Survey helps set baseline for teen vaccination

Washington -- Adolescents were included for the first time in a large national survey on immunization rates, and the news is good and not so good depending on the vaccine in question.

More than 84% of teens had received three or more doses of the hepatitis B vaccine -- in use for about 15 years -- and 89% received two or more doses of the measles, mumps and rubella vaccine -- in use for decades. But only 11% received the Tdap shot, and about 12% were immunized with the meningococcal conjugate vaccine.

Both of these were licensed and recommended a few years ago. Public health goals call for 90% vaccination rates five years after a vaccine's introduction, so there's time yet for the new products to gain ground.

The information was gathered by the Centers for Disease Control and Prevention for its 2006 National Immunization Survey and published in the Aug. 30 Morbidity and Mortality Weekly Report.

The data arrive as the health care community tries to craft an adolescent immunization track, with a focus on 11- and 12-year-olds, that mirrors the well-established track followed by the parents of infants and young children. The new information was welcomed by physicians for providing a baseline with which to compare future efforts.

Although data were collected on all immunizations received by teens, interest was piqued by the acceptance rates for the newest vaccines directed specifically at teens. The survey gathered data on two of the three vaccines recommended since 2005 -- the tetanus and diphtheria with acellular pertussis shot and the meningococcal conjugate vaccine.

The third preventive, the human papillomavirus vaccine, was too new to be included in the survey, although the manufacturer, Merck & Co., has said 7.5 million doses had been distributed in the United States by the end of June, a relatively high number, said Melinda Wharton, MD, MPH, deputy director of the CDC's National Center for Immunization and Respiratory Diseases. She spoke at an Aug. 30 press briefing.

"All three of these vaccines are now recommended for administration at age 11 to 12, and so it's very important for us as we work to implement these new recommendations to be able to monitor vaccination coverage in adolescents," Dr. Wharton said.

Improving immunization rates

"The new survey information shows we have more work to do to protect older children from vaccine-preventable diseases," Dr. Wharton said. "We need to continue to build awareness of these recommendations among parents and health care providers, and we need to continue our efforts to educate everyone about the health benefits of these vaccines."

Bonnie Word, MD, assistant professor of pediatrics at Baylor College of Medicine in Houston, suggested a catchy slogan, perhaps "See you at 11," would help draw parental attention to the need for vaccines for preteens.

"I think every parent wants to provide the best medical care for their children," said Dr. Word, who is also a fellow of the Infectious Diseases Society of America and a member of an AMA task force on adolescent immunization. "I think they may not be immunizing because the parent isn't aware."

The AMA's teen task force was formed after a meeting last year drew attention to the special vaccine needs of adolescents. For example, teens often lack a medical home and are more likely to visit clinics that may not traditionally provide immunizations.

David Kimberlin, MD, a professor of pediatrics and pediatric infectious diseases at the University of Alabama, Birmingham, pointed to shortages last year of meningococcal vaccine as another reason immunization rates may be low for younger teens. Older teens were given priority for the then-scarce vaccine.

"In some situations there has been a start-stop-start-stop approach to it, and that has to be frustrating for a practitioner and patients," Dr. Kimberlin said.

Karen L. Ytterberg, MD, a professor of pediatrics at Mayo Clinic College of Medicine in Rochester, Minn., was not surprised by the low immunization rates. "We have never been successful at achieving good rates for immunization for adolescents if they are not required for school," she said. Currently, states do not require the Tdap or meningococcal vaccines for public school attendance, although many colleges require the meningitis vaccine.