Objectives: Pertussis is endemic in the US despite recommendations for routine vaccination. Recent evidence suggests waning immunity among adolescents is one catalyst for the spread of disease. Although 89% of adolescents received Td/Tdap vaccine in 2012, little is known about coverage of pertussis containing vaccination specifically, or if Tdap is administered at age-appropriate times (age 10 to 12 years). We sought to evaluate coverage and age-appropriate Tdap receipt among adolescents in the US.
Methods: Participant reported demographics and immunization provider reported vaccinations were analyzed from the 2010 and 2011 National Immunization Survey-Teen. Among children aged 13 to 17 years, we assessed the proportion who received at least one dose of Tdap (coverage) and the age at administration (age-appropriate receipt). Among those who received Tdap, we estimated multivariable logistic regression models to identify factors associated with age-appropriate vaccination.
Results: Between 2010 and 2011, the proportion of adolescents who received at least one Tdap vaccination between the ages of 10 to 17 increased from 64.3% to 73.8%, respectively (p<0.0001). Among those who received Tdap, 61.6% in 2010 to 71.3% in 2011 received age-appropriate vaccination (p<0.0001). Among those who delayed Tdap vaccination, the mean age of vaccination was approximately 14 years in both 2010 and 2011. Among adolescents who received Tdap, having a mother with more than 12 years of education (OR=1.2, p<0.0001) increased the likelihood of age-appropriate vaccination. Whereas, not having an adolescent well-child visit (OR=0.46, p<0.0001), having multiple vaccination providers (OR=0.85, p<0.0001), and having a gap in health insurance coverage (OR=0.72, p=0.0004) significantly decreased the likelihood of age-appropriate vaccination.
Conclusions: Coverage and age-appropriate receipt of Tdap among adolescents is suboptimal, yet improving. Overall, two-thirds of adolescents received Tdap, of which 29% to 38% received it after the recommended age, on average leaving two years during which pertussis immunity may have waned.
