National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years – United States, 2019
Three vaccines are recommended by the
NIS-Teen is a random-digit-dial telephone survey·· conducted annually to monitor vaccination coverage among adolescents aged 13-17 years in the 50 states, the
Data were weighted and analyzed to account for the complex sampling design.··· T-tests were used to assess vaccination coverage differences between sociodemographic subgroups. P-values <0.05 were considered statistically significant. All analyses were conducted using SAS-callable SUDAAN (version 11;
National Vaccination Coverage
In 2019, 71.5% of adolescents aged 13-17 years had received >1 dose of HPV vaccine, and 54.2% had completed the HPV vaccination series and were considered HPV UTD (Table 1, Figure). Increases from 2018 in >1 dose HPV vaccine coverage and HPV UTD status were observed for females and for males. Coverage with >1 dose of MenACWY increased by 2.3 percentage points to 88.9%. Coverage with >2 MenACWY doses among adolescents aged 17 years was 53.7%, similar to that in 2018 (50.8%). Coverage with >1 dose of MenB among adolescents aged 17 years increased from 17.2% in 2018 to 21.8% in 2019. Coverage with >1 dose of Tdap remained stable and high (90.2%). Coverage exceeded 90% for >2 doses measles, mumps, and rubella vaccine (MMR), >3 doses of hepatitis В vaccine, and >1 and >2 doses of varicella vaccine among adolescents without a history of varicella disease.!"!"!
Vaccination Coverage by Selected Characteristics
In 2019, compared with adolescents living in MSA principal cities, coverage with >1 dose of HPV vaccine among those living in non-MSA areas was 9.6 percentage points lower, the percentage who were HPV UTD was 9.8 percentage points lower, and coverage with >1 dose of MenACWY was 5.1 percentage points lower. These disparities were only observed among adolescents living at or above the poverty level (Table 2). Coverage with all vaccine doses recommended for adolescents varied by jurisdiction, with differences ranging from 15 percentage points for >1 Tdap dose to 48.4 percentage points for being HPV UTD (Supplementary Table, https:// stacks.cdc.gov/view/cdc/91797). Differences were observed in vaccination coverage by race and ethnicity and by health insurance status.^
Trends in HPV Vaccination by Birth Cohort
HPV vaccination initiation by age 13 years increased an average of 5.3 percentage points for each consecutive birth year, from 19.9% among adolescents born in 1998 to 62.6% among those born in 2006 (Supplementary Figure 2, https:// stacks.cdc.gov/view/cdc/91796). Being HPV UTD by age 13 years increased an average of 3.4 percentage points for each consecutive birth year, from 8.0% among adolescents born in 1998 to 35.5% among those born in 2006.
Discussion
In 2019, coverage with HPV vaccine and with MenACWY improved compared with coverage in 2018. Improvements in >1 dose HPV and HPV UTD vaccination coverage were observed among females and males. In addition, more teens began HPV vaccination on time (by age 13 years) in 2019, suggesting that more parents are making the decision to protect their teens against HPV-associated cancers. Efforts from federal, state, and other stakeholders to prioritize HPV vaccination among adolescents, and reducing the number of recommended HPV vaccine doses from a 3-dose to a 2-dose series, (2) likely contributed to these improvements. Coverage with >1 dose of MenACWY increased to 88.9%; coverage with >2 doses remained low at 53.7%, indicating that continued efforts are needed to improve receipt of the booster dose.
Despite progress in adolescent HPV vaccination and MenACWY coverage, disparities remain; all adolescents are not equally protected against vaccine-preventable diseases. As in previous years, compared with adolescents living in MSA principal cities, HPV UTD status and coverage with >1 dose each of HPV vaccine and MenACWY continue to be lower among adolescents in non-MSA areas (3). However, these geographic disparities were present only for adolescents at or above the poverty level in 2019. This finding is consistent with another study that found socioeconomic status to be a moderating factor in the association between HPV vaccination and MSA (4). The lack of an MSA disparity among adolescents below the poverty level might reflect the access that low-income adolescents have to the VFC program····; previous studies have reported higher HPV vaccination coverage rates among adolescents living below the poverty level (5,6). Reasons for the MSA disparity among higher socioeconomic status adolescents are less clear but might be an indicator of lower vaccine confidence. More work is needed to understand the relationship between socioeconomic status and geographic disparities and the barriers that might be contributing to such differences.
The findings in this report are subject to at least two limitations. First, the CASRO response rate to NIS-Teen was 19.7%, and only 44.0% of households with completed interviews had adequate provider data. A portion of the questionnaires sent to vaccination provider(s) to request the adolescent's vaccination history were mailed in early 2020. A lower response rate was observed for those requests, likely because of the effect of the COVID-19 pandemic on health care provider operations.%% Second, even with adjustments for household and provider nonresponse, landline-only households, and phoneless households, a bias in the estimates might remain.
The COVID-19 pandemic has the potential to offset historically high vaccination coverage with Tdap and MenACWY and to reverse gains made in HPV vaccination coverage. Orders for adolescent vaccines have decreased among VFC providers during the pandemic. A recent analysis using VFC provider ordering data showed a decline in vaccine orders for several VFC-funded noninfluenza childhood vaccines since midMarch when COVID-19 was declared a national emergency (7).
All authors have completed and submitted the
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