October 1996
WASHINGTON, D.C. — Measles outbreaks in several states highlight the importance of the two-dose measles immunization schedule and provide further support for an adolescent health visit.
To date, the Centers for Disease Control and Prevention (CDC) reported 17 measles outbreaks in the United States, a total of 236 cases. The majority (70%) were among individuals 10 years of age and older, most of whom were unvaccinated or received only one dose of measles-containing vaccine.
Lack of immunization is the most frequent cause of measles outbreaks. Despite recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP) for two doses of measles-containing vaccine, adolescents often fall through the cracks and many receive only a single dose.
To catch those adolescents, the ACIP, AAP, National Foundation for Infectious Diseases and other medical organizations are promoting an adolescent health visit for 11-year-olds. They are enlisting the support of the media to help stress the importance of immunizations.
"Public education is one of the most effective tools we have to make sure immunizations are used effectively," Steven Mostow, MD, told the news media at a recent press conference. Mostow is chairperson of medicine, Rose Medical Center, Denver.
An important trend among the measles cases is a shift in age away from infants and young children to adolescents and young adults, said Gregory Poland, MD, chief, Mayo Vaccine Research Group at the Mayo Clinic in Rochester, Minn. Because of close living quarters in college dormitories and military barracks, young adults who fail to receive the second dose are at particular risk.
"The two-dose regimen works, but only if it has been given," Poland said "We have very safe, very effective vaccines that are not being used."
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Measles is not the only vaccine-preventable disease threatening adolescents. Many adolescents also remain at risk for chickenpox and hepatitis B virus. Vaccinations for these diseases generally are given during infancy, but they are also recommended for susceptible adolescents.
Although varicella is largely a disease of childhood, 20% of adolescents have not had the disease and remain at risk for infection. An estimated 4 million cases occur in the United States annually, mostly among children.
Hepatitis B vaccination is especially important for adolescents. Although the vaccine is routinely given to infants, many adolescents have not been vaccinated because it is a relatively new addition to the infant schedule.
About 70% of new cases of hepatitis B infections in the United States are among adolescents and young adults between 15 to 39 years of age, said Harold Margolis, MD, chief of the CDC's hepatitis branch. The rate of hepatitis B virus infection increases during the teenage years, reaching a peak for young adults 20 to 29 years of age.
In-school hepatitis B vaccination programs, typically offered in junior high school, are especially effective in reaching adolescents. These programs help protect the adolescents before they begin engaging in behaviors that put them at risk for infection
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