Tuesday, March 29, 2011
Background: One dose of the meningococcal conjugate vaccine (MCV4) was recommended for routine use in 11-12 year olds in 2005. Recommendations for a booster dose were added in October 2010.
Objectives: Among a U.S. sample of pediatricians (Peds) and family medicine (FM) physicians describe: 1) recommendation and administration practices for MCV4, 2) preferences regarding MCV4 administration, and 3) attitudes and characteristics associated with deferring vaccine recommendation to >12 years old.
Methods: A mail and internet survey in a nationally representative sample of physicians conducted between 12/09 and 3/10, prior to recommendations for a booster dose. A multivariable analysis was conducted to examine factors associated with deferring MCV4 vaccination to >12 years.
Results: Response rates were 88% (Peds 367/419) and 63% (FM 268/423). 83% of Peds and 45% of FM reported strongly recommending MCV4 for 11-12 year olds (p = 0.001); 95% of Peds and 73% of FM reported routinely administering MCV4 to all eligible 11-18 year olds (p = 0.001). 68% of Peds and 35% of FM preferred to administer MCV4 to 11-12 year olds; 27% of Peds and 50% of FM prefer to administer MCV4 at older ages (p<0.0001). Both Peds (24%) and FM (32%) were concerned about waning immunity (p = 0.3). Compared to those who strongly recommend at 11-12, physicians who do not regularly stock MCV4, FM, and physicians concerned about waning immunity were more likely to defer their recommendation, while physicians practicing in the Northeast and those with more Latino patients were less likely to defer.
Conclusions:Most Peds and FM strongly recommend and routinely administer MCV4, but many choose to give it to patients older than 11-12 years old. New recommendations for a booster may encourage those concerned about waning immunity to recommend the first dose at 11-12 years or may reinforce a preference to defer recommendation to later ages.