ATLANTA — Physicians who take care of adolescents are likely to accept routine vaccination of 11- to 12-year-olds with a tetanus-diphtheria-acellular pertussis vaccine instead of the current tetanus-diphtheria vaccine, Karen R. Broder, M.D., reported at a meeting of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.
However, preliminary survey data suggest that vaccinating older adolescents might prove trickier, and that vaccination practices are likely to differ between family physicians and pediatricians, said Dr. Broder, a medical officer with the CDC's National Immunization Program.
In anticipation of the expected licensure of two new specially formulated adolescent tetanus-diphtheria-acellular pertussis (Tdap) vaccines, the University of Michigan and the CDC surveyed approximately 600 randomly selected U.S. pediatricians and family physicians. A total of 154 pediatricians and 143 family physicians returned the surveys and said they provided outpatient primary care to one or more adolescents (aged 11–18 years) per week.
Most of the physicians (75% of pediatricians and 66% of family physicians) worked in private, independent office settings, while 19% of the family physicians worked in practice networks/HMOs, compared with just 7% of the pediatricians.
Both specialties reported high current rates of administering tetanus-diphtheria toxoids (Td) when indicated for wound management (73% pediatricians/83% family physicians) and for camp and/or school requirements (83%/79%). However, while 77% of pediatricians said they routinely gave Td vaccine to 11- to 12-year-olds at preventive care visits, just 51% of family physicians reported doing so.
Among the surveyed physicians, the reported “major” barriers to current adolescent Td vaccination included “lack of patient visits” for 40% of pediatricians and 48% of family physicians; “record keeping” for 11% and 24%, respectively; “reimbursement” for 3% and 17%; and “too busy” by 2% of pediatricians and 7% of family physicians. “No barrier” was reported by 47% of pediatricians and 32% of family physicians.
A total of 70% of pediatricians versus 42% of family physicians either agreed or strongly agreed with the statement that pertussis is a “serious enough disease” to use Tdap for adolescents, rather than Td, she noted.
In a separate survey of a different but comparable group of physicians, 63% of pediatricians and 35% of family physicians reported that more than half of their adolescent patients have a routine preventive visit at 11–12 years, while 44% of pediatricians and 27% of family physicians reported the same for those aged 14–15 years, compared with just 30% and 15%, respectively, at 17–18 years.
A total of 84% of pediatricians and 59% of family physicians said that more than half of their patients received a Td booster at any time between the ages of 11 and 18 years, suggesting more than 50% coverage. By comparison, the 2002 National Health Interview Survey found that just 33% of those aged 13–15 years had a Td dose listed in their shot cards, while coverage for Td varied from 48% to 97% in three states with Td school laws for middle-schoolers, Dr. Broder noted.
In addition to ACIP's expected recommendation for routine Tdap vaccination at the 11- to 12-year-old preventive visit, the committee is also considering a “first opportunity” strategy in which the vaccine would be given to any teenager who had received Td more than 5 years earlier (an interval of 5 years is required to minimize adverse events). These survey data suggest that such a strategy “might pose challenges,” Dr. Broder remarked.