VANCOUVER, B.C. — Your recommendation may be the deciding factor in whether adolescents get vaccinated, and this appears to be especially true in adolescent girls, according to Dr. Paul M. Darden.
“The girls who got recommended HPV [human papillomavirus vaccine] had much higher rates of every vaccine than those who did not and in fact did much better than boys just in general,” Dr. Darden said at the annual meeting of the Pediatric Academic Societies.
This was the finding in a nationwide, cross-sectional study that assessed predictors of immunization among 36,284 adolescents 12-17 years old. The 2007 National Survey of Children’s Health used random-digit dialing to contact and poll parents by telephone about their children’s immunization status, especially the tetanus-diphtheria (Td) vaccine, the tetanus-diphtheria-pertussis (Tdap) vaccine, the meningococcal conjugate vaccine (MCV4), and HPV vaccine.
Specifically, relative to girls whose physicians had not recommended the HPV vaccine, those whose physicians had were more likely to have received that vaccine (49% vs 4%, P less than .01), but also more likely to have received the Td or Tdap vaccine (91% vs 77%, P less than .01) and the MCV4 vaccine (52% vs 30%, P less than .01).
“I think this just points out that a physician’s or health care provider’s recommendation has a huge influence on who gets a vaccine,” he commented. “They usually come to you because they trust you, and if you recommend something, they are much more likely to do it.”
An analysis of the independent predictors of up-to-date status showed the predictors “were actually the opposite of what we typically see for childhood immunizations,” said Dr. Darden, professor of pediatrics at the University of Oklahoma in Oklahoma City.
The proportion of adolescents current on both Td/Tdap and MCV4 was highest among those with Medicaid insurance, at 38%, vs. 33% among those with no insurance and 31% among those with private insurance (P less than .01).
In addition, the proportion up to date on both vaccines was highest among adolescents whose mothers had not completed high school, at 39%, vs. 33% among those whose mothers had schooling beyond this level and 31% among those whose mothers had stopped at high school (P = .02).
Speculating on the reasons for these findings, Dr. Darden noted that the costs of vaccines are covered for adolescents with Medicaid, whereas adolescents with other types of insurance or none may face substantial out-of-pocket costs.
And when it comes to the influence of maternal education, higher education has been associated with greater reluctance to vaccinate. However, he proposed that there are likely additional factors at play. “A 6–percentage point difference seems too big for just vaccine reluctance,” he said.