Vaccine Levels Drop, HPV included, for US Teenagers
Large differences in vaccination coverage for teenagers in the United States show that “substantial missed opportunities” persist, according to a Centers for Disease Control and Prevention (CDC) report published online August 29 in the Morbidity and Mortality Weekly Report. The gap is particularly apparent for human papillomavirus (HPV) vaccination among girls.
C. Robinette Curtis, MD, from the Immunization Services Division, CDC, Atlanta, Georgia, and colleagues analyzed data for teenagers 13 to 17 years old from the National Immunization Survey-Teen (NIS-Teen), which covers the 50 states, the District of Columbia, selected areas, and the US Virgin Islands.
The Advisory Committee on Immunization Practices (ACIP) recommends that young adolescents, aged 11 and 12 years, receive 1 dose of tetanus, diphtheria, and acellular pertussis (Tdap), 1 dose of meningococcal conjugate (MenACWY), and 3 doses of HVP vaccines, all of which can be administered during a single healthcare visit. ACIP also recommends young adolescents and all teenagers receive annual influenza vaccines and any overdue vaccines.
In the current survey, the investigators found that coverage for Tdap and MenACWY vaccines improved steadily from 2006 through 2012, with an annual increase of 12.0% (95% confidence interval [CI], 9.9% – 14.0%) for Tdap and 10.1% (95% CI, 7.5% – 12.6%) for MenACWY. From 2011 to 2012, corresponding increases amounted to 6.4% for Tdap and 3.5% for MenACWY.
However, the widening gap between Tdap coverage and MenACWY suggest there are many missed opportunities for vaccinations. “Healthcare providers should administer recommended HPV and meningococcal vaccinations for teens during the same visits when Tdap vaccine is given,” the authors write.
Between 2007, the first year for reporting HPV vaccine for girls, and 2011, coverage for 1 dose of HPV increased an average 6.1% a year (95% CI, 3.3% – 8.9%), but stalled between 2011 (53.0%) and 2012 (53.8%). Moreover, the coverage of the recommended 3-doses of HPV for girls actually declined from 34.8% to 33.4% between 2011 and 2012.
HPV covered for 1 dose for boys rose from 8.3% in 2011, the first year for reporting, to 20.8% in 2012, but coverage for 3 doses was low, at 1.3% in 2011 and 6.8% in 2012.
Healthy People 2020 targets for vaccinations among teenagers aged 13 to 15 years are 80.0% for Tdap, MenACWY, and 3 doses of HPV among girls. For that age group in 2012, vaccination coverage amounted to 85.3% (95% CI, 84.1% – 86.5%) for 1 or more doses of Tdap, 73.8% (95% CI, 72.3% – 75.2%) for 1 or more doses of MenACWY, and 28.1% (95% CI, 26.1% – 30.2%) for 3 or more doses of HPV among girls.
Coverage varied widely among US states. For instance, coverage for 1-dose HPV among girls ranged from 39.4% in Florida to 73.7% in Rhode Island, and coverage for 3-dose HPV ranged from 12.1% in Mississippi to 57.7% in Rhode Island. The Northeast was the highest-coverage region.
Limitations of the study include possible bias from missing NIS-Teen data from unresponsive households and possibly unreliable data from some states or reporting areas, the researchers write.
Implementation of the Patient Protection and Affordable Care Act, researchers point out, may help to improve vaccine coverage by requiring some health plans to offer vaccines at no cost in 2014.
The researchers conclude that providers, parents, and adolescents should use every visit, including checkups and sports physicals, as opportunities to review and, if necessary, catch up on recommended vaccines. “Achieving high vaccination coverage among adolescents is feasible, and progress is evident for most vaccines. Lack of progress with HPV vaccination among females warrants immediate action by health-care providers, parents, public health agencies, and other immunization stakeholders.”
Morb Mortal Wkly Rep. 2013;62:685-693. Full text
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