Vaccination rates in teens improve, according to 2016 NIS-Teen data

Vaccination coverage in teens has continued to improve, but there is still room for improvement, especially in increasing human papillomavirus (HPV) vaccination coverage, according to a recent report from researchers at the Centers for Disease Control & Prevention (CDC), published in Morbidity and Mortality Weekly Report (MMWR).

“Adolescent vaccination coverage continues to improve, but opportunity remains to increase HPV-associated cancer prevention. A better understanding of reasons for differences in HPV vaccination by metropolitan statistical area (MSA) might identify appropriate strategies to improve coverage. Protection against vaccine-preventable diseases will be increased if clinicians consistently recommend and simultaneously administer tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal conjugate (MenACWY), and HPV vaccines at age 11–12 years,” wrote Tanya Y. Walker, MPH, Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control & Prevention (CDC), Atlanta, GA, and colleagues.

These researchers from the CDC estimated adolescent vaccination coverage in the United States using data from the 2016 National Immunization Survey-Teen (NIS-Teen), an annual survey in which data on vaccines received by adolescents aged 13-17 years in the 50 states, District of Columbia, selected local areas, and territories is collected. The survey is conducted with parents and guardians of eligible adolescents identified via a random-digit-dialed sample of landline and cellular telephone numbers.

They included 20,475 adolescents (9,661 females, 10,814 males) who were aged 13 to 17 years old, who participated in NIS-Teen.

In 2016, HPV vaccination coverage of ≥ 1 dose was 60.4% (65.1% females; 56.0% males). A full 43.4% were updated on the recommended HPV vaccination series (49.5% females; 37.5% males). Between 2015 and 2016, overall HPV vaccination coverage increased for ≥ 1 dose by 4.3 percentage points (6.2 males), for ≥ 2 doses by 3.8 percentage points (2.8 females; 4.6 males), and for ≥ 3 doses by 2.2. percentage points (3.4 males).

Between 2015 and 2016, coverage with ≥ 1 tetanus, diphtheria, and acellular pertussis vaccine (Tdap) dose increased by 1.6 percentage points, to 88.0%. In adolescents with no history of varicella disease, coverage with ≥ 2 varicella vaccine doses increased by 2.5 percentage points, to 85.6%. During the same period coverage with ≥ 2 MenACWY doses increased by 5.8 percentage points, to 39.1% among those aged 17 years.

Researchers also found that coverage with Tdap and MenACWY was similar for each age group. In teens aged 17 years, HVP coverage was higher overall, and by sex, with the exception of up-do-date HPV status among males, which was highest among males aged 16 years. In adolescents aged 13 years, HPV vaccination coverage was similar in females and males, and among those aged 17, it was 14 to 23 percentage points higher among females.

Poverty status did not affect coverage with Tdap, MenACWY, MMR vaccine, hepatitis B vaccine, and ≥ 2 doses of varicella vaccine. HPV coverage, however, was higher in adolescents who lived below the federal poverty level compared with those living at or above it (overall, 12.9 percentage points, and 8.4 percentage points higher for ≥ 1 dose coverage and up-to-date status, respectively).

Coverage with HPV was 13 to 17 percentage points lower for adolescents living in non-MSA areas, and 5 to 8 percentage points lower in those living in MSA non-central city areas, compared with those in MSA central cities.

Among teens living in non-MSA areas, coverage with greater than or equal to tone MenACWY dose and greater than or equal to two varicella disease were 9.5 and 4.5 percentage points lower, respectively, compared with those living in MSA central cities.

Researchers found that adolescents living in non-MSA areas were more likely to have all reported vaccination providers from public facilities (30.4%) compared with those living in MSA non-central cities (10.3%), and MSA central cities (14.4%).

Vaccination coverage varied by state, with coverage with ≥ 1 Tdap dose ranging from 77.5% in South Carolina, to 96.7% in Massachusetts. Coverage with ≥ 1 dose MenACWY ranged from 54.2% in Wyoming, to 96.4% in Rhode Island.

In girls, ≥ 1 dose HPV vaccination coverage ranged from 47.8% in Mississippi, to 90.1% in Rhode Island. In boys, coverage ranged from 36.9% in Indiana and Wyoming, to 87.8% in Rhode Island.

Among girls, HPV up-to-date estimates ranged from 30.8% in South Carolina, to 73.0% in Rhode Island. In boys, it ranged from 19.9% in Wyoming, to 68.7% in Rhode Island.

From 2013 to 2016, coverage with ≥ 1 dose HPV vaccination increased by an overage of 5.0 percentage points per year nationally. The greatest statistically significant average annual increases were seen in New York City (7.7 percentage points), Nevada (7.6 percentage points), Maryland (7.4 percentage points), Guam (7.3 percentage points), New York, (7.2 percentage points), and Alaska (7.1 percentage points).

“Adolescent vaccination coverage can be increased, and the gap between HPV vaccination coverage and coverage with Tdap and ≥ 1-dose MenACWY can be closed with increased implementation of effective strategies. Providers should use every visit to review vaccination histories, provide strong clinical recommendations for HPV and other recommended vaccines, and implement systems to eliminate or minimize missed opportunities (eg, standing orders, provider reminders, patient reminder or recall, and use of immunization information systems) (https://www.thecommunityguide.org/topic/vaccination),” concluded these authors.