New meningococcal vaccine is recommended for teens

When Fred Girton, MD, sees an adolescent patient in his Macon, Ga., office for any reason, he also makes sure to offer a tetanus-diphtheria booster. Until recently, this immunization was the only one routinely recommended for this age group.

"It's like pulling teeth to have them come in for a vaccine because they think they're immortal. ... I can't blame them. I was pretty healthy when I was 14," said Dr. Girton, a family physician and the chair of the Dept. of Family Medicine at Mercer University.

He soon might have to convince these patients, traditionally an age group not targeted for vaccines and who tend to have minimal contact with the health care system, to get even more shots. Vaccines against the human papilloma and herpes viruses are expected to become available in the next few years. A booster against pertussis also is expected to be added to the diphtheria-tetanus vaccine before the end of the year.

More recently, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices last month recommended that 11- and 12-year-olds receive a vaccine against meningococcal disease. Catch-up vaccinations should be offered to those entering high school and to college freshmen, particularly those who live in dorms.

"It's an excellent recommendation," Dr. Girton said. "What we have done in the past is catch the students going to college, but we missed the epidemiological bump in high schoolers."

New and improved

The new CDC recommendation comes on the heels of the approval of an improved meningococcal vaccine with more staying power.

The previous polysaccharide formulation lasted only three or four years and was primarily used in outbreak situations. The new conjugate vaccine could protect an 11-year-old through high school, the first year in college and even beyond.

"We believe that, if adolescents get the vaccine at age 11, they should also be protected if they enter college at age 18, but more research is definitely needed in order to be sure about this," said Nancy Rosenstein, MD, chief of the Epidemiology Section in the CDC Meningitis and Special Pathogens Branch.

The recommendation has been supported by several medical societies, including the American Medical Association, which is collaborating with the CDC on this issue and working to improve adolescent immunization overall. The move also was supported by the American College Health Assn.

"From a college health perspective, it's a very good recommendation," said Ralph Manchester, MD, ACHA past president.

Experts expect the official guidance will provide the resources to pay for the vaccine and will have a more significant impact than previous attempts to address meningococcal disease rates. A vaccine strategy long has been sought because often once a case is diagnosed, it's too late.

"By the time we diagnose and treat, we're already behind the eight ball," said Denise Sur, MD, associate professor of family medicine at the University of California, Los Angeles. "It's much better to prevent instead of treat."

For this approach to be a success, those working on vaccination strategies stress that efforts to vaccinate adolescents, particularly older ones, will have to catch up with what long has been done for children. A study in the January/February Journal of the American Board of Family Practice found that family physicians and pediatricians were more likely to assess immunization status of those ages 11 to 13 than those 19 to 21.

But the increase in vaccinations could be an opportunity as well as a significant challenge.

"Just because it won't be easy doesn't mean that we shouldn't make the recommendation," said Susan Rosenthal, PhD, chair of the ad-hoc committee on adolescent vaccination for the Society of Adolescent Medicine. "When kids are seeking health care, we need to use the opportunity to vaccinate, and we should use the need for vaccine to get kids into health care."