AAP News •
www.aapnews.org • September 2015 27
Chapters Views and News
from the AAP Department of Community,
Chapter and State Affairs
Vaccines recommended for adolescents are
underused, leaving our nation’s teens vulnerable
to serious illness and even death. The Academy
awarded grants to five chapters in spring 2014 to
address barriers and identify opportunities to increase
adolescent immunization rates.
The chapters used grant funding to establish
strategies for physicians and allied health professionals
to remind adolescents to receive immunizations, to
track patients’ immunization data, and to educate
families about the safety and importance of vaccines.
Each chapter also focused on HPV vaccination
education for adolescents, parents and physicians.
Following are highlights of the chapters’ programs.
The chapter collaborated with the State
Immunization Program and the Vaccine Coalition
to identify obstacles pediatric practices encounter
with immunizing adolescent patients and to educate
providers on the Assessment, Feedback, Incentive,
eXchange process to improve immunization service
The chapter also drafted a letter that was distributed
to pediatricians, emphasizing ways to increase
adolescent immunization coverage rates and reduce
The chapter held grand rounds and made presentations on adolescent vaccines to multidisciplinary
groups across the state.
It also put on a webinar that highlighted how to
communicate with families about the HPV vaccine,
how to increase uptake of adolescent vaccines and
how to use technology and reminder systems. The
chapter noted that it was important to approach the
HPV vaccine as “the cancer vaccine.”
The state’s decision to require tetanus, diphtheria and
acellular pertussis (Tdap) vaccine and meningococcal
vaccine for seventh-grade entry led to an increase in
the number of families visiting pediatric offices to
The chapter produced a video showing health care
professionals how to strongly recommend the HPV
vaccine. Results indicated a significant increase/
improvement in strong recommendations from
providers following the educational training.
A group also was assembled to provide technical
support, in partnership with the state health
department, to clinics/health systems using the
same electronic health record software and having
difficulties with the state’s immunization registry data
interface and recall systems. The chapter also provided
clinics/health systems with small grants to implement
a project to increase the accuracy of immunization
data submitted to the statewide registry and use this
corrected data for a patient recall effort.
New Jersey Chapter
The chapter partnered with other groups on
a quality improvement project to improve HPV
immunization rates. First, they visited participating
practices to collect baseline data and assess practice
protocols regarding HPV immunization.
Then, they made recommendations to increase
immunization rates, including utilizing reminder/
recall systems, assessing immunization status at every
visit, vaccinating patients who came in for mild
illnesses, offering immunization-only appointments,
educating patients beginning at ages 10-11, strongly
recommending the HPV vaccine, pairing HPV with
required adolescent vaccinations, and administering
multiple vaccinations during the visit. Peer-to-peer
presentations helped raise awareness about the
importance of HPV vaccination.
As a result, providers in each
of the participating practices are
making a strong recommendation
and administering HPV when
they administer Tdap and
“The program helped us focus
on our HPV vaccination rates and
how we could improve these rates
in our adolescents,” said Joseph V. Schwab Jr., M.D.,
M.P.H., FAAP, the chapter’s immunization champion.
“We worked through several attempts and came up
with a process using information from our state
vaccine registry to reach out to patients overdue for a
dose of vaccine to have them come in for their vaccine.
We are now using the same process and outreach to
increase coverage with all the vaccines we give to
patients of all ages.”
Uniformed Services West Chapter
The chapter identified eight major military treatment
facilities with large populations of adolescents. The
chapter’s adolescent medicine experts appointed a
champion to work with each facility.
The champion acquired baseline immunization
data from the practice with the largest concentration
of eligible adolescent patients. Adolescent medicine
experts then visited the practices to present standardized
HPV immunization education as well as education
on the other vaccines given to adolescents. The
importance of a strong recommendation from health
care professionals for all vaccines was emphasized as
well as initiating the HPV vaccine at the 11- to 12-
year visit when patients come in for meningococcal
and Tdap vaccines. Each of the participating clinics
experienced an increase not only in the number of
vaccines given but also in the number of patients who
received HPV vaccine.
In addition, the chapter did community outreach
in a regional school district during a Family Wellness
and Fitness Fair in April. Information regarding the
HPV vaccine was shared with thousands of young
adolescents and their parents via a booth at the fair.
“It was a great experience traveling around to
different military treatment facilities talking to
health care providers, nursing and administrative staff
across the country on the importance of teamwork
in getting the adolescent vaccines widely accepted,
and in particular the HPV vaccine,” said Maj.
Rachel S. Dawson, D.O., M.P.H.,
FAAP, a chapter member. “It was
amazing to see the enthusiasm at
these facilities and their desire to
improve rates of vaccines for our
military dependent children. We
look forward to continuing to
work with health care providers to
ensure we reach the Healthy People
2020 goals of reaching greater than 80% coverage for
Chapter efforts successful in boosting adolescent immunization rates
all adolescent vaccines.”
The chapter programs were made possible through
a grant from Merck.
oral health updates
Updates on oral health in
primary care related to fluoride
were made to Bright Futures
and AAP Recommendations
for Preventive Pediatric Health
Care (Periodicity Schedule).
Under the Oral Health heading, a
subheading was added for fluoride varnish.
The range includes ages 6 months to 5 years
(up to 6th birthday) and refer to the included
U.S. Preventive Services Task Force (USPSTF)
recommendations that advise fluoride varnish
application for all children in this age group
every three to six months in the primary care
or dental office.
A footnote remains reflecting the need
to assess for presence of a dental home and
perform a risk assessment if no dental home
exists. The edits also recommend brushing
with fluoride toothpaste in the appropriate
amount for age and considering oral fluoride
supplementation if the child’s primary water
source is deficient in fluoride.
The 2015 changes reflect recommendations
by the USPSTF and AAP clinical report, both
issued in 2014. The periodicity schedule is
maintained online for continual updates as
policy changes. Previously, it was published
every five years. Access the schedule at www.