title: National and State-Specific Td and Tdap Vaccination of Adult Populations.
abstract: BACKGROUND
  The Advisory Committee on Immunization Practices recommends a single dose of tetanus, diphtheria, and acellular pertussis vaccine (Tdap) for adults followed by tetanus and diphtheria toxoids (Td) booster doses every 10 years thereafter. This study assessed recent Td and Tdap vaccination among adult populations.
  
  
  METHODS
  The 2013 Behavioral Risk Factor Surveillance System data were analyzed in 2015 to assess Td and Tdap vaccination coverage among adults at national and state levels. Multivariable logistic regression and predictive marginal models were performed to identify factors independently associated with vaccination.
  
  
  RESULTS
  Overall, national vaccination coverage among adults aged ≥18 years for Td was 57.5% and for Tdap was 28.9%. Among states, Td vaccination coverage ranged from 47.8% in Nevada to 73.1% in Minnesota, and Tdap coverage ranged from 17.7% in Mississippi to 47.6% in Minnesota. Characteristics independently associated with an increased likelihood of Tdap vaccination among adults aged ≥18 years were younger age; being female; American Indian/Alaska Native race; being never married; higher education; not being in the workforce; reporting a household income ≥$75,000; living in the West or Midwest U.S.; reporting excellent, very good, good, or fair health; having health insurance; having a healthcare provider; having a routine checkup in the previous year; receipt of influenza vaccination in the previous year; and having ever received pneumococcal vaccination.
  
  
  CONCLUSIONS
  By 2013, Td and Tdap vaccination coverage were 57.5% and 28.9%, respectively. Coverage varied by state. Implementation of evidence-based programs is needed to improve Td and Tdap vaccination levels among adult populations.
authors.affiliation: Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia. Electronic address: lhp8@cdc.gov.
authors.forename: Peng-Jun
authors.initials: PJ
authors.lastname: Lu
authors.affiliation: Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia.
authors.forename: Alissa
authors.initials: A
authors.lastname: O'Halloran
authors.affiliation: Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia.
authors.forename: Helen
authors.initials: H
authors.lastname: Ding
authors.affiliation: Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Liang
authors.affiliation: Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia.
authors.forename: Walter W
authors.initials: WW
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D022422:Diphtheria-Tetanus Vaccine / Q000008:administration & dosage*; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D022422:Diphtheria-Tetanus Vaccine; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines