Reducing Missed Opportunities to Vaccinate Preteens Eligible for the Tennessee Vaccines for Children Program

BACKGROUND:  Adolescent immunization rates among Tennessee teens are below target. Centers for Disease Control and Prevention (CDC) publications in 2013 have highlighted that preteen immunization rates could achieve Healthy People 2020 targets if clinics drastically reduce missed opportunities in this age group. All children entering 7th grade in a Tennessee school must have one dose of tetanus-diphtheria-pertussis (Tdap) vaccine. The first dose of quadrivalent meningococcal conjugate vaccine (MenACWY) and the 3-dose series of HPV vaccine are also recommended. This Tdap requirement provides the ideal opportunity to administer all preteen vaccines to students. These vaccines are offered at no cost to eligible children through Tennessee’s Vaccines for Children (VFC) program. The Tennessee Immunization Program (TIP) began conducting a monthly evaluation of preteen vaccines given at all immunization visits of VFC-eligible children aged 11 through 13 years who received a Tdap, a MenACWY, and/or an HPV vaccine at a local health department (LHD). Visits are categorized as 1-Star (one of the three vaccines given), 2-Star (two of the three vaccines given), or 3-Star (all three given). Regional health departments began receiving evaluation reports in April 2013. Our objective was to determine the impact the report has made on reducing missed opportunities for vaccination of VFC-eligible preteens in our LHDs during the busiest back-to-school immunization months.

METHODS:  Tennessee’s busiest preteen immunization months were determined. A chi-square test of independence was performed comparing the busiest months in 2012 (before the report) to the same months in 2013 (after the report) to examine the relationship between receipt of the report and proportion of 3-Star preteen immunization visits.

RESULTS:  The busiest preteen immunization months in Tennessee were July, August, and September: 59.1% of all immunization visits by VFC-eligible preteens occurred during this period in 2012 and 64.5% in 2013. Tennessee saw a statically significant increase in the proportion of 3-Star visits in 2013 compared to the same months in 2012 before the report was generated. In 2012, 1,980 of 11,102 (17.8%) preteen immunization visits were 3-Star visits, compared to 2,538 of 10,688 (23.7%) in 2013: a 33.1% increase in 3-Star visits.

CONCLUSIONS:  In the absence of other significant changes in policy or practice, we believe tracking and reporting 3-Star visits to clinics has contributed to the rise in VFC-eligible preteens receiving all 3 vaccines during busy back-to-school immunization months and a corresponding decline in missed opportunities for vaccination of preteens in our LHDs.