Morbidity and Mortality Weekly Report Weekly / Vol. 70 / No. 17 April 30, 2021 Health Status and Health Care Use Among Adolescents Identified With and Without Autism in Early Childhood — Four U.S. Sites, 2018–2020 Patrick S. Powell, PhD1; Karen Pazol, PhD1; Lisa D. Wiggins, PhD1; Julie L. Daniels, PhD2; Gabriel S. Dichter, PhD2; Chyrise B. Bradley, MA2; Rebecca Pretzel, PhD2; Joy Kloetzer2; Charmaine McKenzie, MPA1; Alexys Scott1; Britney Robinson, MPH1; Amy S. Sims, MS3; Eric P. Kasten, PhD3; M. Daniele Fallin, PhD4; Susan E. Levy, MD5; Patricia M. Dietz, DrPH1; Mary E. Cogswell, DrPH1 Persons identified in early childhood as having autism spectrum disorder (autism) often have co-occurring health INSIDE problems that extend into adolescence (1–3). Although only 612 Emergency Department Visits for Tick Bites — limited data exist on their health and use of health care services United States, January 2017–December 2019 as they transition to adolescence, emerging data suggest that 617 COVID-19 Outbreak Among Farmworkers — a minority of these persons receive recommended guidance* Okanogan County, Washington, May–August 2020 from their primary care providers (PCPs) starting at age 622 COVID-19 Among Workers in the Seafood 12 years to ensure a planned transition from pediatric to Processing Industry: Implications for Prevention adult health care (4,5). To address this gap in data, researchers Measures — Alaska, March–October 2020 analyzed preliminary data from a follow-up survey of parents 627 Linked Clusters of SARS-CoV-2 Variant B.1.351 — and guardians of adolescents aged 12–16 years who previously Maryland, January–February 2021 participated in the Study to Explore Early Development (https:// 632 Postvaccination SARS-CoV-2 Infections Among www.cdc.gov/ncbddd/autism/seed.html). The adolescents were Skilled Nursing Facility Residents and Staff Members — originally studied at ages 2–5 years and identified at that age Chicago, Illinois, December 2020–March 2021 as having autism (autism group) or as general population 639 COVID-19 Outbreak Associated with a SARS-CoV-2 controls (control group). Adjusted prevalence ratios (aPRs) R.1 Lineage Variant in a Skilled Nursing Facility After that accounted for differences in demographic characteristics Vaccination Program — Kentucky, March 2021 were used to compare outcomes between groups. Adolescents 644 Health Care Utilization and Clinical Characteristics of in the autism group were more likely than were those in the Nonhospitalized Adults in an Integrated Health Care control group to have physical difficulties (21.2% versus System 28–180 Days After COVID-19 Diagnosis — 1.6%; aPR = 11.6; 95% confidence interval [CI] = 4.2–31.9), Georgia, May 2020–March 2021 and to have additional mental health or other conditions† 651 Updated Recommendations from the Advisory Committee on Immunization Practices for Use of the Janssen (Johnson & Johnson) COVID-19 Vaccine * Recommended guidance on health care transition is defined in the context of three After Reports of Thrombosis with transition elements included in the National Performance Measure of the Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau Thrombocytopenia Syndrome Among Vaccine (MCHB) (https://mchb.tvisdata.hrsa.gov/PrioritiesAndMeasures/ Recipients — United States, April 2021 NationalPerformanceMeasures). The three elements are 1) time alone, without a 658 QuickStats parent present, with PCP at last preventive visit; 2) PCP actively worked with child; and 3) parent knows how child will be insured as he or she becomes an adult. Adolescents met the health care transition measure if all three elements were endorsed by the adolescent’s parent. https://doi.org/10.1007/s10995-019-02858-6 † Mental health and other conditions included attention-deficit/hyperactivity Continuing Education examination available at disorder, anxiety, intellectual disability, depression, obsessive-compulsive https://www.cdc.gov/mmwr/mmwr_continuingEducation.html disorder, epilepsy/seizure disorder, bipolar disorder, substance abuse disorders, Tourette syndrome, fragile X syndrome, and Down syndrome. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (one or more condition: 63.0% versus 28.9%; aPR = 1.9; Summary 95% CI = 1.5–2.5). Adolescents in the autism group were more likely to receive mental health services (41.8% versus What is already known about this topic? 22.1%; aPR = 1.8, 95% CI = 1.3–2.6) but were also more Mental health and other conditions are more frequent among children with autism; these conditions often persist into adoles- likely to have an unmet medical or mental health service cence and require more services and coordination of care. need§ (11.0% versus 3.2%; aPR = 3.1; 95% CI = 1.1–8.8). What is added by this report? In both groups, a small percentage of adolescents (autism, 7.5%; control, 14.1%) received recommended health care Compared with a general population control group, adoles- cents with autism were 90% more likely to have additional transition (transition) guidance. These findings are consistent mental health or other conditions and three times more likely to with previous research (4,5) indicating that few adolescents have unmet health care service needs. receive the recommended transition guidance and suggest that What are the implications for public health practice? adolescents identified with autism in early childhood are more Improved provider training on the heath care needs of adoles- likely than adolescents in the general population to have unmet cents with autism and coordination of comprehensive pro- health care service needs. Improved provider training on the grams to meet their needs can improve delivery of services and heath care needs of adolescents with autism and coordination adherence to guidance for transitioning from pediatric to adult of comprehensive programs¶ to meet their needs can improve health care. delivery of services and adherence to recommended guidance for transitioning from pediatric to adult health care. part in a multisite study during 2007–2011 at ages 2–5 years Data were collected during July 2018–December 2020 (6). To assess the feasibility of conducting a larger follow-up from parents and guardians (parents) of adolescents aged study of all participants who took part in the multisite study, 12–16 years (born September 2003–August 2006) who took researchers at four sites (located in Georgia, Maryland, North Carolina, and Pennsylvania) conducted this preliminary follow- § Affirmative response to the question, “During the past 12 months, was there up study. Participants had completed key study components any time when this child needed health care, but it was not received? By health and received a final study classification in the autism or control care, we mean medical care as well as other kinds of care like dental care, vision group during the original study, and parents had consented to care, and mental health services.” ¶ For example, HRSA MCHB’s adolescent and young adult programs. https://mchb. future follow-up. Participants identified in a second control hrsa.gov/maternal-child-health-topics/adolescent-and-young-adult-health arm of the original study as having a developmental disability The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30329-4027. Suggested citation: [Author names; first three, then et al., if more than six.] [Report title]. MMWR Morb Mortal Wkly Rep 2021;70:[inclusive page numbers]. Centers for Disease Control and Prevention Rochelle P. Walensky, MD, MPH, Director Anne Schuchat, MD, Principal Deputy Director Daniel B. Jernigan, MD, MPH, Acting Deputy Director for Public Health Science and Surveillance Rebecca Bunnell, PhD, MEd, Director, Office of Science Jennifer Layden, MD, PhD, Deputy Director, Office of Science Michael F. Iademarco, MD, MPH, Director, Center for Surveillance, Epidemiology, and Laboratory Services MMWR Editorial and Production Staff (Weekly) Charlotte K. Kent, PhD, MPH, Editor in Chief Martha F. Boyd, Lead Visual Information Specialist Ian Branam, MA, Acting Lead Jacqueline Gindler, MD, Editor Alexander J. Gottardy, Maureen A. Leahy, Health Communication Specialist Brian A. King, PhD, MPH, Guest Science Editor Julia C. Martinroe, Stephen R. Spriggs, Tong Yang, Shelton Bartley, MPH, Paul Z. Siegel, MD, MPH, Associate Editor Visual Information Specialists Lowery Johnson, Amanda Ray, Mary Dott, MD, MPH, Online Editor Quang M. Doan, MBA, Phyllis H. King, Jacqueline N. Sanchez, MS, Terisa F. Rutledge, Managing Editor Terraye M. Starr, Moua Yang, Health Communication Specialists Teresa M. Hood, MS, Acting Lead Technical Writer-Editor Information Technology Specialists Will Yang, MA, Glenn Damon, Soumya Dunworth, PhD, Visual Information Specialist Catherine B. Lansdowne, MS, Donald G. Meadows, MA, Srila Sen, MA, Stacy Simon, MA, Jeffrey D. Sokolow, MA, Technical Writer-Editors MMWR Editorial Board Timothy F. Jones, MD, Chairman Matthew L. Boulton, MD, MPH William E. Halperin, MD, DrPH, MPH Patrick L. Remington, MD, MPH Carolyn Brooks, ScD, MA Christopher M. Jones, PharmD, DrPH, MPH Carlos Roig, MS, MA Jay C. Butler, MD Jewel Mullen, MD, MPH, MPA William Schaffner, MD Virginia A. Caine, MD Jeff Niederdeppe, PhD Nathaniel Smith, MD, MPH Jonathan E. Fielding, MD, MPH, MBA Celeste Philip,