Adolescent vaccination rates rise

CDC. MMWR. 2010; 59:1018-1023.

From 2008 to 2009, vaccination coverage among adolescents increased considerably, with some states noting as much as a 15% increase in children receiving routinely recommended vaccines, according to a CDC report.

Each year, CDC researchers estimate vaccine uptake among adolescents aged 13 to 17 years via the National Immunization Survey-Teen (NIS-Teen). In this report, the researchers compared results from the 2008 NIS-Teen data with those from the 2009 study. Provider-verified vaccination records for 20,399 adolescents were included in the analysis.

Results indicated that administration of at least one dose of tetanus and diphtheria (Td) or the tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccines after 10 years of age increased from 72.2% among adolescents in 2008 to 76.2% in 2009 across the United States.

Coverage with at least one dose of Tdap rose from 40.8% to 55.6%, the researchers noted, although these rates fluctuated widely among states, ranging from 22.6% in Mississippi to 76.6% in Colorado. Poverty status or race/ethnicity had little or no effect on vaccination rates. Percentages, however, appeared higher among older adolescents.

“Pertussis outbreaks in several states and an increase in pertussis-related infant deaths in California highlight how important it is for pre-teens to receive the Tdap booster,” said Anne Schuchat, MD, director of CDC’s National Center for Immunization and Respiratory Diseases.

“It is important for teens and adults to get a one-time dose of Tdap to protect themselves and those around them from whooping cough. Young infants are most vulnerable to serious complications from pertussis and can be infected by older siblings, parents or other caretakers.”

Receipt of at least one dose of the meningococcal conjugate vaccine (MenACWY, Menveo, Novartis) also increased from 41.8% to 53.5% for adolescents. Again, coverage varied among states, ranging from 19.3% in Mississippi to 78.3% in Washington, D.C. Unlike Tdap, vaccination with MenACWY was higher among younger adolescents.

Researchers noted that the human papillomavirus vaccine (HPV) has been a particular challenge. The survey data, however, revealed an increase in coverage with at least one dose from 37.2% in 2008 to 44.3% in 2009 among girls in this age group. Administration of at least three doses also rose from 17.9% to 26.7%.

No racial/ethnic differences were observed among girls who initiated the HPV vaccine series, but whites had higher completion rates when compared with black and Hispanic girls. Additionally, more girls living below the poverty level initiated the vaccine series compared to those living above it.

HPV vaccine uptake also appeared higher among older girls, despite being recommended for those aged 11 to 12 years. The researchers noted that some parents and physicians delayed HPV vaccination until they feel discussion about sexual activity is appropriate.

Schuchat encouraged communication between parents and health care providers. “Completing the three-dose HPV vaccine series is very important to ensure protection against cervical cancer,” she said. “Visits for immunization can be a great opportunity to address other important preventive issues that all teens need.”

The researchers also included information on vaccines administered during childhood or as catch-up vaccines during adolescence. Results showed that coverage with any dose of the measles-mumps-rubella vaccine, the hepatitis B vaccine, varicella vaccine, Tdap and MenACWY was generally lower among older adolescents.

The report also revealed that Connecticut, Massachusetts, New Hampshire and Rhode Island all had adolescent vaccination rates that were greater than 60%.

Although the 2009 NIS-Teen report is encouraging, Schuchat noted that vaccination in this population can still be better.

“This year’s data are mixed,” she said. “We can see that more parents of adolescents are electing to protect their children from serious diseases such as pertussis, meningitis and cervical cancer, but there is clear room for improvement in our system’s ability to reach this age group.” — by Melissa Foster

It is exciting to see increased immunization rates among this age group as immunizing adolescents becomes an expected standard similar to the infant immunization platforms. This is a wonderful first step to creating greater awareness about the importance and relevance of immunization recommendations across the lifespan. With continued efforts, I hope we will continue to see improved vaccination rates among this age group that can play such a major role in disease transmission.

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

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