title: Challenges to vaccinating adolescents: vaccine implementation issues.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA. sharon_humiston@urmc.rochester.edu
authors.forename: Sharon G
authors.initials: SG
authors.lastname: Humiston
authors.forename: Susan L
authors.initials: SL
authors.lastname: Rosenthal
mesh_terms: D000293:Adolescent; D000295:Adolescent Medicine / Q000379:methods*; D000328:Adult; D000367:Age Factors; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000009:adverse effects; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D014611:Vaccination / Q000706:statistics & numerical data*; D014917:Whooping Cough / Q000517:prevention & control*
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines