Adolescent Vaccination Rates Climbing, but Some Still Fall Short of HHS Goals

FPs Need to Leverage Every Immunization Opportunity

August 04, 2009 03:20 pm David Mitchell

Tetanus, diphtheria toxoids and acellular pertussis, or Tdap, vaccine is recommended for all 11- and 12-year-olds, but only 30.4 percent of eligible American adolescents received the combination vaccine in 2007, according to the CDC(www.cdc.gov).

Although that figure represented nearly a 20 percent increase compared with 2006 coverage rates, physicians still need to do more to ensure this elusive cohort receives its recommended immunizations(5 page PDF), according to FP and vaccine expert Jonathan Temte, M.D., Ph.D.

Temte is an associate professor in the department of family medicine at the University of Wisconsin School of Medicine and Public Health, Madison, and a member of the CDC's Advisory Committee on Immunization Practices, or ACIP.

"Tdap is indicated, as this is a time the immunity from the childhood series begins to wane, and the likelihood of exposure increases," he said.

A catch-up dose of Tdap also is recommended for adolescents ages 13-18 who have not yet received the vaccine.

Reaching the Adolescent Age Group

Adolescents make far fewer physician visits than younger children, so it is important to review their recommended immunizations at every visit and vaccinate teens and preteens whenever possible, according to Temte.

"Most visits are urgent care," he said of this age group. "Thus, we often do not have a great deal of access to adolescents."

Family physicians, however, are uniquely positioned to reach the parents of those teens. Temte said parents should be reminded during their own office visits or during those of their younger children about the need to vaccinate their adolescent children.

With school about to start again, many adolescents will be visiting physicians for school physicals, which provides a perfect opportunity to update needed immunizations. Temte also suggested the use of reminder cards.

Uptake Rates

In addition to Tdap, two other recommended adolescent vaccines had vaccination rates well below 50 percent in 2007. Quadrivalent meningococcal conjugate vaccine, or MCV4, also is recommended for all 11- and 12-year-olds, but only 32.4 percent of adolescents had received the vaccine in 2007, according to the CDC.

That was an increase from 11.7 percent in 2006, but Temte said the incidence of meningococcal disease begins to increase in early adolescence, and MCV4 can protect adolescents during years of peak risk.

Also in 2007, 25.1 percent of adolescent girls had received at least one dose of the quadrivalent human papillomavirus, or HPV, vaccine that is recommended starting at age 11 or 12.

That vaccine, which was approved in June 2006 and recommended by the ACIP later that fall, is given in a three-dose series. It protects females from two HPV types that cause between 80 percent and 90 percent of genital warts and two other HPV types that cause roughly 70 percent of cervical cancers, said Doug Campos-Outcalt, M.D., M.P.A., the AAFP's liaison to the ACIP and associate head of the department of family and community medicine at the University of Arizona College of Medicine, Phoenix.

Campos-Outcalt said physicians should have a frank discussion with parents and their daughters about the benefits of the vaccine, stressing that HPV vaccine should be provided before the onset of sexual activity.

Temte also emphasized the importance of seasonal influenza vaccine, which is recommended for all children from ages 6 months through 18 years.

"Children from age 5 to 18 are the epitome of influenza transmitters," Temte said. "Providing coverage at this age has a multiplier effect, as chains of transmission are broken."

There was good news on other vaccine fronts, Temte said. Nearly 90 percent of adolescents received two doses of measles, mumps, and rubella vaccine in 2007, while 87.1 percent received three doses of hepatitis B vaccine. Both figures approach HHS' targets for Healthy People 2010(wonder.cdc.gov).

Varicella protection, as measured by either a history of chickenpox or administration of one dose of the vaccine, already surpasses the Healthy People 2010 goal of 90 percent, at 91.7 percent, the CDC said.


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