2018 Vaccination Coverage Rates Among Adolescents in the United States

In 2018, the rate of adolescents with vaccination coverage for meningococcal and human papillomavirus (HPV) infections increased and rates remained high for tetanus and reduced diphtheria toxoids and acellular pertussis (Tdap) vaccinations, according to a study published in Morbidity and Mortality Weekly Report.

To assess adherence to the HPV, meningitis, tetanus, and Tdap vaccination recommendations for adolescents aged 13 to 17 years in the United States, the Centers for Disease Control and Preventions analyzed data from the 2018 National Immunization Survey-Teen cell phone interview survey. Parents and guardians provided sociodemographic characteristics, contact information, and gave consent for the retrieval of the adolescent’s vaccination history from healthcare providers. For analyses, adolescents were grouped according to the location of residence and health insurance status, either private, Medicaid, other insurance, or uninsured.

Of the 18,700 adolescents included in this study, 52% were boys. Vaccination rates for the HPV series increased to 51.1% from 48.6%; further, 68.1% had received ≥1 dose of the HPV vaccine. These increases were attributed to a 4.4% increase in vaccination of boys. Meningitis ACWY coverage, with > 1 dose of the quadrivalent conjugate vaccine, increased 1.5% to 86.6%. Of adolescents aged 17 years, coverage with > 2 doses of this vaccine increased to 50.8% (an increase of 6.5%) and 17.2% also received > 1 dose of serogroup B meningococcal vaccine. No significant increases were noted for coverage against hepatitis B, varicella, or measles, mumps, rubella.

In reference to location of residence, adolescents who lived in metropolitan areas were more likely to have received >1 dose of the vaccines for meningitis, HPV, tetanus, hepatitis B, as well as the measles, mumps, rubella. The rate of up-to-date coverage for the HPV vaccine was 40.7% in the nonmetropolitan areas compared with 56.1% in the metropolitan area principal cities. The rate of ≥2 booster doses of quadrivalent meningococcal conjugate vaccine was 34.6% in the nonmetropolitan areas compared with 54.3% in the metropolitan area principal cities.

Adolescents with private health insurance demonstrated the highest rates of coverage with Tdap (90.1%), meningitis ACWY (87.6%), >2 doses of MMR (92.8%), and hepatitis B (93.0%) vaccines; those with Medicaid had the highest rate of up-to-date coverage for the HPV vaccine 55.7%. Uninsured adolescents demonstrated the lowest rate of coverage with all vaccines.

The most powerful tool for encouraging the HPV vaccine was provider recommendation. For example, when physicians offered parents recommendations about the HPV vaccine, the vaccination rate was 74.7% compared with 46.7% when a recommendation was not received. However, the study authors also noted that in the cases where such recommendations were provided, approximately 25% of parents accepted the vaccine.

Limitations of this study included a low survey response rate, receiving inadequate provider data, the potential for bias as a result of the cellular phone-based survey, low statistical power because of a small sample size, and the possibility for recall bias over provider recommendation.

The researchers concluded that while it is reassuring to see an increase among boys receiving the HPV vaccine, the rate among girls remains steady, which is a cause for concern as approximately 32,100 cases of preventable HPV-related cancers occur per year in the US.. Further, “[P]roviding parents and guardians with information and strong, high-quality recommendations are valuable tools for improving HPV vaccination and preventing HPV infection and diseases caused by HPV, including cancers.”

Reference

Walker TY, Elam-Evans LD, Yankey D, et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years – United States, 2018. MMWR Morb Mortal Wkly Rep. 2019;68(33):718-723.