic.
Create educational slide deck presentations on immunizations and on STDs for health education teachers to use in their classrooms.
Encourage and work with national partners to produce adolescent immunization campaigns.
IP ROLE: ADDRESSING SCHOOL REQUIREMENTS
Potential Strategy for Improvement: Educating Parents
List all vaccines recommended for adolescents, not just those required for school, in communication to parents about school requirements.
Have reminder/recall notices refer parents to providers or public health departments to identify needed vaccines, rather than listing specific vaccines.
Figure 1
Figure 2
Objectives
Understand the 64 state, local and territorial Immunization Program (awardee) programmatic priorities and levels of engagement for increasing older adolescent (OA) immunization activities.
Understand awardee perspectives in promoting adolescent vaccination, especially a 16-year-old platform, and the role for Immunization Programs (IP).
Figure 3
Methods
The 2017 AIM Annual survey (administered online to awardees from June – October 2017), which asked about the prior 12 months. The 2016 AIM Annual Survey (administered online to awardees from April – June 2016), which asked about CY 2015 activities. A 7 person focus group comprised of program managers (6 states, 1 city) was conducted in February 2017.
Survey Results
Prioritization: (see figure 1)
Eighty three percent (54 of 64) of awardees responded to the survey. Approximately two thirds (38/53) of awardees reported increasing older adolescent coverage rates as a moderate to high programmatic priority (3.9 on a 5-point scale) in 2017
Level of Engagement in Activities in 2017: (see figure 2)
Awardees reported the highest level of engagement in educating providers about the older adolescent platform during AFIX and/or VFC site visit. IP also reported high engagement for modifying their IIS to include the older adolescent platform and communicating with providers via newsletter.
Awardees reported wanting to engage in supporting a contest, including ACIP recommended vaccines on school athletic forms, and partnering with organizations that serve older adolescents if they had the resources.
Conclusions
Awardees understand the importance of increasing older adolescent coverage rates and rate this as an important priority for the coming year. Many programs are not heavily involved in direct interaction with older adolescents about immunization, but many programs work with providers in a variety of ways to increase coverage rates in this population. Focus group respondents noted several strategies for improving adolescent vaccination, especially as a 16-year-old platform.
Limitations
The 2017 AIM Annual survey had fewer overall respondents than the 2016 AIM Annual Survey, making comparisons difficult. The data were not tested for statistical significance. Due to the small size of the focus group, the results may not be generalizable to the larger immunization program manager population.
Acknowledgements: Thank you to the AIM Research Committee and AIM Staff
Contact: Anuradha Bhatt, MPH