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Clin Ther. 2010 Aug;32(8):1468-78. doi: 10.1016/j.clinthera.2010.07.016.

Receipt of tetanus-containing vaccinations among adolescents aged 13 to 17 years in the United States: National Immunization Survey-Teen 2007.

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Centers for Disease Control and Prevention, Atlanta, Georgia, USA.



Tetanus-diphtheria-acellular pertussis (Tdap) was licensed in the United States in 2005 to be given in place of tetanus-diphtheria (Td) for single use in adolescents.


This analysis was conducted to determine vaccination coverage with Td and Tdap among adolescents in the United States aged 13 to 17 years and to characterize adolescents who had not received a tetanus-containing booster vaccine.


Data were analyzed from the National Immunization Survey-Teen (NIS-Teen) 2007, a random-digit-dialing telephone survey that is weighted to be nationally representative of adolescents aged 13 to 17 years. Parents gave verbal consent so that vaccination providers could be contacted to obtain the adolescents' immunization histories. Weighted coverage of Td and Tdap vaccines was estimated with bivariate analysis from returned vaccination data from the providers' records. A multivariable analysis was conducted to determine factors independently associated with nonreceipt of tetanus-containing vaccines. Missed opportunities for vaccination with Td or Tdap were determined from documented vaccination visits for other vaccines.


Out of 69,289 households screened, 6572 had an eligible adolescent aged 13 to 17 years and 5486 (83.5%) completed the household interview. Among 5474 adolescents who met the age criterion and completed a household interview, consent to contact providers was obtained for 4114 (75.2%). A total of 2947 adolescents (53.7% of those with completed household interviews) had immunization histories returned from providers for verification. In 2007, a total of 2149 adolescents (weighted percentage, 72.3%) aged 13 to 17 years had received at least one tetanus booster since age 10 years; Tdap coverage was 30.4%. The mean (SE) age at Td or Tdap receipt was 13.04 (0.04) years (range, 10.00-17.84 years); the median age was 12.86 years. More than half (59.4%) of sampled adolescents had received their booster dose on or after January 1, 2005; among those vaccinated in 2007, 89.1% received Tdap as their booster dose. Factors associated with nonreceipt of Td or Tdap included geographic location and not having a provider-reported well-child visit at ages 11 to 12 years.


Almost three quarters of adolescents aged 13 to 17 years included in the NIS-Teen 2007 received a tetanus-containing vaccine, and almost one third received Tdap. Among adolescents who received a tetanus-containing vaccine in 2007, a total of 89.1% received the new Tdap vaccine in place of Td, as recommended. Adolescents not receiving Td or Tdap may face barriers to accessing health care. Research is needed to identify evidence-based strategies to improve vaccination coverage among adolescents.

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