Abstract and Introduction
Introduction
While vaccines are the most cost-effective strategy to prevent disease, their effectiveness is limited by vaccine uptake. Thus, development of a safe and effective vaccine is not sufficient, in or of itself, to result in high coverage rates. A case in point is seasonal influenza vaccine. Although influenza is a vaccine preventable disease, it remains a leading cause of morbidity and mortality in the USA. School-age children, including adolescents, have markedly high illness attack rates and are the primary transmitters of influenza to at-risk populations, such as the elderly. Vaccination is the single most effective tool to prevent influenza infection, and vaccinating adolescents may provide both direct protection for those immunized and indirect protection for vulnerable community members. Thus, there is a clear, cogent and compelling public health urgent need to vaccinate adolescents against influenza. Accordingly, the CDC's Advisory Committee on Immunization Practices expanded the recommended ages for annual influenza vaccination to include all children and adolescents from 6 months to 18 years of age in 2008, and further expanded the recommendation for universal influenza vaccination in 2010.
Despite the need for maximizing influenza vaccine coverage among adolescents, vaccination rates remain persistently low. In 2009–2010, the national combined seasonal or H1N1 influenza vaccine coverage rate was only 55.2% for children aged between 6 months and 17 years. Furthermore, combined influenza vaccination coverage was lower among black children and adolescents compared with their white peers. This highlights the need to identify and intensify strategies to overcome barriers to immunization among adolescents, and particularly minority adolescents.
Challenges to immunizing adolescents against influenza are formidable, ranging from individual factors to structural barriers. The Task Force on Community Preventive Services has identified three main areas targeted for interventions to increase vaccination among children and adolescents: enhancing access to vaccination services, provider-based interventions and increasing community demand for vaccinations.