Vaccines for Teenagers
Immunization record for an individual born in 1996
The College of Physicians of Philadelphia
Parents keep babies and toddlers on track with recommended immunizations by making frequent well-child visits to the pediatrician’s office. Adolescents and teenagers also need vaccines, but they tend not to visit the doctor as often as young children do. Not surprisingly, many teenagers haven’t received all of the vaccines recommended to protect them from potentially life-threatening diseases.
Data from the U.S. Centers for Disease Control and Prevention show that only about half of all teenagers have received the meningococcal vaccine, which protects against bacterial infections that may lead to amputation of infected limbs and death. In 2014, only 39.7% of teenage girls have received the complete three-dose series of the human papillomavirus vaccine (a vaccine that prevents infection with several viruses that cause cervical cancer). About 47% of all U.S. adolescents received the recommended influenza vaccine during the 2014-2015 influenza season. Clearly, large numbers of teenagers remain vulnerable to these diseases.
Apart from protecting themselves, teenagers (and their parents) should consider the benefits of vaccination to the family and community. In most cases, a person who is successfully vaccinated against a disease cannot spread that disease to other people. High rates of vaccination help protect those around us who cannot be immunized for health reasons (such as illness, age, or allergy). This principle is known as herd immunity, or community immunity.
Following are vaccines typically recommended for the pre-teen and teenage years.
The U.S. Advisory Committee on Immunization Practices (ACIP) recommends a booster dose of the tetanus, diphtheria, acellular pertussis (Tdap) vaccine at age 11-12. (Most adolescents will have received five previous doses of a related vaccine by age 4-6.) The immunization provides continuing protection from tetanus, diphtheria, and pertussis.
Tetanus is a disease of the central nervous system caused by a toxin secreted by the bacterium Clostridium tetani. The early symptoms of the disease are lockjaw (the most recognizable of its physical effects), stiffness, and problems swallowing. Later symptoms include severe muscle spasms, seizure-like activity, and severe nervous system disorders. Between 10% and 25% of tetanus cases result in death.
Tetanus is not passed from person to person. Instead, tetanus is transmitted when Clostridium tetani bacteria enter injured skin and underlying tissues. Surprisingly, tetanus infection is more likely from a minor wound than a major one, but this is because severe wounds are more likely to be properly treated and cleaned.
Diphtheria is an uncommon disease that once was a major killer of children. It is caused by the bacterium Corynebacterium diphtheria. Early symptoms of diphtheria are similar to those of a common cold. They include sore throat, loss of appetite, and fever. As the disease progresses, the most notable feature of diphtheria infection may emerge: a thick gray substance called a pseudomembrane may spread over the nasal tissues, tonsils, larynx, and/or pharynx. The pseudomembrane sticks to tissues and may obstruct breathing.
Pertussis, also known as whooping cough, is an extremely contagious disease caused by the Bordetella pertussis bacterium. These bacteria produce toxins that paralyze parts of respiratory cells, leading to inflammation in the respiratory tract.
Early symptoms include runny nose, sneezing, a mild cough, and fever. However, the cough gradually becomes more severe. Eventually the patient experiences bouts of rapid coughing often followed by the “whooping” sound that gives the disease its common name as they try to inhale. While the coughing fit is occurring, the patient may turn blue. Coughing may be severe enough to cause broken ribs, and coughing spells may last for weeks or months. Newborns, who are too young to be immunized, are especially vulnerable to severe complications or death from whooping cough. Family members of newborns are especially encouraged to be immunized in order to protect the newborn.
The ACIP recommends a first dose of the quadrivalent meningococcal conjugate vaccine at 11-12 years old. A 2011 update from ACIP recommends an additional dose of meningococcal vaccine at age 16, to extend protection into the college years.
The quadrivalent meningococcal conjugate vaccine protects against the different illnesses caused by certain strains of Neisseria meningitidis bacteria. These illnesses together are referred to as meningococcal disease. Meningococcal bacteria can cause bloodstream infections, infection of the lining of the brain (meningitis), pneumonia, ear infections, and other infections.
Meningococcal meningitis symptoms include fever, headache, confusion and stiff neck, which may also be accompanied by nausea, vomiting, and sensitivity to light. Meningococcal bloodstream infection symptoms include sudden fever onset and rash.
Invasive meningococcal disease can be fatal; survivors may have permanent injury, including brain damage, hearing loss, or loss of limbs.
Another meningococcal vaccine that provides protection from certain serogroup B strains is available to adolescents. The ACIP declined in 2015 to make a recommendation that all adolescents routinely receive this vaccine; rather, the ACIP supported individual decision making about this vaccine. During ongoing outbreaks of disease caused by serogroup B meningococcal bacteria, the ACIP recommends routine use of this vaccine in individuals at risk of exposure.
Human Papillomavirus Vaccine
The recommended age for human papillomavirus (HPV) vaccination of females and males is 11-12 years. The vaccination is a three-dose series of intramuscular shots.
Human papillomaviruses belong to a large family of viruses, and the vaccine protects against some of the virus types that are sexually transmitted. Most people who contract HPV have no symptoms, and they quickly clear the virus from their bodies. However, in some people the viruses establish persistent infection, causing changes to infected cells that can lead to cancer. Indeed, HPVs are the main cause of cervical cancer, and some are associated with anal, penile, mouth, and throat cancers. The HPV vaccine protects against the most common types of cancer-causing human papillomaviruses. One of the licensed HPV vaccines also protects again certain HPVs that cause genital warts.
HPV is very common: one recent study showed that nearly 27% of girls and women aged 14-59 tested positive for one or more strains of HPV. Rates for boys and men are likely to be similar. Mathematical models have shown that more than 80% of women will have been infected with genital HPV by the time they reach age 50. According to the American Cancer Society, each year about 11,000 U.S. women are diagnosed with cervical cancer, and about 4,000 die from it.
Seasonal influenza vaccination is recommended yearly for all adolescents and teenagers; in fact, it is recommended for everyone over the age of 6 months. The vaccine protects against respiratory illness caused by influenza viruses. Because new strains of influenza appear frequently, the seasonal flu vaccine usually changes each year. Each season’s vaccine is designed to protect against three or four strains of influenza. Influenza vaccine is available as an injected or inhaled vaccine.
Symptoms of influenza (also commonly called flu) tend to emerge suddenly and include fever, chills, coughing, sore throat, achiness, headaches, and fatigue. Vomiting and diarrhea may also occur, but these symptoms are more common for children than for adults. Influenza symptoms typically last about week. Complications from influenza can lead to ear and sinus infections, pneumonia, and, uncommonly, death.
Teenagers with special health needs may be more vulnerable to certain illnesses and require vaccines to protect them. For example, teenagers who have dysfunctions of the immune system may be recommended to receive the pneumococcal vaccine, as they are at risk of serious disease from Streptococcus pneumoniae. Some vaccines are required or recommended before travel to certain countries. Additionally, teenagers who have not received vaccines recommended for early childhood may require “catch-up” vaccination so that they are fully protected.
The beginning of middle school is a trigger in many states for certain vaccine requirements for school attendance. The most commonly required adolescent immunizations are a booster dose of the tetanus, diphtheria, acellular pertussis (Tdap) vaccine and the meningococcal vaccine. Virginia and the District of Columbia require the human papillomavirus (HPV) vaccine for middle school entrance for girls. Some states require that adolescents be immunized with two doses of the measles, mumps, and rubella vaccine and one or two doses of the chickenpox (varicella) vaccine. Normally, the second doses of MMR and varicella are given at age 4-6. If a child did not receive the second dose by the beginning of middle school, the booster would be required.
Adolescents who do not have and will not receive the vaccines required for school entry may need to have their parents file medical, religious, or philosophical belief exemptions with the state government or school district, or face the possibility of being denied entrance to school.
School-based Immunization Programs
In some areas, school districts offer immunizations programs in the schools. School nurses or nurses provided by an outside organization may administer the vaccines. One challenge of school-based immunization is coordinating medical records with the student’s primary care provider.
School vaccine programs commonly include the seasonal influenza vaccine, which is recommended for all adolescents and must be given every year. HPV vaccination has been provided to girls in schools several places, such as New Zealand, Australia, and Great Britain.
Looking to the Adult Years
As they near adulthood, teenagers can prepare to manage their own healthcare by discussing immunization with their doctors and parents. They can find out whether they are up-to-date with their shots and which vaccines are recommended for them. If they plan to go to college, join the military, or switch to a new healthcare provider, teenagers should make sure that they have a copy of their immunization history to include with their medical records.
Resources for Teenagers
Teens Health: Immunizations
CDC: Preteens and Teens Need Vaccines Too
Resources for Parents
CDC: For Parents: Preteen and Teen Vaccines
Vaccine Education Center: A Look at Each Vaccine: Human Papillomavirus Vaccine
American Cancer Society. What are the key statistics about cervical cancer? Accessed 04/05/2017.
Centers for Disease Control and Prevention. Flu Vaccination Coverage, United States, 2014-15 Influenza Season. Accessed 04/05/2017.
Centers for Disease Control and Prevention. National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13 Through 17 Years — United States, 2014. MMWR 64(29);784-92. Accessed 04/05/2017.
Centers for Disease Control and Prevention. School vaccination requirements, exemptions, and web links: HPV. Accessed 04/05/2017.
Centers for Disease Control and Prevention. Use Serogroup B Meningococcal Vaccines in Adolescents and Young Adults: Recommendations of the Advisory Committee on Immunization Practices, 2015. MMWR 64(41);1171-6. Accessed 04/05/2017.
Immunization Action Coalition. State mandates on immunization and vaccine-preventable diseases. Accessed 04/05/2017.
National Conference of State Legislatures. HPV Vaccine: State Legislation and Statutes. Accessed 04/05/2017.
Last update 05 April 2017