Physician Attitudes and Preferences About Combined Tdap Vaccines for Adolescents

Child Health Evaluation and Research Unit, Division of General Pediatrics, General R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan 48109-0456, USA.
American Journal of Preventive Medicine (Impact Factor: 4.53). 08/2006; 31(2):176-80. DOI: 10.1016/j.amepre.2006.03.023
Source: PubMed


Combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) boosters for adolescents are a new strategy to prevent pertussis. We examined the current practices of pediatricians and family physicians regarding adolescent tetanus and diphtheria toxoids (Td) vaccine immunizations and providers' potential adherence to new Tdap recommendations for adolescents.
Using a brief survey instrument sent to a random sample of pediatricians and family physicians in January 2005, we assessed providers' patterns of administration of Td boosters, barriers to Td boosters, and agreement that pertussis vaccination of adolescents is warranted. Results of analyses in February 2005 were presented to the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) to inform its deliberations regarding adolescent Tdap vaccination.
The overall response rate was 56% (57% pediatricians, 55% family physicians). Among 297 respondents (154 pediatricians, 143 family physicians) eligible for analysis because they provide care to adolescents, pediatricians (77%) were significantly more likely than family physicians (51%, p < 0.0001) to report that they routinely administer Td at preventive care visits for adolescents aged 11 to 12 years, but otherwise the specialties were similar in their Td practices. Forty-four percent of respondents cited infrequency of adolescent visits as a barrier to Td immunization. Slightly more than half the sample (57%) agreed or strongly agreed that pertussis is serious enough to warrant replacing Td with Tdap for adolescents; pediatricians (70%) were significantly more likely than family physicians (42%, p < 0.0001) to endorse this statement.
This national survey indicates moderate willingness, stronger among pediatricians than among family physicians, to support recommendations for Tdap among adolescents. In February 2006, CDC released recommendations that adolescents aged 11 to 18 (preferred age 11 to 12) receive a single dose of Tdap in place of Td if they have not already received the latter. Near-term efforts regarding Tdap recommendations must address providers' concerns about infrequent routine visits for adolescents and convince more physicians of the importance of pertussis booster immunization during adolescence.

Download full-text


Available from: Karen R Broder, Jan 13, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Office of Strategic and International Minerals of the Minerals Management Service, U.S. Department of the Interior, has been established to develop a leasing program for nonenergy minerals in the Outer Continental Shelf/ Exclusive Economic Zone (OCS/EEZ) of the United States. The OCS/EEZ nonenergy minerals leasing program is an important element of the Administration's national strategic and critical minerals policy to decrease America's vulnerability to mineral supply disruptions and political pressures from other nations possessing those resources. This paper discusses the heavy and growing dependence of the U.S. on mineral imports, describes the major Executive actions that have been taken to support development of the nonenergy minerals leasing program, briefly reviews the status of global marine mining operations, and discusses the goals and status of the OCS/EEZ leasing program.
    No preview · Conference Paper · Dec 1985
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Advances in technology have led to development of new vaccines for adolescents, but these vaccines will be added to a crowded schedule of recommended adolescent clinical preventive services. We reviewed adolescent clinical preventive health care guidelines and patterns of adolescent clinical preventive service delivery and assessed how new adolescent vaccines might affect health care visits and the delivery of other clinical preventive services. Our analysis suggests that new adolescent immunization recommendations are likely to improve adolescent health, both as a "needle" and a "hook." As a needle, the immunization will enhance an adolescent's health by preventing vaccine-preventable diseases during adolescence and adulthood. It also will likely be a hook to bring adolescents (and their parents) into the clinic for adolescent health care visits, during which other clinical preventive services can be provided. We also speculate that new adolescent immunization recommendations might increase the proportion and quality of other clinical preventive services delivered during health care visits. The factor most likely to diminish the positive influence of immunizations on delivery of other clinical preventive services is the additional visit time required for vaccine counseling and administration. Immunizations may "crowd out" delivery of other clinical preventive services during visits or reduce the quality of the clinical preventive service delivery. Complementary strategies to mitigate these effects might include prioritizing clinical preventive services with a strong evidence base for effectiveness, spreading clinical preventive services out over several visits, and withholding selected clinical preventive services during a visit if the prevention activity is effectively covered at the community level. Studies are needed to evaluate the effect of new immunizations on adolescent preventive health care visits, delivery of clinical preventive services, and health outcomes.
    Preview · Article · Feb 2008 · PEDIATRICS
  • [Show abstract] [Hide abstract]
    ABSTRACT: National guidelines have historically varied for influenza vaccination of children with asthma, depending on asthma severity. This study aims to explore perspectives of primary care physicians regarding influenza vaccination practices for children with persistent versus intermittent asthma. A cross-sectional survey was mailed to general pediatricians (n = 300) and family physicians (n = 300) in primary care offices in Michigan in 2006. The main outcome measures included physicians' influenza vaccination recommendations and reasons for nonadministration of influenza vaccine to children with asthma for the 2005-2006 influenza season. Ninety-six percent of respondents (N = 320) reported routinely recommending influenza vaccination for children with persistent asthma; fewer (82%) reported routinely recommending influenza vaccination for those with intermittent asthma. The adjusted odds of recommending influenza vaccination for intermittent asthma patients was significantly higher among pediatricians versus family physicians (adjusted odds ratio 3.49, 95% confidence interval, 1.68-7.22), controlling for other practice characteristics. Regardless of specialty, physicians with more than 25 asthma patients were more likely than those with fewer asthma patients to routinely recommend influenza vaccination. Physicians who do not routinely recommend influenza vaccination to children with intermittent asthma were more likely to cite overlooking discussion of influenza vaccine during the visit (50% vs 13%, respectively; P < .0001) as a reason for lack of vaccination. Influenza vaccination practices of primary care physicians reflect the inconsistencies historically found in national recommendations. Further research is warranted to determine whether the recent clarification of recommendations of the National Asthma Education and Prevention Program (NAEPP) to remove distinctions by asthma severity is associated with a reduction in missed opportunities to vaccinate.
    No preview · Article · Sep 2008 · Ambulatory Pediatrics
Show more