Teen Vaccination in 2019: HPV and Meningococcal Coverage Up, With a Rural Gap

Three vaccines are routinely recommended for 11- and 12-year-olds by the Advisory Committee on Immunization Practices (ACIP):

Teens aged 16–23 may also get MenB (serogroup B meningococcal vaccine) after a shared decision with their clinician. CDC's 2019 National Immunization Survey-Teen (NIS-Teen) measured how many teens aged 13–17 were covered.

Coverage in 2019

HPV coverage rose for both girls and boys. Coverage was also above 90% for two doses of MMR, three of hepatitis B, and one and two doses of varicella (among teens with no history of varicella).

Teen coverage by year, 2006–2019. Image from CDC's report

More teens starting HPV vaccination on time

Starting the HPV series by age 13 climbed steadily with each birth year:

That suggests more parents are choosing to protect their children against HPV-related cancers. Federal, state and other efforts to prioritize HPV vaccination — and ACIP's switch in late 2016 from a 3-dose to a 2-dose series for most who start before 15 — likely helped. (Three doses are still recommended for those who start at 15–26.)

The gaps

The booster lags. Only 53.7% of 17-year-olds had the second MenACWY dose.

A rural gap — but only for better-off families. Compared with teens in the principal cities of metropolitan statistical areas (MSAs), teens outside MSAs had:

These differences appeared only among teens at or above the poverty level. Lower-income teens may benefit from the Vaccines for Children (VFC) program, which provides free vaccine to children 18 and under who are Medicaid-eligible, uninsured, or American Indian or Alaska Native; earlier studies found higher HPV coverage among teens below the poverty level. Why better-off rural teens lag is less clear — perhaps lower vaccine confidence.

Coverage also varied by race and ethnicity, insurance and state or area — from a 15-point spread between jurisdictions for Tdap to 48.4 points for being HPV up to date.

Then came COVID-19

When COVID-19 was declared a national emergency in mid-March 2020, VFC providers' orders for HPV, Tdap and MenACWY vaccines dropped. The pandemic could erode high Tdap and MenACWY coverage and reverse HPV gains. Most practices appear to be open and vaccinating again, and CDC stresses well-child visits and vaccination as essential services.

What providers can do:

1. Promote well-child and vaccination visits.
2. Follow guidance on vaccinating safely during the pandemic.
3. Use reminder and recall systems for upcoming and missed appointments.
4. Tell families — especially those who lost employer insurance — about free vaccines through VFC.

Immunization programs can use immunization information systems to find areas and groups falling behind.

About the survey

NIS-Teen is a yearly random-digit-dial phone survey of parents, whose teens' vaccination providers are then asked for records. The 2019 estimates cover 18,788 teens. The response rate was 19.7%, and 44.0% of interviewed households had adequate provider data — lower for requests mailed in early 2020, when the pandemic disrupted provider offices. Some bias may remain despite adjustments.

Sources

Based on Laurie D. Elam-Evans, David Yankey, James A. Singleton, Natalie Sterrett, Lauri E. Markowitz, Charnetta L. Williams, Benjamin Fredua, Lucy McNamara and Shannon Stokley, "National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2019," MMWR, volume 69, Centers for Disease Control and Prevention; a work of the United States government in the public domain.