Teen Vaccinations: We Could Be Doing a Lot Better

Just 31% of U.S. adolescents received vaccines against human papillomavirus (HPV), meningococcal disease, and tetanus-diphtheria/pertussis (Tdap), national survey data for 2015-2018 indicated.

But there was “large variation across states,” said Sara Poston, PharmD, of GlaxoSmithKline’s health outcomes research unit in Lancaster, Pennsylvania, speaking at the virtual 2020 IDWeek meeting.

Moreover, several factors associated with the variation appear “actionable,” she said, including state policies and clinician behaviors.

The CDC recommends that the HPV, quadrivalent meningococcal (serogroups A/C/W/Y), and Tdap vaccines be given to all teenagers. The agency routinely collects data on how many actually complete the recommended courses, but factors that may influence these rates have not been well studied, Poston’s group said.

One of the CDC’s surveillance tools is the National Immunization Survey (NIS), which asks parents and guardians about vaccinations for their young and adolescent children, along with their healthcare providers when parents give permission.

Poston and colleagues analyzed data from the NIS’s teen version for 2015-2018, which not only indicated whether the youths received the vaccinations, but also sociodemographic characteristics, maternal education, and insurance status. The data also included whether providers had specifically recommended the vaccinations.

The researchers found a whopping fivefold variation among states in rates of completion for all three vaccinations: from 11.3% in Idaho to 56.4% in Rhode Island.

One likely driver, Poston said, is state policy to mandate the meningococcal vaccine as a condition of attending school. That increased the odds that a teen would have received all three vaccines by 64% (95% CI 16%-133%), relative to states without such mandates.

But an even stronger correlation was with provider recommendations for HPV vaccination, which more than tripled the odds of receiving the three sets of shots (OR 3.24, 95% CI 2.76-3.80).

A third significant factor was having seen a healthcare professional at age 16 or 17 (OR 2.35, 95% CI 1.80-3.07). The number of recent healthcare visits also appeared to increase the likelihood of complete vaccine coverage, and in a largely dose-related fashion (i.e., OR 1.27 for a single visit vs OR 1.72 for 10-12 visits).

Lack of or inconsistent health insurance, on the other hand, was associated with reduced probability of receiving the three vaccines.

Another factor associated with incomplete teen vaccination: middling maternal education. Adolescents whose mothers had more than 12 years of schooling but without a college degree were about 30% less likely to have received the three vaccines compared with teens whose mothers hadn’t completed high school.

At a press briefing on the study, Poston focused on state policies, clinician recommendations, and simply getting teens in to see providers as key modifiable factors that could increase adolescent vaccination rates.

Co-author Elizabeth La, PhD, of RTI Health Solutions in Research Triangle Park, North Carolina, also emphasized that it matters when clinicians are proactive.

“It’s important to treat every clinical encounter as an opportunity to vaccinate,” she said at the briefing.

The investigators acknowledged that the NIS data came prior to the COVID-19 pandemic and the associated disruptions in routine care; it’s likely that completion rates will be lower this year, Poston said.

Asked about vaccine hesitancy in the adolescent population versus older and younger individuals, Poston noted that people “at every age level” have questions about the products’ efficacy and safety. She said clinicians must take these questions seriously and provide solid answers.