Teen Vaccination Rates Continue to Climb, Though Raising Awareness Remains Key

Uptake of Tdap, Meningococcal Vaccines Up More Than 10 Percent

By David Mitchell
Posted: 9/1/2010, 3:30 p.m.

In 2009, the nation experienced double-digit increases in the percentage of U.S. teenagers who had received at least one dose of two of the three vaccines routinely recommended for adolescents, according to the results of a survey released Aug. 20 in the CDC's Morbidity and Mortality Weekly Report.

Stock photo of teenage girl getting an immunization

Uptake of at least one dose of two of the three vaccinations routinely recommended for adolescents -- meningococcal conjugate vaccine and tetanus, diphtheria and acellular pertussis vaccine -- increased by more than 10 percent in 2009. Coverage with one or more doses of the third recommended vaccine -- human papillomavirus vaccine -- increased 7 percent among teenage girls.

"There's been steady incremental uptake in vaccination rates among teens," said Doug Campos-Outcalt, M.D., M.P.A., the AAFP's liaison to the CDC's Advisory Committee on Immunization Practices. "It would be nice to be doing better than we are, but it is improving."

The CDC collected vaccination information from more than 20,000 teenagers ages 13-17. Compared with 2008 figures, coverage for meningococcal conjugate vaccine increased nearly 12 percent to 53.6 percent, and coverage for tetanus, diphtheria and acellular pertussis, or Tdap, vaccine increased nearly 15 percent to 55.6 percent.

The increase in Tdap coverage, in particular, is significant in light of pertussis outbreaks that occurred in several states this year, most notably in California. The California Department of Public Health said in an Aug. 24 report (4-page PDF; About PDFs) that the state has had more than 3,300 reported cases, with at least 169 hospitalizations and eight infant deaths.

"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," said Anne Schuchat, M.D., director of the CDC's National Center for Immunization and Respiratory Diseases, in an Aug. 19 news release that coincided with the release of the survey results. "Young infants are most vulnerable to serious complications from pertussis and can be infected by older siblings, parents or other caretakers."

Interactive map showing estimated vaccination coverage percentages among adolescents ages 13-17, by state/area and selected vaccine and number of doses, in 2009

MCV = meningococcal conjugate vaccine
Tdap = tetanus, diphtheria, acellular pertussis vaccine
HPV = human papillomavirus vaccine

Source: CDC National Immunization Survey -- Teen, 2009

Link to a chart showing this state-by-state breakdown of teen vaccination coverage.

Human papillomavirus, or HPV, vaccine uptake among teenage girls also increased last year compared with 2008 figures, although coverage with at least one vaccine dose remained less than 50 percent. Specifically, coverage with one or more doses increased 7 percent to 44.3 percent, and only 26.7 percent of teenage girls in the survey had completed the three-dose series, up from 17.9 percent a year ago.

Campos-Outcalt, who also is associate head of the department of family and community medicine at the University of Arizona College of Medicine, Phoenix, said the relatively high cost of the HPV vaccine might deter some parents, while others may have concerns about vaccine safety.

"People are getting bad information from some antivaccine websites," he said. "It's a very safe vaccine, and it's an effective vaccine."

From the time Merck & Co. Inc.'s HPV vaccine -- which is marketed as Gardasil -- was approved by the FDA in 2006 through May 31 of this year, nearly 30 million doses of the vaccine had been administered in the United States. A total of 16,140 adverse events were reported to the CDC during that time, with more than 90 percent of those reports deemed nonserious by CDC officials.

According to the 2009 teen survey, overall vaccination rates varied widely among the states. For example, Connecticut, Massachusetts and Rhode Island achieved coverage of 60 percent or more with the three vaccines routinely recommended for teens. Conversely, Oklahoma and South Carolina saw rates below 40 percent for all three vaccines, and Mississippi was below 25 percent for all three.

The CDC survey also included information about coverage rates for vaccines administered during childhood or as catch-up vaccines in adolescents:

At 89.1 percent, the rate of coverage with two or more doses of measles, mumps and rubella vaccine was similar to the 2008 rate.
Coverage with three or more doses of hepatitis B vaccine increased from 87.9 percent to 89.9 percent.
Reported history of varicella disease decreased from nearly 60 percent to 52.7 percent, and nearly 76 percent of teens achieved protection from varicella disease through either a history of disease or two or more doses of vaccine.

Campos-Outcalt said adolescent vaccinations need to become as high a priority for parents as childhood vaccinations are.

"It has to develop into a mindset," he said. "Teens should come in to see if they are developing correctly, get their shots and any tests that might be indicated. Then it becomes routine for them -- just as it is for infants and children."