Broder Karen R, Cohn Amanda C, Schwartz Benjamin, Klein Jonathan D, Fisher Martin M, Fishbein Daniel B, Mijalski Christina, Burstein Gale R, Vernon-Smiley Mary E, McCauley Mary M, Wibbelsman Charles J
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Pediatrics. 2008 Jan;121 Suppl 1:S25-34. doi: 10.1542/peds.2007-1115D.
Advances in technology have led to development of new vaccines for adolescents, but these vaccines will be added to a crowded schedule of recommended adolescent clinical preventive services. We reviewed adolescent clinical preventive health care guidelines and patterns of adolescent clinical preventive service delivery and assessed how new adolescent vaccines might affect health care visits and the delivery of other clinical preventive services. Our analysis suggests that new adolescent immunization recommendations are likely to improve adolescent health, both as a "needle" and a "hook." As a needle, the immunization will enhance an adolescent's health by preventing vaccine-preventable diseases during adolescence and adulthood. It also will likely be a hook to bring adolescents (and their parents) into the clinic for adolescent health care visits, during which other clinical preventive services can be provided. We also speculate that new adolescent immunization recommendations might increase the proportion and quality of other clinical preventive services delivered during health care visits. The factor most likely to diminish the positive influence of immunizations on delivery of other clinical preventive services is the additional visit time required for vaccine counseling and administration. Immunizations may "crowd out" delivery of other clinical preventive services during visits or reduce the quality of the clinical preventive service delivery. Complementary strategies to mitigate these effects might include prioritizing clinical preventive services with a strong evidence base for effectiveness, spreading clinical preventive services out over several visits, and withholding selected clinical preventive services during a visit if the prevention activity is effectively covered at the community level. Studies are needed to evaluate the effect of new immunizations on adolescent preventive health care visits, delivery of clinical preventive services, and health outcomes.
技术进步促使了针对青少年的新型疫苗的研发，但这些疫苗将被添加到本就繁杂的青少年临床预防服务推荐日程中。我们回顾了青少年临床预防保健指南以及青少年临床预防服务的提供模式，并评估了新型青少年疫苗可能如何影响医疗就诊以及其他临床预防服务的提供。我们的分析表明，新的青少年免疫接种建议有可能改善青少年健康，既作为“针剂”，也作为“钩子”。作为针剂，免疫接种将通过预防青少年期和成年期的疫苗可预防疾病来增强青少年的健康。它也很可能成为一个“钩子”，促使青少年（及其父母）前往诊所进行青少年保健就诊，在此期间可以提供其他临床预防服务。我们还推测，新的青少年免疫接种建议可能会增加在医疗就诊期间提供的其他临床预防服务的比例和质量。最有可能削弱免疫接种对其他临床预防服务提供的积极影响的因素是疫苗咨询和接种所需的额外就诊时间。免疫接种可能会在就诊期间“挤出”其他临床预防服务的提供，或者降低临床预防服务的提供质量。减轻这些影响的补充策略可能包括优先提供有充分有效性证据的临床预防服务，将临床预防服务分散到几次就诊中，如果预防活动在社区层面得到有效覆盖，则在一次就诊中不提供某些临床预防服务。需要开展研究来评估新的免疫接种对青少年预防性保健就诊、临床预防服务的提供以及健康结果的影响。
