Physician Adoption of Adolescent Tdap Recommendations

Learning Objectives for this Presentation:
By the end of the presentation, participants will be able to understand physician practices regarding uptake of ACIP recommendations for Tdap vaccination of adolescents.

Background:
Pertussis rates have risen dramatically, with adolescents comprising the highest risk age group. In February 2006 the ACIP issued recommendations for universal vaccination of adolescents with Tdap.

Objectives:
To determine physician practices regarding uptake of Tdap vaccination of adolescents.

Methods:
In January 2007, a cross-sectional, mailed survey was administered to a national sample of 725 family physicians (FP) and 725 pediatricians (PD). Chi-square analyses were used to determine bivariate associations between variables. Multivariable logistic regression was used to identify independent predictors of routinely recommending Tdap to adolescents.

Results:
Overall response rate was 60% (53% FP, 68% PD). Most respondents indicated that they routinely recommend Tdap to adolescents aged 11-12 years (87%) and 13-18 years (89%). In bivariate analyses, pediatrician specialty, specialty society membership, stocking Tdap in the office, participation in VFC/state vaccine program, and prior experience diagnosing adolescents with pertussis were associated with routinely recommending Tdap to adolescents. In multivariable models adjusting for these factors simultaneously, only pediatrician specialty (OR 4.8, 95% CI 2.5-9.3) and stocking Tdap in the office (OR 14.5, 95% CI 7.5-28.5) remained significantly associated with routine recommendation. For patients who had already received a Td booster, 48% of respondents indicated 5 years as the shortest acceptable interval between Td and Tdap, 44% would wait at least 2 years, and 5% indicated they would give Tdap at an interval <2 years under special conditions (e.g., newborn in the household). More family physicians than pediatricians would wait at least 5 years. Lack of adolescent visits was commonly cited as a major barrier to Tdap administration.

Conclusions:
There is widespread uptake of ACIP recommendations for universal vaccination of adolescents with Tdap, though this is significantly more common among pediatricians.