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

1. Immunization:What 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.

2. 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 end—as children born later receive the vaccines as infants and young children • New adolescent vaccines are permanent additions to a growing adolescent schedule

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

4. 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 child’s entire life, from birth to the interview date

5. 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 < 18 years old • Parents can report from vaccination record, memory, or both • In 2003, data collection for adolescent vaccination ended

6. 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

7. Who are these adolescents? • Born in 1979 – 1990 • Ages 11 or 12 in 1990 - 2002

8. 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

9. 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

10. Results • Sample size • Hep B • MMR • Td

11. Vaccination record in the home by year of birth for all adolescents surveyed

12. Vaccination coverage, 3+ Hep B by age 10 years* * Among those age ≥ 13 years with vaccination record in the home

13. 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

14. 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

15. 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

16. 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

17. 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

18. Vaccination coverage, 2+ MMR by age10 years and during ages 11 and 12* 11 yrs old in 1990: 12 yrs old in 1991 12 yrs old in 1995 11 yrs old in 1995 * Among those age ≥ 13 years with vaccination record in the home

19. Percent eligible who received MMR at ages 11 and 12* * Among those age ≥ 13 years with vaccination record in the home

20. Vaccination coverage, 1+ Td by age13 years* * Among those age ≥ 13 years with vaccination record in the home

21. 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

22. 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

23. 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

24. Challenges • Reaching adolescents with the recommended visit at ages 11 and 12 • Assuring vaccine financing and equity • Assuring the system’s 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

25. Thank you. Mary McCauley, CDC MMcCauley@cdc.gov