Immunization: What Happens at Ages 11 12 National Health Interview Survey, 1997 2003

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ImmunizationWhat Happens at Ages 11
12?National Health Interview Survey, 1997 2003

• Mary McCauley
• John Stevenson
• Shannon Stokley
• Dan Fishbein
• National Immunization Program

The findings and conclusions in this presentation
have not been formally disseminated by CDC and
should not be construed to represent any agency
determination or policy.
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History vs the Future

• Until 2005, Td was the only vaccine universally
  recommended for 11- and 12-year-olds
• Today, an 11- or 12-year-old who has not received
  all doses of Hep B, MMR, or varicella needs
  catch-up
• Because of high childhood coverage, the impact of
  adolescent catch-up recommendations is coming to
  an endas children born later receive the
  vaccines as infants and young children
• New adolescent vaccines are permanent additions
  to a growing adolescent schedule

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Therefore...

• Adolescent providers will be on the front lines
  to assure high coverage with new vaccines, such
  as MCV4, Tdap, HPV, and others

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Study Question

• How many children in the NHIS were brought up to
  date with Hep B, MMR, and Td when they were 11 or
  12?
• Differs from the traditional measure of
  vaccination coverage, which counts all vaccines
  accumulated during the childs entire life, from
  birth to the interview date

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National Health Interview Survey

• Face-to-face household survey of
  non-institutionalized U.S. residents
• Covers various health topics
• In 1991, an immunization supplement was added for
  children 0-6 years old
• In 1997, the immunization section was expanded to
  include all children
• Parents can report from vaccination record,
  memory, or both
• In 2003, data collection for adolescent
  vaccination ended

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Methods

• We included all those who were at least age 13 at
  the time of the interview
• We limited this analysis to respondents who
  reported information from a vaccination record

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Who are these adolescents?

• Born in 1979 1990
• Ages 11 or 12 in 1990 - 2002

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What recommendations applied?

• For 11- and 12-year-olds
• 1989 AAP recommended 2nd dose MMR
• 1995 ACIP recommended the Hep B series, 2nd dose
  MMR, and Td
• 1996 ACIP and other major professional
  organizations recommended a health visit to
  assess for and deliver vaccines and other
  preventive services

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We Examined

• Coverage attained by age 10 and during ages 11
  and 12 for 3 Hep B,
• 2 MMR, and Td
• Yearly trends in vaccine administration to assess
  impacts of recommendations
• Percent of each birth cohort who were eligible
  for vaccine and who received it while age 11 or
  12

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Results

• Sample size
• Hep B
• MMR
• Td

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Vaccination record in the home by year of birth
for all adolescents surveyed
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Vaccination coverage, 3 Hep B by age 10 years
Among those age 13 years with vaccination
record in the home
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Vaccination coverage, 3 Hep B by age 10 years
and during age 11 years
Among those age 13 years with vaccination
record in the home For vaccine receipt at
11 and 12 years, includes receipt of Hep B 3 only
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Vaccination coverage, 3 Hep B by age 10 years
and during age 11 years
11 yrs old in 1995
Among those age 13 years with vaccination
record in the home For vaccine receipt at
11 and 12 years, includes receipt of Hep B 3 only
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Vaccination coverage, 3 Hep B by age 10 years
and during ages 11 and 12
Among those age 13 years with vaccination
record in the home For vaccine receipt at
11 and 12 years, includes receipt of Hep B 3 only
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Vaccination coverage, 3 Hep B by age 10 years
and during ages 11 and 12
12 yrs old in 1995
Among those age 13 years with vaccination
record in the home For vaccine receipt at
11 and 12 years, includes receipt of Hep B 3 only
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Percent eligible who received Hep B 3 at ages 11
and 12

• Among those age 13 years with vaccination
  record in the home
• For vaccine receipt at 11 and 12 years,
  includes receipt of Hep B 3 only

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Vaccination coverage, 2 MMR by age10 years and
during ages 11 and 12
11 yrs old in 1990 12 yrs old in 1991
11 yrs old in 1995
12 yrs old in 1995
Among those age 13 years with vaccination
record in the home
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Percent eligible who received MMR at ages 11 and
12
Among those age 13 years with vaccination
record in the home
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Vaccination coverage, 1 Td by age13 years
Among those age 13 years with vaccination
record in the home
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Limitations

• Vaccination history not provider validated
• We can only evaluate visits at which a vaccine
  was administered children may have seen a
  provider at age 11 or 12 and had a missed
  opportunity
• Data are not weighted to represent the entire
  adolescent population
• The sampling strategy was not devised with this
  type of analysis in mind

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Conclusions from Data

• The number of adolescents who received Hep B and
  MMR during birth through 10 years increased
  steadily
• Overall, few adolescents who needed vaccine
  received it while ages 11 12 during 1990 - 2002
• Nevertheless, we can observe some effect of
  recommendations in the timing of vaccine
  administration

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Discussion

• The capacity to deliver multiple doses of
  multiple vaccines to adolescents should be
  considered
• Where feasible based on epidemiology and
  logistics, including vaccine supply,
  consideration should be given to recommending new
  vaccines for all adolescent age groups to reach
  as many as possible, especially given data that
  suggest that adolescents make few visits,
  especially for preventive care

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Challenges

• Reaching adolescents with the recommended visit
  at ages 11 and 12
• Assuring vaccine financing and equity
• Assuring the systems capacity to deliver an
  ever-increasing number of vaccines, some
  multi-dose
• Educating providers, parents and adolescents
  about risks of the VPDs, the efficacy of the
  vaccines, and the safety of interventions for
  sexually transmitted infectious in general for
  NOT increasing risk-taking behavior

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Thank you. Mary McCauley, CDC MMcCauley_at_cdc.gov