Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Concomitant Vaccination at Time of Tdap in Teens

Vaccine; ePub 2018 Sep 25; Doke, et al

Among teens receiving their school-required tetanus, diphtheria, and acellular pertussis (Tdap) booster, half did not receive a human papillomavirus (HPV) or meningococcal (MenACWY) vaccine, and most remained unvaccinated 2-3 years later. Researchers used Medicaid and commercial claims data in Kansas from 2013, 2014, and 2015 to identify HPV and MenACWY vaccinations among 6th and 7th graders receiving a Tdap booster. They found:

  • Of 6th and 7th graders in Kansas receiving their required Tdap booster, 53-82% failed to receive a concomitant HPV vaccine and 36-47% failed to receive a concomitant MenACWY vaccine from 2013 to 2015.
  • Most of the tennis remained unvaccinated 2-3 years later.
  • Concomitant vaccination rates varied by geographic location.
  • Female gender, younger age, and Medicaid insurance were positively associated with concomitant vaccination.
  • These vaccines may be more accepted if offered with school-required Tdap vaccines.


Doke K, Fitzgerald SA, Barral RL, Griffin P, Ellerbeck EF. Concomitant HPV and MenACWY vaccination among sixth and seventh graders receiving Tdap. [Published online ahead of print September 25, 2018]. Vaccine. doi:10.1016/j.vaccine.2018.08.076.


This is an interesting study. It clearly shows that we could do a better job with vaccinating adolescents. It is often difficult to get an adolescent patient into the office. Clinicians should seize this opportunity and catch them up on all vaccines they might need. The question of why they were not vaccinated needs to be answered. Were they offered these vaccines and the parents turned them down or more likely, did physicians not offer the vaccines? We should not be afraid to give multiple different vaccines at 1 visit, and our HPV counseling should be more about cancer prevention than sexually transmitted infections. —John Russell, MD