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AAP News Vol. 17 No. 3
September 2000, p. 81
35 million teens missing recommended vaccinesJessica LittleEditorial Intern
Data over the past two years indicate a worrisome trend—most adolescents do not have the immunizations they need.
An estimated 35 million U.S. adolescents may be missing at least one of the recommended vaccinations, according to Francisco Averhoff, M.D., M.P.H., a medical epidemiologist with the U.S. Centers for Disease Control and Prevention (CDC). Pediatricians should review their adolescent patients’ immunization records and bring patients up-to-date in their vaccines, advised Dr. Averhoff and Margaret Rennels, M.D., FAAP, member of the AAP Committee on Infectious Diseases. By age 12, children should have received: three doses of hepatitis B vaccine; the second dose of measles-mumps-rubella (MMR); and the varicella vaccine, if indicated. The tetanus and diphtheria toxoid (Td) should be given between the ages of 11 and 16 years. Adolescents who are missing immunizations, especially the hepatitis B and, when necessary, the varicella vaccine, put themselves at a far greater risk of developing infectious diseases and complications that arise from these diseases, said Dr. Rennels. Upsetting statistics Several studies point to the potential trend in adolescent immunization rates. • Coverage for hepatitis B among adolescents is only 30% to 50% nationally, far below the optimal 90% coverage rate, according to the National Health Interview Survey, to be published within the next year.
• Immunization completion rates for 13-year-olds enrolled in HMOs — organizations known for their preventive health care measures — were between 52% and 59% in 1996 (
Himmelstein D, et. al. JAMA. 1999;282:159-163 • Only 52% of U.S. adolescents enrolled in health plans are fully immunized, according to a National Committee on Quality Assurance report titled 1999 State of Managed Care Quality (www.ncqa.org). The south central United States (including Arkansas, Louisiana, Oklahoma, New Mexico and Texas) had the lowest average coverage rate at 37%. Central and southwestern states had below-average coverage as well. • In San Diego County — an area with one of the best immunization programs in the nation, according to Dr. Averhoff — only about 16% of children entering the fifth and sixth grade had received all three doses of hepatitis B vaccine by April 1998. About 70% of the same students received two doses of MMR, 9% had the Td booster, and, of children without a history of chickenpox, only 16% had the varicella vaccine ( MMWR.2000;49:101-102,111[Medline] ). • Despite a lack of hard data, CDC officials estimate that less than 20% of Florida seventh-graders had the hepatitis B vaccine before the state passed a law requiring students to have the three vaccinations before entering seventh grade. The Orange County Health Department saw a 380% increase in vaccines administered after the requirement was enacted ( MMWR. 1998;47:711-715[Medline] ).
The statistics are upsetting, but not alarming, said Dr. Rennels.
"Clearly, this needs to be improved upon," Dr. Rennels said. "But, we’ve never been good about vaccinating our adolescents." An age group left at risk Pediatricians should be most alarmed about the low varicella vaccination rates, she said. "Now that more and more children are being vaccinated, people will have less exposure to the virus," Dr. Rennels said. "Unvaccinated children won’t get exposed to the disease until they are adults." Adults who get chickenpox are increasingly at risk of having a serious case, possibly requiring hospitalization, and of complications and death. In the United States, there are about 100 deaths every year from chickenpox, according to CDC statistics. Missing the hepatitis B vaccine also is potentially life threatening. Hepatitis B infection usually occurs during adolescence and early adulthood. One in about 20 people will get hepatitis B, Dr. Averhoff said. "For adolescents, what’s on the horizon is hepatitis B infection," Dr. Averhoff said. Many underestimate the threat of hepatitis B, Dr. Rennels said. Pediatricians and parents may make the dangerous assumption that their adolescents aren’t at risk for infection, she warned, noting, "There is no way to know whether children will put themselves at risk." There’s no reason for pediatricians not to be giving the hepatitis vaccine, a safe and effective series of vaccines, to their adolescents, Dr. Rennels said. Recall your 12-year-olds "If pediatricians don’t have mechanisms in place to actively recall 12-year-olds, then they ought to work on instituting that," Dr. Rennels advised. Pediatricians can help develop this infrastructure by establishing routine visits with their 11- to 12-year-old patients, as recommended by the Academy, the American Medical Association, the Advisory Committee on Immunization Practices and the American Academy of Family Physicians. At this visit, pediatricians have the opportunity to provide adolescents with the varicella virus vaccine (if indicated), hepatitis B vaccine, the second dose of MMR vaccine, and a booster dose of Td. Pediatricians also should administer other vaccines that may be recommended for certain adolescents and provide other recommended preventive services, according to the 1996 Immunization of Adolescents Recommendations. Dr. Averhoff said creating the infrastructure now will help get future vaccines to adolescents. Developing an adolescent vaccination infrastructure has historically taken years, Dr. Averhoff said. The hepatitis B vaccine is one example; it’s been available for adolescents since 1994, yet coverage figures remain low. Currently, vaccines against HIV, herpes, chlamydia and gonorrhea are being developed, Dr. Averhoff said. On the brink of sexual activity, adolescents are the likely targets for these vaccines against sexually transmitted diseases, he said. "We need the infrastructure when these vaccines come on board," Dr. Averhoff said. Pediatricians definitely should not ignore these statistics and settle for the status quo, Dr. Rennels cautioned. This article has been cited by other articles:
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