Teenagers Difficult to 'Capture' for Vaccinations; Rates on Rise Overall, But
Still Low
New Vote on Whether to Vaccinate Males Against HPV Leaves it up to Parents and
Health Care Providers; Prompts Robust Discussion
BETHESDA, Md., Oct. 26 /PRNewswire/ -- More teenagers are being vaccinated
against human papillomavirus (HPV), meningococcal meningitis and pertussis
(whooping cough), though the rates are still too low, according to recently
released government data and a panel of experts convened by the National
Foundation for Infectious Diseases (NFID). Now, in addition to urging routine
HPV vaccination for girls, providers can educate adolescent boys, young men -
and their parents - about HPV and its potential consequences, and offer
vaccination to boys as well. Last week, the Advisory Committee on Immunization
Practices (ACIP) to the Centers for Disease Control and Prevention (CDC) voted
for a 'permissive' HPV vaccination strategy for boys.
In taking the vote, the Advisory Committee considered research specific to the
impact of genital warts in males and whether vaccination in males would be
unnecessary if females were vaccinated at high rates. Presently, only about 40
percent of teenage girls receive the first dose of HPV vaccine with fewer than
20 percent receiving the complete three-dose series. Committee members could
not consider research about HPV-related cancers in males in their
deliberations, though that may leave the door open to revisit or even expand
the recommendation to prevent cancer in the future.
"Voting for a permissive HPV vaccination strategy in boys puts the choice
squarely in the hands of the parents and puts the onus for educating boys and
their parents about HPV squarely on the health care providers' shoulders,"
said William Schaffner, M.D., president-elect of NFID. "It is a good way to
get the conversation going about human papillomavirus in boys, but if current
rates are any indication, this strategy will not make a big dent in
vaccination coverage."
Even for those vaccinations that are routinely recommended, rates do not yet
reach target rates set forth in 2000 for the year 2010. "Adolescents are less
likely to have regular wellness visits," according to Amy B. Middleman, M.D.,
M.P.H, MsEd, Director of Adolescent and Young Adult Immunization at Texas
Children's Hospital Center for Vaccine Awareness and Research and Liaison
Representative to the ACIP for the Society for Adolescent Medicine. "They're a
challenging group to reach, with increasingly busy lives; their health needs
are uniquely different from those of infants and adults. We need to address
this challenge and develop immunization delivery strategies that make sense
for this specific age group. Our youth deserve to move into adulthood with
every health advantage we can give them and immunity against
vaccine-preventable diseases is a big step toward that goal."
Another obstacle to vaccination is that parents and providers don't make
vaccination a priority during adolescence. While infants and toddlers
regularly have wellness visits where they are weighed, measured and
inoculated, adolescents are more likely to see a health care provider only
when they're ill, and vaccinations are not likely to be offered during these
sick visits. Sports physicals are a good opportunity to capture this age
group, but that leaves out a large contingent of teens. Regular wellness
visits including vaccinations are recommended for all adolescents at 11-12
years of age.
Vaccination Rates Demonstrate Need for Improvement; Surprising Disparities in
Coverage
Overall, vaccine coverage rates for the nation's preteens and teens are
increasing, but they remain low. The CDC's National Immunization Survey (NIS)
Teen survey estimates the proportion of teens aged 13 through 17 years who
have received six recommended vaccines by the time they are surveyed. Three of
these are recommended to be given at age 11-12: meningococcal vaccine,
tetanus-diphtheria-acellular pertussis (Tdap), and, for girls, HPV vaccine.
The survey also covers three other vaccines recommended to be given at an
earlier age: measles- mumps-rubella (MMR), hepatitis B and varicella
(chickenpox) vaccine. Influenza vaccine is also recommended every year for all
adolescents up to age 18, but vaccination rates for influenza are not measured
yet by the NIS-Teen survey.
The survey results reveal some ethnic and socioeconomic disparities. Hispanic
females were more likely than Blacks and Whites to start the vaccination
series against HPV, but less likely to complete the recommended three-dose
series. Overall, Hispanics were also more likely than Blacks and Whites to be
vaccinated against meningococcal disease, hepatitis B, varicella and Tdap. In
another surprising finding, teens living below poverty were more likely than
those living at or above poverty to start the HPV series. Teens living at or
above the poverty level had the highest vaccination rates for MMR and the
lowest rates for HPV.
Key findings--racial and ethnic disparities:
-- Hispanic females were more likely than Blacks and Whites to start the
HPV vaccination series (44.4 percent), but less likely to complete the
recommended three-dose series (14.7 percent).
-- Fewer White females than Hispanics started the HPV vaccination series
(35.0 percent), but more completed the three-dose series (19.5
percent).
-- Hispanic teens were also more likely than Black and White teens to be
vaccinated against meningococcal disease. Hispanics (46.8 percent);
Blacks (43.1 percent), Whites (39.7 percent).
Key findings--poverty level:
-- Teens living below poverty level are more likely to start the HPV
vaccination series (46.4 percent) than those living at or above the
poverty level (35.8 percent).
-- For all other diseases, teens living at or above the poverty level are
more likely than those living below to be vaccinated against MMR (89.6
percent vs. 87.1 percent), hepatitis B (88 percent vs. 86.7 percent),
varicella (82.9 percent vs. 77 percent), tetanus-diphtheria-pertussis
(41.2 percent vs. 38.6 percent) and meningococcal disease (42 percent
vs. 40.8 percent).
The complete NIS Survey, including state-by-state vaccination rates, can be
found at http://www.cdc.gov/vaccines/stats-surv/nis/nis-2008-released.htm.
"It's great to report that we're doing better at reaching Hispanic females and
those living below the poverty level about the threat of the human
papillomavirus, but we need to do more to increase the rate of those actually
completing the three-dose schedule," said Lance E. Rodewald, MD, Director,
Immunization Services Division; National Center for Immunization and
Respiratory Diseases (NCIRD); Centers for Disease Control and Prevention.
National Foundation for Infectious Diseases Expands Its Adolescent
Immunization Initiative
In an effort to educate healthcare professionals and parents about adolescent
immunization, the National Foundation for Infectious Diseases is expanding its
adolescent immunization initiative. Later this fall, NFID will re-launch an
expanded Web site, www.adolescentvaccination.org, dedicated to providing
scientifically-based information for parents, teens, healthcare professionals
and the media. NFID is also actively partnering with nearly two dozen other
organizations to proactively communicate that immunization rates in
adolescents need to be improved to reduce the impact of vaccine-preventable
diseases in this population.
About Vaccine-Preventable Diseases
Vaccine-preventable diseases can cause serious morbidity and mortality in
adolescents. Even when treated quickly and appropriately, meningococcal
disease kills about 10 to 14 percent of people infected, with 11 to 19 percent
of survivors suffering serious long-term effects, such as hearing loss, brain
damage and digit or limb amputation. Pertussis is underreported, making it
difficult to pinpoint U.S. incidence, but some estimates range from 1 million
to over 2 million cases each year. Infected adolescents can pass the disease
to infants and others who are at higher risk of serious illness or death.
There are more than 6 million new HPV infections in the U.S. each year, nearly
75 percent are in females 15 to 24 years of age. HPV infection can lead to
cervical cancer.
About the National Foundation for Infectious Diseases
The National Foundation for Infectious Diseases (NFID) is a non-profit,
tax-exempt (501c3) organization founded in 1973 and dedicated to educating the
public and healthcare professionals about the causes, treatment and prevention
of infectious diseases. More information can be found at www.nfid.org.
The adolescent panel discussion and Web site update is supported through an
unrestricted educational grant to the National Foundation for Infectious
Diseases from Merck & Co., Inc.
SOURCE National Foundation for Infectious Diseases (NFID)
Jennifer Corrigan, +1-732-382-8898, Cell +1-732-742-7148,
jenn.corrigan@comcast.net, for NFID
