Introduction: strengthening the delivery of new vaccines for adolescents.

B 2005, VACCINATION of adolescents typically focused on catching up with vaccines that they had not received by school age, most commonly, the second dose of the measles-mumps-rubella vaccine, the complete hepatitis B vaccine series, and a dose of varicella vaccine if needed. With the exception of the booster dose of tetanus and diphtheria toxoids (Td), recommended for administration at a health care visit at ages 11 to 12, adolescence was not considered a primary opportunity to deliver routinely recommended vaccines. The recommendation to administer Td at ages 11 to 12 was a prominent component of the 1996 joint recommendations for adolescent immunization by the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Medical Association.1 The 1996 recommendations were intended, in part, to provide a rationale for a health care visit at ages 11 to 12, and this idea has evolved into the “adolescent vaccination platform,” in which, similar to the childhood platform, immunizations draw parents and their children to routine preventive care visits at which other preventive care services can be delivered. Nevertheless, although results vary, surveys of adolescents have found that many report not making a preventive health care visit in the last year.2 Moreover, according to a national survey of vaccination records in the home in 1997–2003, coverage with Td at ages 11 to 12 did not exceed 16% for any birth cohort studied. Coverage by ages 13 to 15 ranged from 29% to 35% over the study years (Centers for Disease Control and Prevention, unpublished data, 2005). Beginning in 2005, 3 new vaccines that were licensed and recommended for adolescents renewed attention to the benefits of and barriers to an adolescent vaccination platform. In May 2005, recommendations were published for the administration of the first meningococcal conjugate vaccine to adolescents at 11 to 12 years of age during their preventive health care visit, to students before high school entry, and to college freshmen who live in dormitories.3 In March 2006, recommendations were published for the administration of the new tetanus toxoids, reduced diphtheria toxoids, and acellular pertussis vaccine (TdaP), for which adolescents aged 11 to 12 are a primary target group.4 Most recently, in March 2007, recommendations for administration of the human papillomavirus vaccine were published, and again, 11to 12-year-olds are the primary target group for this vaccine.5 With more vaccines targeted specifically toward 11to 12-year-olds, the case for using vaccination to create an adolescent platform is now more compelling. Making the best possible use of these vaccines to protect adolescents from vaccine-preventable diseases and to offer other clinical preventive care is an important prevention opportunity, the planning for which reveals the need to identify: