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Giving teens a shot

While Mass. child immunization rates are strong, getting older kids vaccinated is a struggle

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By Deborah Kotz
Globe Staff / September 19, 2011

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Like many parents of teenage girls, Joyce Alla and her husband decided to delay getting their daughter Cassidy vaccinated against the human papillomavirus (HPV) - when she reached the recommended age of 11 - until last month, well past her 14th birthday.

“I was surprised that her pediatrician never really pushed it that much,’’ recalled Alla, a 48-year-old recruiter from Marblehead. “So I checked with my gynecologist and other doctors and across the board it was recommended’’ for protection against the sexually transmitted virus that causes cervical cancer.

Soon after getting the shot, marketed as Gardasil or Cervarix, however, Cassidy fainted and shook like she was having a small seizure - both temporary side effects that occur in a small percentage of those vaccinated. “She was out for 30 to 40 seconds and felt very sick to her stomach for about an hour or so afterward,’’ said Alla. Although Cassidy is fine now, her mother said her daughter is reluctant to get the final two doses. “It’s an experience she does not want to repeat.’’

While Massachusetts enjoys childhood vaccination rates that are among the highest in the nation, there’s room for improvement in teen immunizations. Only two-thirds of girls ages 13-to-17 have received one dose of the HPV vaccine, and just 47 percent have received all three doses that are required to give them full protection from the virus known to infect most unvaccinated, sexually active women.

Those already low rates could dip further if parents get scared off after watching a “Today’’ show interview last week with Republican presidential contender Michele Bachmann, who said she met a mother who told her “that her little daughter took that vaccine, that injection, and she suffered from mental retardation thereafter.’’ The American Academy of Pediatrics said there was “no scientific validity’’ to the statement linking the HPV vaccine to brain damage.

Other vaccines have better track records: 83 percent of teens have been immunized against meningococcal meningitis, and 75 percent have received their second chicken pox booster, according to 2010 data from the US Centers for Disease Control and Prevention. That’s not bad, but it’s still lower than state vaccination rates for infants and toddlers, which hover above 90 percent.

“As teenagers grow up, they don’t see their primary care doctors as frequently,’’ explained Kevin Cranston, director of the state Department of Public Health’s Bureau of Infectious Disease. And guidelines change almost every year, he said. Thus, teens who skip well visits can easily fall behind on the latest recommendations.

And that’s alarming to public health officials given that certain vaccines given in infancy wear off by adolescence, while others protect against illnesses that pose particular risk to teens and young adults like HPV and bacterial meningitis. Parents of teens - who may not have gotten any shots themselves in adolescence - may not be aware that their kids need at least one shot or more every year. The latest CDC guidelines for older children include a yearly flu shot, a booster for tetanus, diptheria, and acellular pertussis (Tdap) at age 11 or 12, two shots against meningococcal meningitis spaced five years apart, and three doses of HPV vaccine for girls and possibly soon for boys.

The state has taken steps to address the lower teen rates, Cranston said, by mandating that seventh graders and college freshmen be up to date on certain immunizations. As of this month, for example, both age groups were required to have received two doses of the varicella vaccine against chicken pox, two doses of the measles-mumps-rubella (MMR) vaccine, and one dose of Tdap before being allowed in class. The state requires preschoolers to have one dose of MMR and one dose of chicken pox, but two shots are needed to get full immunization; protection against tetanus, diptheria, and pertussis wears off after a certain number of years, requiring a booster.

“Mandates for school entry are potent motivators for immunization,’’ said Dr. Carole Allen, director of pediatrics for Harvard Vanguard Medical Associates. “We expect to see increased rates of adolescent vaccines with the new state requirements.’’

For example, 82 percent of Massachusetts teens had received Tdap as of last year, according to the latest CDC data, which could rise to well above 90 percent if other mandated vaccines are any indication. Some 96 percent of state teens have their full set of hepatitis B shots because they couldn’t enter seventh grade without them.

The state public health department, however, doesn’t mandate the meningococcal meningitis vaccine for high schoolers, though it is recommended by the CDC for 11-year-olds, with the recent addition of a booster shot at age 16. Massachusetts teens aren’t required to get the shot until they enter college, a high-risk time for contracting the disease.

Thus, many parents put off the vaccine until after high school, which astounds Frankie Milley, who lost her 18-year-old son to that form of bacterial meningitis in 1998 right before he started college. At that time, the two vaccines used today, Menactra and Menveo, weren’t available.

“People think this is a college disease, but it doesn’t stop at the dorm-room door,’’ said Milley who, soon after her son’s death, started a meningitis education and support group near her Houston home. “Even one child lost is too many,’’ she said of the disease, which strikes 2,600 Americans every year, killing about 260.

Horror stories like Milley’s motivate some parents to insist their teens get vaccinated on time. “More commonly, parents ask me about the meningitis vaccine,’’ said Dr. Claire McCarthy, a pediatrician at Children’s Hospital Boston. “They want to make sure their teens have that one,’’ after hearing about deaths or limb amputations in young people who were healthy days earlier.

The HPV vaccine, though, is a tougher sell. “Parents have a lot of phobia when it comes to this shot,’’ McCarthy said. Allen concurs, adding that parents worry that getting their teens vaccinated against a sexually transmitted disease is akin to giving them a condom and telling them to go have sex.

“They’ll tell me, well, we’re not there yet,’’ said Allen. “I try to convince them that this is a preventive vaccine that has to be given before their kid has sex.’’

Allen remembers having the same discussions with parents in the late 1980s about the hepatitis B vaccine, given to protect against a sexually transmitted, blood-borne virus that causes liver cancer. “It was a bit of a hard sell, too, since parents figured their kids weren’t at high risk - having sex or injecting drugs - so why did they need this?’’

The vaccine is now given routinely at birth to prevent transmission of the virus from infected mothers to infants, so most parents no longer associate it with providing protection against an STD. (Massachusetts toddlers now must have three doses of the vaccine before they can enter preschool, while older unvaccinated kids must get fully immunized before seventh grade.)

One other major barrier to vaccinations? Teens themselves. “When a 4- or 5-year-old says I don’t want a shot, a parent says you’re getting it, and that’s that,’’ said Allen. “But some parents may not want to wage a bigger battle with teens, especially if they, themselves, are already on the fence about a particular vaccine, like HPV. They’d rather just put it off for another year.’’

Alla, whose daughter had the bad reaction to Gardasil, hasn’t yet convinced her daughter to acquiesce to a second shot. “It’s up in the air right now because of her bad experience,’’ she said. “It will take some long discussions with her about why it’s important to have the full set of shots, but I’m hoping to convince her.’’

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.

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