Vaccination opportunities often are missed in adolescents with chronic medical conditions, said Annika M. Hofstetter, MD, PhD, of Columbia University, New York, and her associates.

The National Health Interview Survey on Disability in 1994-1995 estimated that chronic conditions of any type affected 15%-18% of U.S. children and adolescents. The Advisory Committee on Immunization Practices recommends that all adolescents, whether or not they have chronic medical condition, be vaccinated with human papillomavirus (HPV), Tdap, meningococcal, and flu vaccines.

In this retrospective study in four pediatric primary care clinics serving a low-income minority population in New York, 3,989 adolescents aged 11-17 years who had one or more visits between Aug. 1, 2011, and Jun. 30, 2013, were evaluated. Of these adolescents, 27% had chronic medical conditions (CMCs), most commonly asthma (77%), mental retardation (7%), epilepsy (7%), autism spectrum disorder (4%), and congenital heart disease (4%).

Fewer adolescents with CMCs had received one more doses of HPV (81%), than did those without CMCs (85%; P less than .01). Fewer adolescents with epilepsy (63%), mental retardation (58%), cerebral palsy (54%), and autism spectrum disorder (46%) had started HPV vaccination, compared with those without each of these conditions (84%; all comparisons, P less than .001). No differences were seen for asthma or congenital heart disease, the investigators said.

More adolescents with CMCs had gotten their flu shot than did those without CMCs during the 2011-2012 season (67% vs. 50%; P less than .001) or during the 2012-2013 season (74% vs. 65%; P less than .001). More adolescents with asthma got their flu shot than did those without asthma during the 2011-2012 season (69% vs. 51%; P less than .001) or during the 2012-2013 season (74% vs. 65%; P less than .001). No differences were seen for the other common CMCs.

Nonetheless, the mean number of missed opportunities was significantly higher among unvaccinated adolescents with CMCs, compared with those without CMCs, for the first HPV vaccination, meningococcal vaccination, and influenza vaccination in both seasons measured (P less than .001 for all).

“Missed opportunities for the third HPV vaccine dose or Tdap did not differ by CMC status,” Dr. Hofstetter and her associates said.

Read more in the American Journal of Preventive Medicine ( 2017 Nov;53[5]:680-8 ).


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