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.