Receipt of Recommended Adolescent Vaccines Among Youth With Special Health Care Needs

Abstract

We examined vaccination coverage among youth with special health care needs (YSHCN) using data from parents of adolescents (11-17 years) who responded to a statewide survey in 2010-2012 (n = 2156). Using a validated screening tool, we identified 29% of adolescents as YSHCN. Weighted multivariable logistic regression assessed associations between special health care needs and receipt of tetanus booster, meningococcal, and human papillomavirus (HPV) vaccines. Only 12% of youth had received all 3 vaccines, with greater coverage for individual vaccines (tetanus booster, 91%; meningococcal, 32%; HPV, 26%). YSHCN had greater odds of HPV vaccination than other youth (33% vs 23%, OR = 1.70, 95% CI = 1.16-2.50) but vaccination coverage was similar ( P ≥ .05) for other outcomes. In subgroup analyses, HPV vaccination also differed depending on the number and type of special health care needs identified. Findings highlight low levels of vaccination overall and missed opportunities to administer recommended vaccines among all youth, including YSHCN.

Oral HPV prevalence and HPV vaccination among special needs population in the US

“…Females aged 9–26 years and males aged 9–21 years with special needs had a vaccination rate of 32% (vs 37%) in females and 16% (vs 21%) in males. Previous studies have also indicated the lower vaccination rates; however, these studies were limited to small sample size and geography [[38], [39], [40], [41]].…”

Vaccination in people with disability: a review

“…Some studies used specific diagnostic groups such as: those with inborn errors of metabolism, 16 ASD, 17 intellectual disability, [18][19][20] cerebral palsy, 3 and spina bifida. 21 Other studies used broad definitions of disability such as: children with special health-care needs (CSHCN), [22][23][24] women with physical disabilities, 25 youth attending specialist schools, 26,27 children with neurological diseases, neurodevelopmental disorders, chronic neurological deficits or developmental disabilities, [28][29][30][31][32] and females with mental and physical limitations. 33 The issue with broad definitions is illustrated by two American studies which found no difference between immunization uptake for people with disabilities as compared to their typically developing peers.…”

“…The majority of the studies measured immunization uptake, with 18/28 (64%) calculating the uptake of one or more vaccinations in a population of people with disability. 3,16,[18][19][20][21][22][23][26][27][28][29][30][31][32][33][34]37 The recognition of inequities in immunization services for vulnerable populations relies on the existence of disaggregate data. 38 Aggregate immunization uptake figures do not generally identify small populations at risk for under-immunization 38 and therefore lower immunization coverage in people with disabilities can be missed.…”

“…The studies suggested a likelihood of missed immunizations in people with disabilities, with 14/18 (78%) of the coverage studies finding that people with disabilities have lower rates of immunization uptake across a range of different vaccines then their typically developing peers. 3,16,[18][19][20][21][22][23][26][27][28]30,31,33 Some studies measured immunization coverage indirectly. Three studies did not specifically explore a cohort of people with disabilities but instead found that disability predicted incomplete vaccination, including in girls in non-mainstream schools, 39 children with congenital malformations, 40 and Trisomy 21 and Autism Spectrum Disorders (ASD).…”

The intersectional importance of race/ethnicity, disability, and age in flu vaccine uptake for U.S. adults

“…For example, in cross-sectional analyses using secondary data, researchers found that people with mobility impairments affecting their ability to walk, climb stairs, or stand for long periods of time were as likely to receive a flu vaccine as their peers ( Iezzoni et al, 2021 ). Adolescents with special healthcare needs (i.e., having an activity impairment, need for prescription medications or specialized therapies, or presence of conditions requiring ongoing treatment or counseling) had similar odds of receiving meningococcal and tetanus vaccines and greater odds of HPV vaccinations compared to their peers ( McRee, Maslow, & Reiter, 2017 ). Similarly, people with various functional impairments that limited their participation in basic self-care tasks like bathing and dressing (i.e., activities of daily living), or other daily life activities like shopping and home management duties (i.e., instrumental activities of daily living), were more likely to receive a flu vaccine compared to their non-disabled peers ( Diab & Johnston, 2004 ; Khan et al, 2018 ; Pharr & Bungum, 2012 ).…”