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Tdap, MCV4 vaccination uptake improved compared with HPV vaccination
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Tdap and the quadrivalent meningococcal conjugate vaccination rates increased more than HPV vaccination rates from 2007 to 2013 among children aged 11 years living in New York City, according to study results.
To determine vaccine uptake and co-administration among children aged 11 years, Monica Sull, MPH, of the New York City Department of Health, and colleagues assessed data from the Citywide Immunization Registry. For children born in 1996 to 2000, catch-up vaccination was monitored through 2013. Data for HPV vaccination among boys was from 2010 to 2013. The researchers defined co-administration as a visit where MCV4 (Menactra, Sanofi-Pasteur) or HPV vaccine were co-administered with Tdap.
During the first year of Tdap requirement there was a significant increase in Tdap vaccine administration, especially in late summer and early fall of 2007. Tdap vaccine uptake increased 305.9% from August 2006 to August 2007, when vaccine uptake peaked.
Receipt of MCV4 and the first dose of HPV vaccine also increased during the first year of Tdap requirement.
However, while doses of MCV4 significantly increased each year, HPV vaccine uptake decreased among girls. Conversely, HPV vaccine uptake among boys began to significantly increase in January 2010 and continued to rise until reaching similar dosage rates to girls by 2012.
From 2007 to 2013, co-administration of MCV4 increased from 29% (95% CI, 28.6-29.3) to 65.4% (95% CI, 65-65.8), indicating a 36.4 percentage point increase (P<.001).
For each study year, the proportion of Tdap vaccination visits that included co-administration of MCV4 was greater than co-administration of first dose of HPV (P<.001).
Among children born in 1996, 52.8% of children received Tdap at age 11 years and 19.3% received MCV4 by 2007. At the end of 2013, when children were aged 17 years, Tdap coverage increased to 97.5% and MCV4 coverage increased to 92.8%.
Children born more recently had higher vaccination coverage for all vaccines, according to researchers.
“Our findings highlight the importance of promoting co-administration of all adolescent vaccines during the 11-year-old Tdap vaccination visit required for school entry in New York City,” Sull and colleagues wrote. “Increasing the number of adolescents who receive the HPV vaccine at this health care encounter can help reduce the number of adolescents unprotected in their late teens and early 20s, when nearly half of new annual HPV infections occur.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Henry Bernstein, DO, MHCM, FAAP
New York state instituted a requirement of Tdap vaccination for school entry among adolescents aged 11 years and older beginning with the 2007-2008 school year. This study assessed Tdap vaccine uptake and co-administration with MCV4 or HPV in 11 year olds living in New York City since then. Tdap vaccination coverage increased to 97.5% during the 6-year academic period from 2007-2013. Routine co-administration of MCV4 with Tdap similarly increased coverage rates for MCV4. The same success was not found when HPV was co-administered with Tdap; coverage rates for HPV were notably lower.
Every adolescent visit should be viewed as a potential opportunity to immunize. This includes educating the patient and family about HPV. One of the most powerful messages to transmit is that the HPV vaccine is a critical approach to cancer prevention. Yet, some parents still have a hard time deciding the need for children to be vaccinated against a virus that is spread through sex. Some healthcare providers also have reservations about offering the HPV vaccine, given societal perceptions and associations of HPV with sexual behavior.
There is a downward trend in healthcare utilization as children progress from childhood through early adulthood. Missed opportunities to recommend and update a teen’s immunizations, particularly with HPV vaccine, have been noted. When given during the same clinical encounter as another vaccine (like Tdap), the vaccination rate for at least one dose of HPV should be higher. We must take full advantage of every chance we can to vaccinate all adolescents to protect against HPV.
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Steven B. Black, MD
Sull and colleagues recently report in Pediatrics that since TdaP has been required for school entry for adolescents in New York City, routine co-administration of meningococcal conjugate with TdaP in adolescents has increased coverage rates for meningococcal conjugate vaccine.
The study emphasizes the importance of giving all appropriate immunizations to adolescents when they appear for care. Unfortunately, the authors report that there has not been a similar increase in HPV coverage among girls. It is not clear whether this is due to lack of practitioner recommendation for this vaccine or parental refusal.
Giving all three vaccines simultaneously is safe and effective. Practitioners who care for teenagers are well aware that one should not waste an opportunity to vaccinate teens against all recommended vaccines including HPV when they appear for care.
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