Vaccine Protection: Adolescents Falling Through the Cracks; Latest Vaccine News in Time for Back-to-School Check-Ups

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WASHINGTON, Aug. 15, 1996 -- The National Foundation for Infectious Diseases today issued the following:

Health officials presented data today that reveal continuing threats to the health of our nation's teens from immunizable infectious diseases. They called for all 11 to 12-year-old adolescents to be adequately immunized, noting that the back-to-school period is an ideal time to assess vaccination status. Also divulged during the news conference were figures on measles outbreaks during the 1995-96 season, details on the new availability of the chicken pox vaccine, and results of a national survey of adolescents and their knowledge and perceptions of vaccines.

Chicken pox More Serious in Adolescents

Alarmingly, 20% of our nation's 11 to 12-year-old adolescents haven't had chicken pox, and therefore are at risk. Although chicken pox is usually considered a benign childhood disease, it can cause complications such as bacterial superinfections, encephalitis, pneumonia and Reye's syndrome. The disease results in the hospitalization of more than 9,000 previously healthy people each year, and as many as 50 to 90 people die each year from chicken pox complications. "Adolescents who develop varicella may be ill for over a week, miss school for that interval, and be at greater risk than children to develop varicella complications, said Anne Gershon, M.D., Department of Pediatrics, Columbia University College of Physicians and Surgeons. This makes it all the more crucial for those adolescents who have not had chicken pox to receive the vaccine. "It is highly recommended for adolescents 11 to 12 years of age who have not had varicella." said Gershon.

Just in time for fall immunizations, many public health clinics nationwide will begin to offer the chicken pox vaccine. About 60% of U.S. children now receive their immunizations through federal and state funded programs, including the federal Vaccines for Children program. Availability of the chicken pox vaccine through these and private providers will protect tens of thousands of children and adolescents from the disease.

Adolescents in High-Risk Group for Measles

Adolescents are among three groups at high risk for contracting measles, along with college students and health care workers. According to the Centers for Disease Control and Prevention (CDC), there have been 17 outbreaks of measles in the United States thus far this year, resulting in 276 individual cases. More than 70% of these cases occurred among those 10 years old or older. Most had received no measles vaccine or only one dose. "Measles has shifted from predominately being a disease of young children, to a disease of adolescents and young adults," stated Gregory Poland, M.D., Chair, Mayo Vaccine Research Group, and Chair of the National Coalition for Adult Immunization. The death rate among those who contract measles varies, from one in 1,000 cases to three in 1,000 cases. Measles is often far more serious when contracted later in life. Two doses of measles vaccine are recommended and will provide protection to most persons. Therefore, it is imperative that adolescents returning to school this fall be up-to-date with two doses of measles vaccine.

Most Hepatitis B Occurring Among Adolescents and Young Adults

While the overall incidence of hepatitis B is decreasing, the CDC reported that 70% of new cases occur in adolescents or young adults 15 to 39 years old. Routine immunization of adolescents against hepatitis B has been recommended since 1995. Beginning in 1996, the National Health Interview Survey will provide vaccination coverage data on a national sample of adolescents. Every day, 11 to 14 people die from hepatitis B-related illnesses and liver cancer.

Common modes of disease transmission include sexual contact; maternal-fetal transmission at birth, sharing toothbrushes and razors; using unsterilized needles for injection drug use, body piercing, tattooing or acupuncture; and living with someone infected with hepatitis B. "What is frightening to note, however, is that one-third of individuals with acute hepatitis B do not have a readily identifiable source for their infection," said Harold Margolis, M.D., Chief, Hepatitis Branch, CDC. "Immunization at age 11 to 12 is crucial to ensuring that all teens are properly immunized against hepatitis B."

Diphtheria Outbreaks Threaten

Diphtheria represents another potential threat to adolescent health, due to waning of vaccine protection received in infancy. In a Minnesota survey, 62% of persons 18 to 39 years old lacked adequate protection against diphtheria.

Although there have been no recent diphtheria epidemics in the U.S., and while only zero to 5 cases are reported each year, an outbreak could occur at any time. In 1994, there were over 47,000 cases and over 1,700 deaths due to diphtheria in the Newly Independent States of the former Soviet Union, as well as a number of cases in Europe. "In this age of global travel, diphtheria could easily cross the ocean," said Dr. Gershon. "The back-to-school visit is the ideal time for adolescents to receive a booster shot to protect them from this dangerous disease."

Results of National Survey

Public health experts point out that many adolescents are not receiving the immunizations they require. This is partly blamed on the fact that since the advent of vaccines, diseases such as measles mumps, rubella and diphtheria no longer plague our nation in epidemic proportions. Vaccines have reduced the fear of these diseases among adults, and thus the fear -- and knowledge of these diseases -- has not been passed on to children and adolescents.

Steven Mostow, M.D., Chairman, Department of Medicine, Rose Medical Center in Denver, and Director, National Foundation for Infectious Diseases, cited a recent national survey, sponsored by Merck & Co., Inc., of adolescents and their knowledge and perceptions of vaccines. "Vaccines and national immunization programs have significantly reduced childhood infectious diseases in America," states Dr. Mostow. "However, this success is paralleled by a generally low name recognition and understanding of these diseases among children today."

For example, when asked if they knew what polio was, 55% of 10 to 12 year olds had heard the word before, and of those, only 26% reported knowing what it meant. Furthermore, most children who claimed they knew what polio was gave responses that indicated only partial knowledge of the disease, such as "Franklin D. Roosevelt died from it, or It is caused by unclean drinking or pool water." When asked if they had heard the word "rubella," 22% of 10 to 12 year-olds said they had, yet only 4% reported any knowledge of the disease. Rubella is a disease which can cause serious complications during pregnancy, leading to fetal death, premature delivery, and congenital birth defects.

By contrast, for chicken pox, a disease most adolescents have experienced, 100% report having heard of it, and 95% reported knowledge of the disease. Similarly, 97% of 10 to 12 year-olds had heard the word measles, and 72% claimed awareness of the disease, most likely due to recent outbreaks.

Missed Opportunities

One proposed solution to the problem of inadequate immunization of adolescents is the routine preventive care visit at age 11 to 12 years. This visit, already recommended by a number of professional medical organizations, would enable health care professionals to administer any necessary boosters, as well as provide other recommended preventive services.

Experts point out that routine visits for infants and large-scale childhood immunization campaigns have significantly increased immunization rates for infants and young children, but there has been virtually no focus on adolescents.

"Comprehensive adolescent immunization activities are needed to achieve national disease elimination goals," stated Walter W. Williams, M.D., Chief, Adult Vaccine Preventable Diseases Branch, National Immunization Program, CDC. "An effective adolescent immunization strategy should include review of immunization status, delivery of indicated vaccines, and provision of other preventive services as needed. Dr. Williams notes that laws and regulations requiring immunization for school entry can he a very effective tool in increasing vaccination levels and decreasing spread of disease.

This conference was sponsored by the National Foundation for Infectious Diseases (NFID), through an unrestricted educational grant from Merck & Co., Inc.

SOURCE: National Foundation for Infectious Diseases

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