Vaccines are one of the most important and crucial aspects for the long-term health of babies and young children. Except for a tiny, and irresponsible, minority of individuals who are opposed to vaccinations, greater than 95% of children are fully vaccinated for most vaccine preventable diseases by kindergarten. Unfortunately, a recently published article in Pediatrics provided evidence that teens are not keeping up with vaccinations that are critical to avoid infections from serious, and deadly, diseases. The study examines how vaccination rates have changed over the three year study period, and some of the reasons why they are not getting vaccinated.
The researchers used data from the three National Immunization Surveys of Teens from 2008 through 2010. They focused on three vaccines: Tdap (or Td), MCV4 and HPV. Tdap is the older child/adult version of the DTaP vaccine for immunization against tetanus, diphtheria and whooping cough (pertussis). The Td vaccine, just for tetanus and diphtheria, was also included in this group. MCV4 is the vaccine for meningococcal disease, a dangerous infection caused by the Neisseria meningitidis bacteria. The HPV vaccine is used to prevent human papillomavirus, which is the cause of about 70% of cervical cancers and most HPV-induced anal, vulvar, vaginal, and penile cancers.
The study examined the survey to determine reasons for parents not having their teens’ vaccinations updated or, in the case of the HPV vaccine, not getting the shot at all.
Here are some of the key results:
- For Tdap/Td, the vaccination rate for teens is just over 80%, with little variance from 2008 through 2010.
- For MCV4, the vaccination rate has increased slightly from an abysmal 31.2% in 2008 to a slightly less abysmal 37.4% in 2010.
- For HPV, the vaccination rate has increased from an irresponsible 16.2% in 2008 to a slightly better 24.8% in 2010.
Among teens who were not up to date on the Tdap/Td or MCV4, the reasons parents gave most frequently for not vaccinating was “not recommended,” “not needed or not necessary,” or “lack of knowledge.” What’s particularly interesting is that around 35% of respondents stated that they did not get the MCV4 vaccine because it was not recommended.
The reasons for not vaccinating teens for HPV varied from the Tdap and MCV4 responses. Parents, in addition to mentioning that the vaccine was “not recommended” or “not necessary,” also listed “safety concerns/side effects” and “not sexually active”. The “safety concerns” reasoning rose from 4.5% in 2008 to 16.4% in 2010. This is probably as a result of vaccine denialist invented claims about the safety of the vaccine. Just over 9% of parents thought that the HPV vaccine is unnecessary because their teen wouldn’t be sexually active.
Although the vaccine uptake level for Tdap/Td is relatively high at around 80%, teens (and adults) should be current for this vaccine throughout their life. Tetanus is a serious and deadly disease that is a danger to anyone at any age. Whooping cough, though not as serious to teens and adults as it is to babies, can be debilitating for adults and teens. In addition, adults and teens can be a vector for spreading pertussis to unvaccinated babies (who generally can’t get the first DTaP vaccination until around 6 months old).
The incredibly low MCV4 vaccine uptake is very troubling. When the meningococcal bacteria enters the bloodstream, a condition called Meningococcal septicemia, it can kill an infected child or teen within a few hours. And the disease spreads quickly in settings where children and teens are close together, such as college dormitories, classrooms and similar areas. In fact, Tennessee has proposed legislation that would make proof of MCV4 immunization against meningococcal disease prior to enrollment to be a condition of entering the university. I’m also surprised at the results where 35% of parents said that the vaccine “wasn’t recommended.” I think that physicians should make this vaccine a priority for school aged children, especially those going to university.
But the most troubling results was regarding the HPV vaccine, which can prevent a wide variety of cancers. These are real, serious, and deadly cancers that can be easily treated. The excuse that “my child is not sexually active” is not relevant, since early vaccinations seem to have better results. Moreover, the presumption that many parents have, that their children won’t be sexually active until way in the future, is probably not reasonable. And even if those girls and boys aren’t sexually active, their future partners might have been.
And the excuse of “safety concerns” which tripled from 2008 to 2010, is based on nothing more than a dedicated effort by the vaccine denialists to push a meme that somehow the vaccine is extremely harmful. In a recently published, well designed multi center study involving 190,000 vaccinated females, which included substantial and detailed post-vaccination follow-up, the authors concluded that, “this study did not detect evidence of new safety concerns among females 9 to 26 years of age secondary to vaccination with HPV4.” There really is no safety issue.
HPV vaccination has the potential of eliminating 60-70% of cervical cancers, a disease that kills 9 in every 100,000 women. There is just no excuse imaginable to not save lives through the HPV vaccine. But I’ve said this before.
In a recent New York Times article, reporter KJ Dell’Antonia urged changes in how we provide information about the HPV vaccine to parents:
…the increasing rates of HPV vaccine refusal suggest that widespread vaccination will require more than marketing campaigns. Medical professionals need to look for ways to tell a better story to parents and teens about HPV, vaccination and cancer. Perhaps more important, they need to find ways to incorporate HPV vaccination into the lives of busy families.
Every teen should have Tdap, MCV4 and, especially, HPV as part of routine immunizations. Those vaccines prevent deadly, life altering diseases. This shouldn’t even be a point of discussion.
- Darden PM, Thomson DM, Roberts JR, Hale JJ, Pope C, Naifeh M, Jacobson RM. Reasons for Not Vaccinating Adolescents: National Immunization Survey of Teens, 2008–2010. Pediatrics. 2013;131:645-651. doi: 10.1542/peds.2012-2384. PubMed PMID: .
- Klein NP, Hansen J, Chao C, Velicer C, Emery M, Slezak J, Lewis N, Deosaransingh K, Sy L, Ackerson B, Cheetham TC, Liaw KL, Takhar H, Jacobsen SJ. Safety of quadrivalent human papillomavirus vaccine administered routinely to females. Arch Pediatr Adolesc Med. 2012 Dec;166(12):1140-8. doi: 10.1001/archpediatrics.2012.1451. PubMed PMID: 23027469.
- Leval A, Herweijer E, Ploner A, Eloranta S, Fridman Simard J, Dillner J, Young C, Netterlid E, Sparén P, Arnheim-Dahlström L.Quadrivalent Human Papillomavirus Vaccine Effectiveness: A Swedish National Cohort Study. J Natl Cancer Inst. 2013 Mar 13. [Epub ahead of print] PubMed PMID: 23486550.
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