Teen immunization rates improve with middle school vaccine mandates
■ Because no state requires all recommended immunizations, physicians are advised to educate adolescents and their families about them.
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States that require middle schoolers to be up to date with vaccines have greater coverage among teens for those particular immunizations than states without such mandates, a recent study shows.
But because no state requires all of the three vaccines recommended for adolescents, physicians should review youths’ immunization history at each visit and offer any vaccine the teen is missing, said Shannon Stokley, MPH, co-author of the study published online May 7 in Pediatrics.
The Centers for Disease Control and Prevention recommends that youths 13 to 17 receive the following vaccines: meningococcal conjugate (MenACWY); tetanus, diphtheria, acellular pertussis (Tdap); and human papillomavirus (HPV).
“We need to do a better job of reducing missed opportunities to vaccinate adolescents and taking advantage of every visit with” adolescent patients, said Stokley, a CDC epidemiologist.
Researchers examined data from the National Conference of State Legislatures and several other organizations to identify states with middle school vaccination requirements in place at the start of the 2008-09 academic year. They also assessed the results of the 2008-09 National Immunization Survey-Teen to determine vaccination coverage rates for adolescents 13 to 17.
They found that 32 states require middle schoolers to receive the Td or Tdap vaccine. In those states, 80% of adolescents had at least one dose of either Td or Tdap compared with 70% of youths in states without a mandate for either of the immunizations.
Similarly, in Arizona, New Jersey and North Dakota — the three states with a MenACWY requirement for middle school — 71% of adolescents received at least one dose of the vaccine compared with 53% of youths in states without the mandate, data show. Those states also require the Td or Tdap vaccine (link).
Data were not studied for coverage of the HPV vaccine because only one state — Virginia — requires it.
The Healthy People 2020 targets for youths 13-15 are 80% coverage for at least one dose of Tdap and MenACWY immunizations and at least 80% for three doses of HPV vaccine among females.
Researchers found that 12 states required middle schools to educate parents about the MenACWY or HPV vaccines rather than mandate that the child get the immunization. Such education often is in the form of informational materials that the school mails to parents or sends home with students, the study said.
Only three states required either immunizations or education on all three recommended vaccines: New Jersey, which requires education on HPV; and North Carolina and Washington, which require Tdap and education on MenACWY and HPV. Twelve states require neither vaccination nor education.
Parental education requirements were not associated with higher immunization rates, data show.
“The issue is determining the best ways to disseminate the information so parents can make an educated decision about whether or not to vaccinate their child,” Stokley said.
The Pediatrics study did not assess which forms of vaccine education are most beneficial.
“We know adolescents don’t visit the doctor as often as recommended,” she said. “So it’s really important that doctors take advantage of every opportunity to administer all the vaccines they can while they have the adolescent in the office.”