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Adolescent vaccination rates increased after addition to schedule

Stokley S. Pediatrics. 2011;doi:10.1542/peds.2011-1048.

The addition of three vaccines to the immunization schedule for adolescents was linked to significant increases in coverage rates for those vaccines, according to study findings.

The aim of the study was to assess implementation of the three adolescent vaccines that were added to the schedule from 2005 to 2007: tetanus-diphtheria-acellular pertussis; meningococcal conjugate (MenACWY); and human papillomavirus for girls.

Data for the study were taken from the 2006-2009 National Immunization Survey-Teen.

The primary outcome measures included the following:

• Percentage of adolescents who received each vaccine according to survey year;
• Potential coverage if all vaccines were administered during the same vaccination visit; and
• Among unvaccinated adolescents, the reasons for not receiving vaccine.

Coverage with one or more Tdap doses increased from 11% to 65% between 2006 and 2009. During that same period, coverage with at least one MenACWY dose increased from 12% to 54%.

Coverage with one or more HPV dose among girls increased from 25% to 44% between 2007 and 2009. Between 2008 and 2009, the coverage rate for at least three HPV doses increased from 18% to 27%.

If providers had administered all recommended vaccines during the same vaccination visit in 2009, coverage rates for that year could have reached more than 80% for Td/Tdap and MenACWY, and as high as 74% for the initial dose of the HPV vaccine.

For all years, the top reasons cited for nonvaccination with Tdap and MenACWY included no knowledge about the vaccine, the provider did not recommend the vaccine and that the vaccine is not needed/necessary. For HPV, the reasons for not receiving the vaccination were that the adolescent is not sexually active, there was no knowledge about the vaccine and that the vaccine is not needed/necessary.

“Adolescent vaccination coverage is increasing but could be improved,” the researchers wrote. “Strategies are needed to increase parental knowledge about adolescent vaccines and improve provider recommendation and administration of all vaccines during the same visit.”

Disclosure: The researchers report no disclosures.

As time moves forward, and adolescent vaccination at specific ages becomes further ingrained as a standard of care, vaccination rates among this vulnerable population will continue to rise. Although more may need to be done to reach adolescents in their social environment, many of the same strategies used among infants and children will ultimately improve adolescent vaccination rates, including simultaneous vaccine administration, minimizing missed opportunities, and making sure providers and parents are aware of vaccine recommendations.

Focusing on the protection from disease, regardless of mode of disease transmission - as providers do with hepatitis B vaccination among infants - may help dispell confusion regarding the benefits of HPV vaccination among youth. As more providers and parents view immunizations as a primary prevention strategy to combat a multitude of diseases across the life span, vaccine adherence among adolescents, and eventually adults, will hopefully become as expected as the 2-, 4- and 6-month visits that most would not dare to miss for their infants.

Amy Middleman, MD, MPH
Infectious Diseases in Children Editorial Board member

Disclosure: Dr. Middleman reports no relevant financial disclosures.

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