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Factors Associated With Receipt of Two Doses of Varicella Vaccine Among Adolescents in the United States

Kawai, Kosuke ScD*; O’Brien, Megan A. PhD, MPH; Conway, James H. MD, FAAP; Marshall, Gary S. MD§; Kuter, Barbara J. PhD, MPH

The Pediatric Infectious Disease Journal: May 2013 - Volume 32 - Issue 5 - p 538–542
doi: 10.1097/INF.0b013e31827f4c3c
Vaccine Reports

Background: In 2006, routine two-dose varicella vaccination for all children was recommended, including a second dose catch-up program for older children and adolescents. Recent studies have shown that a second dose of the vaccine provides incremental protection against varicella disease.

Methods: This study is a cross-sectional analysis of data collected in the National Immunization Survey–Teen 2010 combined with publicly available data related to state immunization requirements. Bivariate and multivariable logistic regression analyses were performed to examine individual-level and state-level factors associated with receipt of two doses of varicella vaccine among 10,542 adolescents 13 to 17 years of age with no history of varicella.

Results: Overall, 58.1% of adolescents without any history of varicella had received two doses of varicella vaccine. Coverage varied widely among states, ranging from 19.7% in South Dakota to 85.3% in Rhode Island. In the multivariable model, receipt of two doses of varicella vaccine was significantly associated with younger age, higher maternal education level, private health insurance, more frequent health care visits, receipt of both quadrivalent meningococcal conjugate and tetanus, diphtheria, and acellular pertussis vaccinations, and residing in a state with two-dose policies for middle school entry. Vaccines for Children program–eligible adolescents were less likely to have received two doses.

Conclusion: Two-dose varicella vaccination coverage remained low among adolescents in 2010, despite the universal recommendation. Programs that are aimed specifically at Vaccines for Children program–eligible adolescents, state policies requiring two doses for middle school entry, and broad education and implementation of the adolescent vaccination platform may help to improve varicella vaccination coverage.

From the *School of Pharmacy, Temple University, Philadelphia; Merck, West Point, PA; Department of Pediatrics, Division of Pediatric Infectious Disease, School of Medicine and Public Health, University of Wisconsin, Madison, WI; and §Division of Pediatric Infectious Diseases, University of Louisville School of Medicine, Louisville, KY.

Accepted for publication November 27, 2012.

K.K., M.A.O., J.H.C., G.S.M. and B.J.K. are responsible for the work described in this article. All authors were involved in at least one of the following: conception; design; acquisition; analysis; statistical analysis; interpretation of data and drafting the article or revising the article for important intellectual content. All authors provided final approval of the version to be published. M.A.O. and B.J.K. are employees of Merck Sharp & Dohme, a subsidiary of Merck, and own stock in the Company. K.K. is a postdoctoral fellow funded by Merck. G.S.M. has been a principal investigator on research contracts from GlaxoSmithKline, Merck, Novartis and Sanofi-Pasteur, and has received honoraria from those companies as well as Pfizer for service as a consultant. J.H.C. has been a principal investigator on research contracts from Sanofi-Pasteur, has received program support from the Merck Foundation and has received honoraria for scientific advising from Merck and Novartis. The findings and conclusions in this article are those of the authors and not necessarily of the National Center for Health Statistics. The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Kosuke Kawai, ScD, Temple University, School of Pharmacy, 3307 N. Broad Street, Philadelphia, PA 19140. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.