title: Low proportion of high school senior athletes receiving recommended immunizations.
abstract: BACKGROUND
  The preparticipation physical evaluation (PPE) often serves as the only preventive health care visit for athletes, but immunization status is not uniformly addressed in such visits. Thus, athletes may not be receiving recommended immunizations. Our aim was to determine the proportion of high school senior athletes who received all recommended immunizations.
  
  
  OBJECTIVE
  Our hypothesis was that females would be less likely than males to receive all recommended immunizations given suboptimal human papillomavirus (HPV) vaccine uptake.
  
  
  METHODS
  We conducted a cross-sectional survey evaluation of the immunization status of high school senior athletes in Davidson County, TN. The primary composite outcome was receipt of recommended immunizations for tetanus, meningococcal, and seasonal influenza. For females, the primary outcome also included completion of the HPV series.
  
  
  RESULTS
  A total of 162 participants, 104 males and 58 females, were included. More males than females received all recommended immunizations (15.4% vs 3.5%; P = 0.02). When HPV immunization was excluded from the composite outcome, there was no difference in the proportion of males and females who received all recommended immunizations (15.4% vs 15.5%; P = 0.98). The odds of receiving all recommended immunizations was 0.14 (95% CI, 0.03-0.72) for females compared with males when adjusted for covariates. Athletes seen at retail-based clinics for their PPE were less likely to receive all recommended immunizations compared with athletes seen in primary care (OR, 0.13; 95% CI, 0.02-0.69).
  
  
  CONCLUSIONS
  Only 1 in 6 high school senior athletes received the recommended tetanus, meningococcal, and influenza immunizations. A lower proportion of females, only 1 in 28, received all recommended immunizations due to the HPV series. Policy changes requiring a review of immunizations at the PPE would benefit many high school athletes.
authors.affiliation: Section of Internal Medicine and Pediatrics, Department of General Internal Medicine and Public Health. ashley.karpinos@vanderbilt.edu.
authors.forename: Ashley Rowatt
authors.initials: AR
authors.lastname: Karpinos
authors.forename: Katherine H
authors.initials: KH
authors.lastname: Rizzone
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Cribbs
authors.forename: Christianne L
authors.initials: CL
authors.lastname: Roumie
mesh_terms: D000293:Adolescent; D056352:Athletes; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D010808:Physical Examination; D012574:Schools; D011795:Surveys and Questionnaires; D013714:Tennessee; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*