Physician attitudes and preferences about combined Tdap vaccines for adolescents

Combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) boosters for adolescents are a new strategy to prevent pertussis. We examined the current practices of pediatricians and family physicians regarding adolescent tetanus and diphtheria toxoids (Td) vaccine immunizations and providers' potential adherence to new Tdap recommendations for adolescents.

Using a brief survey instrument sent to a random sample of pediatricians and family physicians in January 2005, we assessed providers' patterns of administration of Td boosters, barriers to Td boosters, and agreement that pertussis vaccination of adolescents is warranted. Results of analyses in February 2005 were presented to the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) to inform its deliberations regarding adolescent Tdap vaccination.

The overall response rate was 56% (57% pediatricians, 55% family physicians). Among 297 respondents (154 pediatricians, 143 family physicians) eligible for analysis because they provide care to adolescents, pediatricians (77%) were significantly more likely than family physicians (51%, p < 0.0001) to report that they routinely administer Td at preventive care visits for adolescents aged 11 to 12 years, but otherwise the specialties were similar in their Td practices. Forty-four percent of respondents cited infrequency of adolescent visits as a barrier to Td immunization. Slightly more than half the sample (57%) agreed or strongly agreed that pertussis is serious enough to warrant replacing Td with Tdap for adolescents; pediatricians (70%) were significantly more likely than family physicians (42%, p < 0.0001) to endorse this statement.

This national survey indicates moderate willingness, stronger among pediatricians than among family physicians, to support recommendations for Tdap among adolescents. In February 2006, CDC released recommendations that adolescents aged 11 to 18 (preferred age 11 to 12) receive a single dose of Tdap in place of Td if they have not already received the latter. Near-term efforts regarding Tdap recommendations must address providers' concerns about infrequent routine visits for adolescents and convince more physicians of the importance of pertussis booster immunization during adolescence.