Missed Opportunities to Adhere to the ACIP Vaccine Initiation Schedule among Privately Insured Preteens in the United States, 2010-2012
Background: The Advisory Committee on Immunization Practices (ACIP) recommended that preteens get three vaccines (Tetanus, Diphtheria and Pertussis (Tdap), Meningococcal Conjugate Vaccine (MCV4) and Human papillomavirus (HPV)) during a single clinic visit. However, the vaccine initiation rates for these three vaccines as per the CDC's NIS 2012 were 54% for HPV, 74% for MCV4 to 85% for Tdap. The objective of this study was to assess and compare adherence to the ACIP recommended vaccine initiation schedule for preteens.
Methods: This study used the MarketScan Commercial Claims database of 1,245,336 eligible preteens between age 11 and 12 years, who were continuously enrolled and had a vaccination visit for at least one of the three recommended vaccines between January 2010 and December 2012. Adherence to ACIP recommendation was assessed for the very first vaccination visit. Adherence to ACIP recommendations was defined as preteens who received all three vaccines during their first vaccination visit as recommended by the ACIP. Descriptive statistics were used to assess adherence to ACIP recommendations. Multivariate analysis was also carried out to understand association of adherence to ACIP recommendations with variables such as sex, year, age and region.
Results: Only 10% of the preteens received all three vaccines during a single visit (first vaccination visit) per ACIP recommendations, 36% were given only one of the three vaccines and 54% had any two recommended vaccines. The most prevalent practice (50%) was to give Tdap and MCV4 (Fig 1). The HPV vaccine was missed in 63% of preteens who received 1 or 2 vaccines in a single visit (data not shown) and in 93% of preteens who received Tdap and MCV4 in a single visit (Fig 2). Though adherence to ACIP recommended vaccination schedule has doubled from 7% in 2010 to 14% in 2012, it is still very low. Adherence to ACIP recommendations was significantly lower in 12 year olds (OR: 0.83) and in West and South regions (OR: 0.43 and 0.56 respectively) compared to North-East region and was higher for females (OR: 2.99) and for each additional year (OR: 2.23).
Conclusion: Adherence to ACIP guidelines is low as very few preteens receive all three vaccines in a single visit. Of the three vaccines mentioned in the ACIP recommendations, HPV vaccine poses as the biggest missed opportunity.
N. N. Borse,
Merck: Consultant, Consulting fee
S. S. Sen, Merck: Employee, Salary
L. Niccolai, Merck: Collaborator, Research Contractor and Scientific Advisor, Consulting fee
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