La EM, Garbinsky D, Hunter S, Poston S, Novy P, Ghaswalla P. National and state-level composite completion of recommended vaccines among adolescents in the United States, 2015-2018. J Adolesc Health. 2021 Nov;69(5):762-8. doi: 10.1016/j.jadohealth.2021.07.020

BACKGROUND: Routine adolescent vaccination recommendations in the United States (US) include tetanus, diphtheria, and acellular pertussis (Tdap), quadrivalent meningococcal conjugate (MenACWY) vaccine, and human papillomavirus (HPV) vaccines. Although completion for these individual vaccines is known, limited data are available on composite completion for all three vaccines.

METHODS: This cross-sectional analysis of pooled 2015–2018 National Immunization Survey-Teen (NIS-Teen) data used logistic regression to estimate model-adjusted composite vaccination completion nationally and by state among US adolescents aged 17 years. NIS-Teen data were combined with state-level data to estimate multilevel model identifying factors associated with composite vaccination completion.

The pooled model-adjusted composite vaccination completion was 30.6% (95% confidence interval [CI], 30.13%–31.04%) nationally, varying from 11.3% in Idaho (6.91%–17.95%) to 56.4% (49.81%–62.82%) in Rhode Island. Individual-level factors with the greatest impact on composite completion were having a provider’s recommendation for HPV vaccination (odds ratio [OR], 3.24; 95% CI, 2.76–3.80) and a check-up visit at age 16–17 years (OR, 2.35; 95% CI, 1.80–3.07), with other individual-level factors associated with completion including being Medicaid insured, female, Hispanic, or non-Hispanic Black. State-level MenACWY vaccination mandates were also associated with an increased likelihood of composite vaccination completion (OR,1.64; 95% CI, 1.16–2.33).

CONCLUSIONS: Fewer than one-third of 17-year-olds have completed all 3 recommended vaccines, with rates varying by state. Although this study identified implementable strategies to improve composite completion, additional research is needed to further understand factors associated with adolescent vaccination completion.

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