The State of the ImmUnion in Maine: Tweens, Teens and Vaccines

Posted on August 15th, 2016

Maine has made great strides in stepping up the state’s vaccination rates for infants, babies and young children to at or above national levels. But when it comes to adolescents, we still have some catching up to do. At Vax Maine Kids, we’re working hard to make sure parents know how to protect their children from several serious illnesses that can strike during the teen years.


By Gabriel Civiello, MD in collaboration with VaxMaineKids

Healthcare providers all across Maine are celebrating the recent rebound in vaccination rates for our youngest children. In fact, our childhood immunization rates rank among the highest in the country. According to the 2014 National Immunization Survey, over 85% of Maine toddlers are up-to-date on their recommended vaccinations, and kindergarten non-medical exemption requests fell to 3.9% during the 2014-2015 school year.

The trends aren’t quite as positive for Maine’s preteens and teens, however. Nationwide, as children grow into their preteen and teen years under immunization becomes much more common—and Maine is no exception. In fact, Maine’s vaccination rates for the tetanus, diphtheria, and pertussis (Tdap) vaccine and the meningococcal vaccine are below the national average and the lowest in New England. Following the national trend, human papillomavirus (HPV) vaccine rates are at least half of the rates of the other adolescent vaccines.

Why are immunization rates lower for Maine teens?

  • Preteens and teens have lower attendance at well child visits. If they aren’t seeing their healthcare provider on a regular basis, they and their parents aren’t being reminded of the CDC-recommended vaccination schedule (and the importance of sticking to it). When teens see a provider solely for sick visits or emergencies, vaccinations may not come up in the discussion as often as they should.
  • Critical vaccines for teens are not required for school attendance in Maine. Teens are allowed to attend school without getting the meningococcal vaccine and the HPV vaccine, and Maine is one of only three states that doesn’t require the Tdap vaccine. By leaving these vaccines out of school requirements, parents may get the impression that their children don’t need them.
  • The HPV vaccine remains as poorly understood and under-utilized (by families and providers), in Maine as it is elsewhere in the country. We aren’t communicating the importance of safely vaccinating adolescents against the common cancers caused by the HPV virus before they become sexually active as well as we should.

There is good news for Maine teens in the NIS data, however. Our HPV vaccination rates are higher than the national average. This tells us that Maine parents and providers want to protect our children all the way into adulthood, and that HPV vaccine rates will likely improve with better communication about the vaccine.

Which diseases threaten Maine teens, and which vaccines can protect them?

There are four vaccines that are routinely recommended for all preteens between 11 and 12 years of age. Teens also need a booster dose of meningococcal vaccine at age 16, and teens may also need additional vaccines based on risk factors, travel, or if they missed previous doses. The vaccines routinely recommended for preteen and teen girls and boys are:

  • Quadrivalent meningococcal conjugate vaccine, which protects against four types of meningococcal disease. Meningococcal disease is caused by bacteria and is a leading cause of bacterial meningitis – a serious infection around the brain and spinal cord – in teens and young adults. Two doses are needed for full protection.
  • HPV vaccine, which protects against several types of HPV. HPV can cause cancers of the cervix, vulva and vagina in females and cancers of the penis in males. In both females and males, HPV infection can also lead to head/neck cancers, anal cancer and genital warts. Three doses are needed for full protection.
  • Tdap vaccine, which is a booster shot against tetanus, diphtheria and pertussis. Pertussis (whooping cough) can keep kids out of school and activities for weeks. Infants, for whom pertussis can be deadly, are often infected by an older sibling or adult. One dose of Tdap is needed (with boosters for tetanus and diphtheria (Td) needed every 10 years throughout adulthood).
  • Flu vaccine, because even healthy kids can get influenza, and it can be serious. All preteens and teens, should get the flu vaccine every year.

What is Maine doing to raise awareness of and access to the immunizations Maine teens need?

  • MaineHealth, the state’s largest healthcare system has a Child Health Program dedicated to improving childhood and adolescent immunization rates. The program partners with other organizations on a childhood immunizations task force and works with its hospitals, practices, and providers to implement quality improvement initiatives that promote well child visits and on-time immunizations.
  • The Maine Vaccine Board, the Maine Immunization Program, and payers work together to implement Maine’s universal childhood vaccine purchase program, so that CDC-recommended vaccines are available for children under age 19 at little or no cost to all Maine families.
  • MaineHealth is working with local community groups to form a workgroup focused on improving the health and wellbeing of adolescents in the greater Portland area.
  • Several organizations (Maine Chapter of the American Cancer Society, Maine Cancer Foundation, MaineHealth, Maine Immunization Coalition, Maine Quality Counts, Maine Immunization Program, Maine Chapter of American Academy of Pediatrics, Maine Primary Care Association, Maine Area Health Education Center at the University of New England) are working to improve provider education and communication about adolescent vaccines and improve adolescent immunization rates.
  • Policy initiatives are being developed to improve vaccine requirements for school attendance.
  • Vax Maine Kids is working to provide education and information for Maine families on adolescent immunizations and their importance.

So what’s the State of the ImmUnion in Maine for preteens and teens? It could be better, and it will be! If we work together to improve awareness of and access to the vaccinations preteens and teens need, we can help elevate teenage vaccination rates in Maine.

DrGabeCivielloDr. Gabriel Civiello is a pediatrician at Franklin Health Pediatrics in Farmington, ME. He received his medical degree from Dartmouth Medical School where he received the Saul Blatman Award for Excellence in Maternal and Child Health. He completed his residency and was chief resident at Maine Medical Center.  Dr. Civiello also serves as the MaineHealth clinical advisor for the Child Health and Raising Readers programs and is the father of four children.

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