Compliance with recommended immunizations among adolescents is not the best, but what may be more startling is the fact that most parents don't even realize that their child is missing vaccines.
A new report from the University of Michigan C.S. Mott Children's Hospital, Ann Arbor, found that many parents are unaware of what vaccines their teenagers need and when, and that they rely on their pediatricians for guidance in sorting out a confusing set of guidelines.
Sarah Clark, MPH, co-director of the C.S. Mott Children's Hospital National Poll on Children's Health, led the report and says she hopes the poll highlights to pediatricians how important they are in the vaccination process, even as children age into adolescence.
"You are the driving force behind adolescent vaccination. Pediatricians facilitate early childhood vaccination through the timing of visits; parents don’t have much responsibility for learning which vaccines are due at certain ages. Parents have grown accustomed to this paradigm, and many assume it continues into adolescence," Clark says.
The report found that parents are not keeping up with adolescent vaccines, particularly for vaccines that require more than 1 dose. The poll investigated the vaccination habits of teenagers aged 13 to 17 years by asking parents about their understanding of adolescent vaccine recommendations.
The poll data, published in July, revealed that 79% of parents believed that their child "definitely" had received all their vaccines, and 14% report that their teenager "probably" received all their vaccines. Ultimately, many parents weren't sure when their child was due for his or her next vaccine, with 19% believing their teenager was due for a vaccine in the coming year; 26% in a year or more; 19% assuming their teenager was finished receiving vaccines; and 36% admitting they didn't know anything about the need for additional vaccines for their adolescent.
Parents cited their child's physician's office as the primary source for their knowledge about vaccines. Forty-four percent of the parents polled said they knew about a particular vaccine because their child's physician scheduled an appointment for vaccination; 40% reported receiving a recommendation from a doctor or nurse during an unrelated visit; and 11% reported receiving a vaccine reminder from the physician's office. Another 10% of parents were reminded of vaccines after their child's school sent a notice home; 1% because of a health plan reminder; and 0.3% after a notice from the public health department. Ten percent of parents reported that they weren't even sure how to find out when or if a vaccine was due, according to the report.
The poll highlights the fact that many parents overestimate their teenager's vaccination status, according to Clark.
Part of the challenge of enforcing adolescent vaccinations is the low level of well visits at this age. When teenagers go for several years without a well visit, there is limited opportunity for the caregivers to discuss vaccination status, which may contribute to parental beliefs that no additional vaccines are needed, the report notes.
"This can be exacerbated by hard deadlines for camp or sports physicals, or even by school vaccination requirements," Clark says. "Parents look for the quickest way to meet the requirement, rather than the most comprehensive care. Pediatricians should learn the details of these types of requirements for their local schools, and then use outreach strategies to encourage the scheduling of comprehensive well visits in advance of the deadlines."
Pediatricians would also be well served to consider holding a certain number of adolescent well visit appointments open in the weeks before those deadlines occur to accommodate families who learn about the requirements at the last minute, Clark says. Mailed or e-mailed reminders and/or phone calls may also help.
Education is key as well, as many parents are overwhelmed by the frequent changes to vaccine recommendations.
"Knowledge gaps about adolescent vaccine recommendations play a role, as over half of parents in this poll did not know their teenager was due for additional vaccines," C.S. Mott Children's Hospital states in a report on the poll. "This lack of awareness may reflect the evolution of the US immunization schedule."
Since 2006, the Centers for Disease Control and Prevention (CDC) has recommended that 11- to 12-year-olds receive pertussis and meningitis vaccines and start the HPV vaccine series. Later, recommendations for a second dose of meningococcal vaccine for all teenagers was added, along with the option to receive a new vaccination against meningitis B. Add to that recommendations for flu vaccinations, and parents can be left with a lot of confusion.
"Many states have vaccination requirements at middle school entry, which compel parents to bring children for vaccination. In contrast, few states have added requirements for vaccines recommended in the later teenaged years," the report states.
Changing practice methods among pediatricians as children age also may play a role, according to the report. "It is clear from this Mott Poll that parents view their teenager’s healthcare provider as the main source of information about when their [child] is due for another vaccine. Nearly half of parents believe the provider will schedule an appointment when the teenager’s next vaccine is due. This is common during the early childhood period, when practices schedule the child’s next well-child visit to coincide with the timing of vaccine doses," the report notes. "However, as children get older and well-child visits occur less frequently, both parents and practices find it difficult to schedule a year or more in advance. Thus, parents may perceive that a lack of a scheduled appointment means that no vaccines are due."
To help clear the confusion, the CDC recently revised its vaccine schedule format to focus on age 16 as a way to ensure that teenagers receive the second dose of the meningococcal vaccine on time, the report notes, as well as to catch up on any other outstanding vaccinations. "This new schedule may help providers put more of a focus on the unique needs of older teenagers, including scheduling well-child visits at age 16 to address immunizations and other aspects of preventive care," the report states.
Clark says there are many other ways pediatricians can help spread the message for adolescent vaccinations.
"There are a number of key messages that would help to facilitate teenager vaccination. First is the message that vaccination is a lifelong preventive service; pediatricians can set this up by adding an anticipatory guidance statement during kindergarten checkups that tells parents to expect another set of vaccines at middle school entry and beyond," Clark says. "The second message is that teenager vaccination is important; pediatricians can support this message by being more vocal and visible in promoting annual flu vaccination for patients of all ages. The third message is that teenager vaccination goes beyond school requirements; vaccines to prevent cancer caused by HPV and vaccines to prevent meningitis represent important scientific advances to protect teenagers and young adults. Parents need to make sure teenagers receive all recommended vaccines."