With several new vaccines known to be a safe and effective way to protect against a number of adolescent diseases, why are many teens still not getting the recommended vaccinations? New research out of the University of Oklahoma Health Sciences Center provides important answers.
"Since 2005, three new vaccines recommended for adolescents have been licensed and approved for use, but we are not achieving our national goals," said study author Dr. Paul Darden of the Department of Pediatrics, OU College of Medicine.
The three vaccines are Tdap (tetanus toxoid, diptheria toxoid, and acellular pertussis vaccine), a vaccine for meningitis — MCV4 (quadrivalent meningococcal conjugate vaccine), and the vaccine for HPV (human papilloma virus).
The research analyzed data from the 2008-2010 National Immunization Survey of Teens by the Centers for Disease Control and Prevention. The goal was to determine why parents did not have their teens up to date on recommended vaccinations, and how these reasons have changed over the years. "One of the U.S. Department of Health and Human Services’ Healthy People 2020 goals is to attain vaccination rates of 90 percent, but the reality falls short of that goal," Darden said.
Some increases in vaccination rates were noted. For instance,Tdap vaccination rates improved from 72.2 percent in 2008 to 81.2 percent in 2010 and MCV4 vaccination rates over the same period rose from 41.8 percent to 62.7 percent. However, the percentage of adolescent females immunized with the HPV vaccine remains much lower, climbing from 17.9 percent to only 32 percent during the same three years. "While we’re seeing increases, those increases are uneven with some vaccines more widely accepted than others," Darden said, adding the low rate of HPV immunization (which is now recommended for adolescent boys too) is especially concerning.
"HPV is a vaccine that prevents cervical cancer, a serious health condition in women. So it’s worrisome that adolescents are not getting the HPV vaccine," he said.
To find out why adolescents are not receiving these vaccinations, even though physicians commonly recommend them, Darden and six fellow researchers analyzed parent survey data.
"Our goal was to understand how adolescents and their parents make decisions around adolescent vaccines, to gain better insights into parents’ concerns and to discover how doctors should best approach adolescents and their parents to help them make these decisions," Darden said.
Researchers learned that when it comes to the Tdap and MCV4 vaccines, parents generally gave several reasons for not having their teenaged children immunized. These include:
• The vaccination was "not recommended" by their physician.
• They believed it was "not necessary" to have the vaccination.
• They didn’t know enough about the vaccine.
In the case of the HPV vaccine, parents gave the same reasons for failing to vaccinate their teens, but they added some additional reasons as well. One of those was that their child was not yet sexually active and therefore did not need the vaccine. Darden said that reveals that some parents are laboring under a misapprehension about the vaccine.
"Getting the infection is related to having sex," he said. "The problem is, of course, once a person is having sex, they may become infected with HPV and the vaccine is only effective when given before infection. This vaccine is most effective if given prior to initiation of sexual activity."
Another reason parents gave for not having their child receive the HPV vaccine related to concerns about the vaccine’s safety and potential side effects. The study found that concern had increased almost four-fold in three years.
"In addition, despite their doctors increasingly recommending the HPV vaccine, parents’ intent to not vaccinate for HPV also increased," Darden said.
In 2008, 39.8 percent of parents were intent on not vaccinating their teens for HPV. In 2010, that number rose to 43.9.
Currently, in Oklahoma, only the Tdap vaccination is required for entry into middle school. The meningitis and HPV vaccines, though recommended, are not mandatory.
Darden said that despite the clear health benefits of these vaccines, it is unlikely the HPV vaccine would be made mandatory. Darden and his colleagues believe the study points to the importance of better educating families and health care providers about the safety and effectiveness of vaccines. Researchers said such a campaign might also directly target teens with education through social media.
The study, "Reasons for Not Vaccinating Adolescents: National Survey of Teens, 2008-2010," was published online and also will appear in the April issue of Pediatrics.