August 28, 2024

Estimated routine vaccination coverage (≥1 HPV vaccine dose, ≥1 Tdap, ≥1 MenACWY) among adolescents by age and birth year, National Immunization Survey-Teen, 2015-2021

This CDC report analyzes the impact of the COVID-19 pandemic on adolescent vaccination rates of ages 12-13 and provides information on vaccination coverage for ages 14-17.

Background and Purpose

The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of adolescents aged 11–12 years with tetanus, diphtheria, and acellular pertussis vaccine (Tdap), human papillomavirus (HPV) vaccine, and meningococcal serogroups A, C, W, Y vaccine (MenACWY)1. On September 2, 2022, CDC released a report using data from the National Immunization Survey-Teen (NIS-Teen) which analyzed the potential effect of the COVID-19 pandemic on routine adolescent vaccination by ages 12 and 13 years among adolescents born 2006-20082. This report provides additional information on potential effect of the pandemic on adolescent vaccination coverage by ages 14 through 17 years.

Methods

To estimate vaccination coverage, CDC analyzed data for 18,002 adolescents aged 13–17 years from the 2021 National Immunization Survey-Teen (NIS-Teen). Vaccination coverage estimates are based on provider-reported vaccination histories and include any vaccines administered before the 2021 NIS-Teen interview date. The cumulative percent of adolescents vaccinated by age in years (12 to 17 years) was assessed, stratified by year of birth (2002-2008). To assess vaccination coverage by ages 14 to 17 years, Kaplan-Meier estimation was used to account for censoring of vaccination status at ages 14 and older. To assess potential COVID-19 pandemic effects for ≥1 HPV vaccine, ≥1 MenACWY, and ≥1 Tdap, vaccination coverage by age 12 years was compared for adolescents born in 2008 (reached age 12 years in 2020, during the pandemic) to those born in 2007 (reached age 12 years in 2019, pre-pandemic); vaccination coverage by age 13 years was compared for adolescents born in 2007 and 2008 (reached age 13 years in 2020 and 2021) to those born in 2006 (reached age 13 years in 2019). Reference birth years for vaccination coverage difference estimates by ages 14, 15, 16, and 17 years were the 2005, 2004, 2003, and 2002 birth years, respectively. Children in these reference birth years reached the given age in 2019 (e.g., for coverage by age 14 years, children born in 2005 reached 14 in 2019, which was pre-pandemic). Analyses were conducted using SAS-Callable SUDAAN (version 11; RTI International). This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.

Results

Coverage with ≥1 HPV vaccine dose among adolescents who reached 12, 13, 14, 15, 16 or 17 years of age during the pandemic (in 2020 or 2021) was similar to coverage before the pandemic.

Uptake of ≥1 HPV Vaccine* by Age and Birth Year 2002-2008, NIS-Teen 2015-2021 — HPV vaccine coverage among adolescents aged 12-17 during the pandemic (2020-2021) was similar to pre-pandemic levels.

_{Abbreviations: HPV = human papillomavirus; CI = confidence interval; NIS = National Immunization Survey.}

_{* HPV vaccine includes nine-valent (9vHPV), quadrivalent (4vHPV), or bivalent (2vHPV) in females and males combined.}

_{^† Table cells are shaded according to whether persons with the indicated birth year (rows) reached the age indicated (columns) in 2019 or earlier (pre-pandemic, shaded in blue or pink) or in 2020 or 2021 (during pandemic, shaded in yellow). Cells shaded in pink were used as the pre-pandemic referent cell for comparisons with pandemic cells, for each age indicated (column).}

Differences in Uptake of ≥1 HPV* Vaccine by Age and Birth Year† s 2002-2008, NIS-Teen 2015-2021 — The birth years used as references for vaccination coverage differences at ages 14, 15, 15 and 17 were 2005, 2004, 2003, and 2002 respectively.

_{Abbreviations: HPV = human papillomavirus; CI = confidence interval; NIS = National Immunization Survey.}

_{* HPV vaccine includes nine-valent (9vHPV), quadrivalent (4vHPV), or bivalent (2vHPV) in females and males combined.}

_{^†Reference birth years (denoted in pink cell shading) for vaccination coverage difference estimates by ages 14, 15, 16, and 17 years were the 2005, 2004, 2003, and 2002 birth years, respectively. Children in these reference birth years reached the given age in 2019 (pre-pandemic year) (e.g., for coverage by age 13 years, children born in 2006 reached 13 in 2019, which was before the pandemic). The reference pre-pandemic year (pink cell shading) is compared to pandemic years (2020 and 2021, yellow cell shading)}

Coverage with ≥1 Tdap dose was 4.1 percent points lower (95% confidence interval, -8.1, -0.1) among adolescents who reached 12 during the pandemic (in 2020) than among those who reached 12 before the pandemic (in 2019). Tdap coverage among adolescents who reached 13, 14, 15, 16 or 17 years of age during the pandemic (in 2020 or 2021) was similar to coverage before the pandemic (in 2019).

Uptake of ≥1 Tdap* Vaccine by Age and Birth Year 2002-2008, NIS-Teen 2015-2021 — Adoeslecents who turned 12 during the pandemic had a 4.1% lower Tdap vaccination coverage compared to those who turned 12 before the pandemic.

_{Abbreviations: Tdap = tetanus, diphtheria, and acellular pertussis vaccine; CI = confidence interval; NIS = National Immunization Survey.}

_{* Includes percentages receiving Tdap vaccine at age ≥10 years.}

Differences in Uptake of ≥1 Tdap Vaccine by Age and Birth Year† 2002-2008, NIS-Teen 2015-2021 — Comparison of vaccination coverage estimates between pre-pandemic (pink) and pandemic years (yellow) for different age groups: 14, 15, 16, and 17 years.

_{Abbreviations: Tdap = tetanus, diphtheria, and acellular pertussis vaccine; CI = confidence interval; NIS = National Immunization Survey.}

_{* Includes percentages receiving Tdap vaccine at age ≥10 years.}

_{^†Reference birth years (denoted in pink cell shading) for vaccination coverage difference estimates by ages 14, 15, 16, and 17 years were the 2005, 2004, 2003, and 2002 birth years, respectively. Children in these reference birth years reached the given age in 2019 (e.g., for coverage by age 13 years, children born in 2006 reached 13 in 2019, which was before the pandemic). The reference pre-pandemic year (pink cell shading) is compared to pandemic years (2020 and 2021, yellow cell shading)}

Coverage with ≥1 MenACWY dose among adolescents who reached 13 years of age during the pandemic (in 2021) was 5.1 percentage points lower (95% confidence interval, -9.8, -0.4) than among those who reached 13 before the pandemic (in 2019). MenACWY coverage among adolescents who reached 12, 14, 15, 16 or 17 years of age during the pandemic was similar to coverage before the pandemic.

Uptake of ≥1 MenACWY Vaccine by Age and Birth Year 2002-2008, NIS-Teen 2015-2021 — MenACWY coverage among adoslescents who turned 13 during the pandemic was 5.1% lower compared to those who turned 13 before the pandemic.

_{Abbreviations: MenACWY = quadrivalent meningococcal conjugate vaccine; CI = confidence interval; NIS = National Immunization Survey.}

_{* Includes percentages receiving MenACWY and meningococcal-unknown type vaccine.}

Differences in Uptake of ≥1 MenACWY Vaccine by Age and Birth Year† 2002-2008, NIS-Teen 2015-2021 — Comparison of vaccination coverage for children born in reference to birth years (2002-2005) before the pandemic (pink cells) and during the pandemic (yellos cells).

_{Abbreviations: MenACWY = quadrivalent meningococcal conjugate vaccine; CI = confidence interval; NIS = National Immunization Survey.}

_{* Includes percentages receiving MenACWY and meningococcal-unknown type vaccine.}

_{^† Reference birth years (denoted in pink cell shading) for vaccination coverage difference estimates by ages 14, 15, 16, and 17 years were the 2005, 2004, 2003, and 2002 birth years, respectively. Children in these reference birth years reached the given age in 2019 (e.g., for coverage by age 13 years, children born in 2006 reached 13 in 2019, which was before the pandemic). The reference pre-pandemic year (pink cell shading) is compared to pandemic years (2020 and 2021, yellow cell shading)}

The following graphs use estimates in the tables above to visually show trends by year of birth in coverage with ≥1 HPV vaccine, ≥1 MenACWY, and ≥1 Tdap by each age from 13 through 17 years. The vertical lines represent the pre-pandemic referent birth year; estimates to the right of this line are for adolescents who reached the indicated age during the pandemic (in 2020 or 2021).