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Improved hepatitis A vaccination coverage urged for adolescents
Dorell CG. Pediatrics. 2012;doi:10.1542/peds.2011-2197.
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Hepatitis A vaccination rates vary widely according to states, leaving pockets of adolescents vulnerable to the disease, according to a study published online.
Christina G. Dorell, MD, MPH, and colleagues from the CDC’s Immunization Services Division and Division of Viral Hepatitis reviewed data from 20,006 adolescents from the 2009 National Immunization Survey-Teen to evaluate hepatitis A vaccine (HepA) coverage among 13- to 17-year-olds. Vaccine coverage rates were determined using provider records.
The researchers divided the data sets into three groups: Group one included 11 states that required universal child vaccination since 1999. Group two included six states that considered the vaccine. Group three included those children who received the vaccine at 1 year of age, following recommendations from the CDC.
Researchers said 42% of adolescents received one dose of HepA and 70% of those vaccinated received the two-dose series. Group one had 74.3% one-dose coverage; group two had 54% coverage with one dose; and only 27.8% of the children in group three had received one dose of the vaccine.
“Adjusted prevalence ratios of vaccination initiation were highest for states with a vaccination requirement and for adolescents whose providers recommended HepA,” Dorell and colleagues said, adding that improved vaccination coverage is needed for adolescents because “susceptible adolescent and adult populations have high potential for symptomatic hepatitis A infection and its associated complications and costs.”
Disclosure: The researchers report no relevant financial disclosures.
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Hepatitis A infection in adolescents and adults is usually severe, with abrupt onset of symptoms that may last up to 2 months, leading to significant expenditures for medical care and indirect costs from lost work and school. Men who have sex with men, illegal drug use and international travel, behaviors which may occur in adolescence, are associated with increased risk of hepatitis A infection.
Efforts to control this infection through vaccination have evolved over the past 15 years. In 1996, the Advisory Committee on Immunization Practices recommended routine two-dose hepatitis A vaccination for children aged 2 years and older who live in communities with the highest rates of hepatitis A infection. These recommendations were expanded in 1999 to include children aged 2 years and older who live in the 11 states with the highest infection rates and consideration of vaccination in an additional six states with infection rates above the national average. In 2006, ACIP recommended hepatitis A immunization for all US children older than 1 year of age. The 2006 recommendations further advise encouraging programs to immunize patients 2 to 18 years of age.
Dorell and colleagues at the CDC used the 2009 National Immunization Survey-Teen survey to assess national adolescent hepatitis A vaccination rates. Data available from 20,066 13- to 17-year-olds (58% of the completed surveys with adequate information) revealed that 42% had received hepatitis A vaccine and 70% of these completed the two-dose series. States in which hepatitis A vaccination for patients aged 2 years and older began in 1996 had the highest rates of adolescent immunization, while the lowest vaccination rates were seen in states where routine hepatitis A immunization was not introduced until 2006.
Other factors correlating with higher vaccination rates were provider recommendation and access to health care. Asians, American Indians, Hispanics and blacks were more likely to be immunized against hepatitis A, possibly reflecting increased outreach to these groups.
The 42% vaccination rate for hepatitis A is less than that reported for Tdap and meningococcal conjugate vaccines in this age range, but comparable to rates reported for human papillomavirus vaccine in adolescent women, where a multi-dose schedule is also needed.
These findings emphasize the role of the primary care provider in improving adolescent vaccination rates, as well as the benefits of a strong recommendation or requirement for a vaccine in achieving compliance.
Leonard R. Krilov, MD
Chief, Pediatric Infectious Disease
Vice Chairman, Department of Pediatrics
Winthrop University Hospital
Mineola, N.Y.
Disclosure: Dr. Krilov reports no relevant financial disclosures.
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