National Survey Assessing Pediatricians Adoption of New Tdap (Adacel/Boostrix) and MCV4 (Menactra) Vaccines for Adolescents

Background : A number of new vaccines for adolescents were approved by the ACIP in 2005 and were subsequently endorsed by the AAP. Pediatricians' adoption of these new recommendations has not been studied.

Objective : Assess pediatricians' adoption of Tdap (Adacel or Boostrix) and the quadravalent meningococcal (Menactra, MCV4) vaccinations for adolescents.

Design/Methods : A national random sample, mailed Periodic Survey of American Academy of Pediatrics U.S. members, in 2006 (N=1620; response=49%). Analysis was limited to 585 pediatricians who offer immunizations in their practice. Questions assessed attitudes and practices toward Tdap and MCV4. Bivariate and multivariate analysis examined associations between pediatricians' demographic and practice characteristics and their reported practice of offering Tdap and MCV4 to all patients vs. to some or none.

Results : Overall 90% of pediatricians currently offer Tdap but only 66% offer MCV4 to all of their adolescent patients. Pediatricians are more likely to offer Tdap to all patients if they have a majority of private pay patients (95% vs. 87% with majority publicly insured patients, p<.01), are in small or large group practices (95%, 96% vs. 83% solo/2-physician and 84% hospital/clinic practice, p<.01), practice in suburban (96% vs. 88% inner city vs. 81% urban vs. 85% rural, p=.001) or are themselves white (91% vs. 85% non-white, p<.05). Pediatricians are more likely to recommend MCV4 to all patients if they have more private pay patients (68% vs. 59%, p<.01), are in small or large group or hospital/clinic practices (70%, 68%, 69% vs. 48% for solo/2-physician practices, p<.001), and practice in suburban area (74% vs. 61% inner city, 59% other urban, or 59% rural, p<.01). The most common reasons given for not providing MCV4 include lack of available vaccine (67%) and problems with patient reimbursement from insurance companies (26%).

Conclusions : Ninety percent of pediatricians offer Tdap but only two-thirds offer MCV4 to their adolescent patients. Problems with availability was the most commonly identified barrier to MCV4 adoption.