Sneller Vishnu-Priya, Fishbein Daniel B, Weinbaum Cindy M, Lombard Andrea, Murray Paula, McLaurin Jennie A, Friedman Lawrence
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Pediatrics. 2008 Jan;121 Suppl 1:S55-62. doi: 10.1542/peds.2007-1115G.
Meeting the health needs of adolescents who live in high-risk settings such as homeless shelters, migrant camps, juvenile detention centers, prisons, and other types of residential facilities presents many challenges. Although there is no doubt that adolescents in many high-risk settings are at increased risk for hepatitis B and human papillomavirus, acute medical and psychological problems may consume all of the provider's time and resources. Potential health threats such as vaccine-preventable diseases must necessarily be given lower priority. Lack of vaccination expertise, supplies, and access to records further complicate delivery of vaccines. Since the 1990s, a number of approaches have been used to deliver hepatitis B vaccine to adolescents in many high-risk settings. Close collaboration among state and federal programs, local health departments, and community-based organizations has been necessary to introduce and sustain the delivery of vaccines to these young people. Medicaid, Statute 317 of the Public Health Service Act, the Vaccines for Children program, and State Children's Health Insurance Program have been used to finance vaccinations for adolescents 18 years or younger, and the expanded Medicaid option in the Foster Care Independence Act of 1999 has been used for adolescents older than 18 years of age. A number of states allow adolescents under age 18 to consent to their own hepatitis B vaccination under laws passed to allow treatment of sexually transmitted infections without parental consent. In this article, we present the experiences of several model programs that developed successful hepatitis B vaccination programs in venues that serve adolescents at risk, the important role of state laws and state agencies in funding immunization and other preventive health services for adolescents in high-risk situations, and discuss barriers and means to resolve them.
满足生活在高风险环境中的青少年的健康需求面临诸多挑战，这些环境包括无家可归者收容所、难民营、青少年拘留中心、监狱以及其他类型的居住设施。尽管毫无疑问，许多高风险环境中的青少年感染乙型肝炎和人乳头瘤病毒的风险增加，但急性医疗和心理问题可能会耗尽医疗服务提供者所有的时间和资源。像疫苗可预防疾病这类潜在的健康威胁必然会被置于较低的优先级。缺乏疫苗接种专业知识、供应以及获取记录的途径，进一步使疫苗接种工作变得复杂。自20世纪90年代以来，已经采用了多种方法为许多高风险环境中的青少年接种乙型肝炎疫苗。州和联邦项目、地方卫生部门以及社区组织之间的密切合作对于向这些年轻人引入并持续提供疫苗而言是必要的。医疗补助、《公共卫生服务法》第317条、儿童疫苗计划以及州儿童健康保险计划已被用于为18岁及以下的青少年接种疫苗提供资金，而1999年《寄养独立法》中扩大的医疗补助选项则被用于18岁以上的青少年。一些州依据通过的法律允许18岁以下的青少年在无需父母同意的情况下自行同意接种乙型肝炎疫苗，这些法律允许在无父母同意的情况下治疗性传播感染。在本文中，我们介绍了几个示范项目的经验，这些项目在为有风险的青少年提供服务的场所成功开展了乙型肝炎疫苗接种项目，阐述了州法律和州机构在为高风险情况下的青少年提供免疫接种及其他预防性健康服务提供资金方面的重要作用，并讨论了障碍及解决这些障碍的方法。
