Adolescence – A Challenging Time to Promote Prevention and Immunization . Juan Carlos Batlle, MD ‘04 University of Pennsylvania School of Medicine Thomas K. Zink, MD GlaxoSmithKline, Immunization Policy and Scientific Affairs. Adolescence: A Hidden Opportunity.
Juan Carlos Batlle, MD ‘04
University of Pennsylvania School of Medicine
Thomas K. Zink, MD
GlaxoSmithKline, Immunization Policy and Scientific Affairs
Handal G. Adolescent immunization. Adolescent Medicine: State of the Art Reviews. 2000;11(2):439-452.; MMWR 2002; 51: 73-76.
YRBS: CDC-conducted national school-based survey of 13,601 students in grades 9-12 during Feb-Dec 2001.
Youth risk behavior surveillance--United States, 2001. Morbidity & Mortality Weekly Report. Surveillance Summaries. 51(4):1-62, 2002 Jun 28.
1999 Add Health Study: 12,105 adolescents (grades 7-12), 1994-95 school year.
Ford CA. Bearman PS. Moody J. Foregone health care among adolescents. JAMA. 282(23):2227-2234, 1999 Dec 15.
No insurance Immunization
Alternative Site 10%*
Other 1° 20-25%**
80% Access Care
20% Don’tThe Teen Health Care Universe
65-70 million visits / yr
*Includes School Health Centers, Family Planning Clinics
**Includes OB/GYN, Internal Medicine, Hospital Outpatient
Source: JAMA 1999;282(23): 2227-34.; NAMCS
NAMCS Office Visit Data
NIAID: The Jordan Report 2002.
Source: NAMCS 2000 data. Advance No. 328.; Kaiser Family Foundation National Survey of Adolescents and Young Adults 2003.
Immunization registries Immunization
Improved access to care
Middle school mandates
Passive: Attempt to “catch” patients.
Active: Influence patients to ask for immunization.“Passive-Teen” vs. “Active-Teen” Strategies
At 30% annual rate, entire cohort is easily caught if all teens presented to system.
# of years of catch-up is fixed.
Churn rate is crucial: Increasing teens new to system to 58.3% yields 0.7mm incremental catchup each year and no lost teens
The Churn Factor
New 10 yr olds 4mm
Imm. rate (4mmx30%) -1.2mm
Churn Rate 58.3%
Incremental gain/yr -0.7mm
Years of catch-up 4yrs
Incremental Catchup (-0.7mmx4yrs) -2.8mm
Lost 10 year olds 0Getting Teens Into System Is Key
Pediatrics 2002;110: 940-945.,Pediatrics 1999;103:31-38., Pediatrics. 1999; 103:1218-1223., Ped Inf Disease Journal. 1998;17(7 Suppl):S43-6.
F I N I SH Immunization
L I NE?Crowded schedule … until 24 months
Hep B virus isolated Immunization
Hep B vax available
Kid coverage hits 90%
2001Hep B Vaccine As A Model
SLOWHep B Immunization, Kids 19-35mos.
ACIP Birth dose reco Oct 01
ACIP Reco Nov 91
CDC/NHIS Healthy People 2000 & 2010 Database; http://www.cdc.gov/nchs/about/otheract/hp2000/immunization/immunization.htm
… Thank you!