On a media tour through Southern California, Anne Schuchat, MD, assistant surgeon general of the United States Public Health Service and director of the Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases, spoke with Southern California Physician, hoping to draw physicians' attention to recommendations about preteen checkups and related vaccines.

SCP: Highlight what physicians need to know about caring for preteens and why it's important for them to understand the vaccination guidelines.

Dr. Schuchat: Most parents have been trained to bring in their young children for well-child visits, but most parents don't realize that immunizations are also important for older children, ages 11 and 12. The CDC, the American Academy of Pediatrics and the American Academy of Family Physicians are trying to get the message out about the importance of preteen checkups.

For physicians, a preteen checkup is a great opportunity to promote a lot of health issues. It gives doctors a chance to discuss what the kids can expect in the years to come, covering nutrition, safety, exercise, substance abuse and peer pressure, as well as all the ways their bodies are changing. One of the most important aspects of the preteen checkup is the recommended immunizations.

These vaccines are MCV4, which protects against meningitis and its complications; Tdap, which is a booster against tetanus, diphtheria and pertussis; and for girls, the human papilloma virus vaccine, which protects against the most common types of cervical cancer. We want providers to know about the recommendations and to understand parents' concerns so they can educate them.

SCP: Are these new recommendations?

Dr. Schuchat: The Tdap and MCV4 vaccines were first licensed in 2005 and the HPV vaccine was licensed in 2006. The products are fairly new, and one thing we learned was that parents get nervous if we call these things "new vaccines." So we are trying to get the idea out that what's new is the emphasis on the preteen checkup, which includes the recommended immunizations together with the discussion of the other health aspects I mentioned.

Although the vaccine recommendations have been out for a while, we haven't yet done a big education campaign, until August, which is National Immunization Awareness Month. This topic is not just an issue for August and back to school, it's an issue for year-round. In fact, the California Department of Health Services instituted a Preteen Vaccine Week in January 2007. The state is expected to do the same in 2008.

SCP: How are the vaccines funded?

Dr. Schuchat: Pediatricians and family physicians already know about the Vaccines for Children Program, but we are trying to expand that awareness to more doctors who care for adolescents. If doctors want to learn more, they can go to www.cdc.gov/vaccines to find state and local funding resources.

SCP: Our magazine goes to doctors in all specialties. Do some need this information more than others?

Dr. Schuchat: This recommendation is new enough that doctors are not so used to the notion of the preteen visit or the vaccines. If you look at statistics, very few office visits in this age group are for preventive care; they are for illnesses or injuries. We want providers and parents to understand how important well-child visits are. It's a critical age because parents are in good contact with their kids, but those kids are about to go through enormous changes. It's a really good time for doctors to begin the discussions that need to happen between parents and children.

SCP: The HPV vaccine recommendation seems more controversial. Can you discuss it?

Dr. Schuchat: Doctors need to be able to explain to parents why the vaccine is being recommended for the 11- to 12-year-old girls. A lot of parents are worried that it's way too early to think about sexually transmitted diseases. They are confused about why this is coming up.

We can provide two messages for doctors to relay. First, studies showed that antibody response in 11- and 12-year-olds was really good. It was actually higher than the antibody response in older teens and young women. Second, the HPV vaccine is a preventive vaccine, not a therapeutic vaccine. It's really important to give it before girls are exposed to the virus. While the onset of sexual activity varies, we feel the preteen age group is well before sexual activity starts in almost all the population. Plus, the girls are supposed to get three separate HPV vaccines, so doctors need time to administer those doses within a six-month timeframe, at zero, two months and six months.

SCP: What resources are available for doctors to communicate these points to parents?

Dr. Schuchat: Materials on CDC's Web site at www.cdc.gov/vaccines are free. They are in color and black and white, and in Spanish and English. The materials were developed through focus groups, so they really resonate with parents, urging them to fully immunize their preteens.