Department of Family Medicine, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA.
Department of Epidemiology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA.
Women Health. 2020 Nov-Dec;60(10):1129-1140. doi: 10.1080/03630242.2020.1802639. Epub 2020 Aug 9.
To capture strategies for achieving high adolescent coverage of tetanus-diphtheria-acellular pertussis (Tdap), meningococcal conjugate (MenACWY), and human papillomavirus (HPV) vaccination, we surveyed employees of 20 North Carolina (N.C.) clinics that achieved adolescent vaccination coverage higher than the state average. One employee per clinic completed a surveysummarizing clinic practices regarding adolescent vaccination; perceived barriers and facilitators to Tdap/MenACWY/HPV vaccination; and the role of "champions" who made special efforts to promote adolescent vaccination. Common perceived barriers for all vaccinations were parental opposition and logistical barriers to receiving vaccination. For HPV vaccination, employees cited parental concerns about sexual behavior and injection site pain; no school vaccination requirement; and low-perceived benefit in boys. Most clinics (80%) implemented successful changes to increase adolescent vaccination: consistently offering vaccination, tracking vaccination status using existing data, providing appointment reminders, updating providers on vaccination recommendations, and expanding vaccination hours. Strategies to improve HPV vaccination included co-administration with Tdap and MenACWY, and providing reminders to complete the vaccination series. Vaccine champions strongly recommended vaccination to parents (55%) and educated parents on vaccination recommendations (36%). Clinics in N.C.and similar settings can implement these and other low-resource strategies to overcome adolescent vaccination barriers.
CDC=Centers for Disease Control and Prevention; EHR=Electronic health record; HPV=Human papillomavirus; Tdap=Tetanus-diphtheria-acellular pertussis vaccine; MenACWY=Meningococcal Conjugate Vaccine; NCIB=North Carolina Immunization Branch; NCIR=North Carolina Immunization Registry; ACIP=Advisory Committee on Immunization Practices.
为了了解实现青少年破伤风、白喉、无细胞型百日咳(Tdap)、脑膜炎球菌结合疫苗(MenACWY)和人乳头瘤病毒(HPV)疫苗高覆盖率的策略,我们调查了北卡罗来纳州(NC)20 家诊所的员工,这些诊所的青少年疫苗接种率高于州平均水平。每家诊所的一名员工完成了一份调查,总结了诊所关于青少年疫苗接种的实践、Tdap/MenACWY/HPV 疫苗接种的感知障碍和促进因素,以及特别努力促进青少年疫苗接种的“拥护者”的作用。所有疫苗接种常见的感知障碍是父母的反对和接种疫苗的后勤障碍。对于 HPV 疫苗接种,员工提到了父母对性行为和注射部位疼痛的担忧、没有学校疫苗接种要求以及男孩的低预期收益。大多数诊所(80%)实施了成功的改变来增加青少年疫苗接种率:持续提供疫苗接种、使用现有数据跟踪疫苗接种状况、提供预约提醒、向提供者更新疫苗接种建议以及扩大疫苗接种时间。改善 HPV 疫苗接种的策略包括与 Tdap 和 MenACWY 联合使用,并提供完成疫苗接种系列的提醒。疫苗拥护者强烈建议家长接种疫苗(55%),并就疫苗接种建议对家长进行教育(36%)。北卡罗来纳州和类似环境中的诊所可以实施这些和其他低资源策略来克服青少年疫苗接种障碍。
CDC=疾病控制与预防中心;EHR=电子健康记录;HPV=人乳头瘤病毒;Tdap=破伤风、白喉、无细胞型百日咳疫苗;MenACWY=脑膜炎球菌结合疫苗;NCIB=北卡罗来纳免疫部;NCIR=北卡罗来纳免疫登记处;ACIP=免疫实践咨询委员会。