The Advisory Committee on Immunization Practices (ACIP) recommends that all children receive at least one “booster” dose of Tetanus Toxoid and Reduced Diphtheria Toxoid and Acellular Pertussis vaccines (TDaP) before they reach 19 years of age. The preference is for the booster to be received at age 11 or 12. However, there have been reports of unexpected outbreaks of the vaccine-preventable disease pertussis in recent years. Pertussis among adolescents may represent a substantial health burden and source of transmission to young children and infants. Our objective was to measure completion of recommended and preferred age-related TDaP vaccination in a cohort of commercially insured children.
We identified children aged 10 between the years 7/1/2002 and 6/30/2005 in a large US administrative claims database. We followed one cohort with continuous medical and pharmacy enrollment for 3 years prior to their 13th birthday (cohort 1), and another group with continuous enrollment through to their 19th birthday (cohort 2). We used Current Procedural Terminology (CPT) code 90715 to identify the occurrence of TDaP vaccination during the preferred window of age 11-12, as well as prior to age 19.
We identified a total of 272,229 children in cohort 1 and 125,970 children in cohort 2. Both cohorts had similar proportions of males and females (51% male). The majority of children were from the South, followed by the North Central region of the US, and more than 80% were from an urban residence. Among children in cohort 1, a total of 55,259 (20.3%) completed the TDaP booster prior to their 13th birthday, at an average age of 11.6. Among children in cohort 2, a total of 24,509 (19.5%) completed prior to age 13, and 70,899 (56.3%) completed prior to age 19 at a mean age of 13.8. Vaccine completion was most common at age 12 (21.5%), followed by age 14 (16.2%) and age 13 (15.9%). The majority (73%) of vaccine administrations occurred in the years 2006-2009.
Low rates of TDaP booster vaccination were observed during late childhood and adolescence in a population of commercially insured children in the US. Failure to follow ACIP recommendations may be related to recent unexpected outbreaks, and should continue to be monitored for possible remediation.
H. Varker, None
L. Palmer, GSK: Consultant , Research support