Coverage rates increase for HPV, Tdap, MenACWY vaccines
JuliaHasten, M.D. and Larry K.Pickering, M.D., FIDSA, FAAP
MMWR in Review
Walker TY, et al. “National, Regional, State, and Selected Local Area Vaccination
Coverage Among Adolescents Aged 13–17 Years — United States, 2016.” MMWR Morb Mortal Wkly Rep. 2017;66:874-882, DOI:http://dx.doi.org/10.15585/mmwr.mm6633a2.
Over the past decade, vaccination coverage in the U.S. has been lower for adolescent
vaccines than for vaccines administered in early childhood.
However, the Centers for Disease Control and Prevention (CDC) recently published data
from 2015-’16 suggesting that vaccination trends for adolescents 13 through 17 years
of age are improving. Coverage rates increased for all adolescent vaccines administered
routinely at 11 through 12 years of age or as catch-up at 13 through 18 years of age,
including human papillomavirus (HPV); tetanus, diphtheria and acellular pertussis
(Tdap); and meningococcal conjugate (MenACWY) (see figure). Annual influenza vaccine
data were not included in this survey.
The CDC analyzed data from the 2016 National Immunization Survey-Teen (NIS-Teen).
Data were collected on vaccines received by more than 20,000 adolescents 13 through
17 years of age in the 50 states, the District of Columbia, and selected local areas
HPV continues to be an important cause of cancer in the U.S. Estimates show that vaccination
could prevent up to 90% of the 31,500 cancers attributable to HPV that are diagnosed
Prior to 2017, a three-dose vaccine series was recommended, and only 37% of all adolescents
13 years of age and older received all three doses.
In December 2016, the CDC’s Advisory Committee on Immunization Practices (ACIP) updated
the HPV recommendations to include a two-dose schedule for immunocompetent adolescents
who begin the series before 15 years of age. If the updated HPV recommendations are
applied retrospectively, 43% of adolescents can be considered up to date.
By 17 years of age, HPV coverage is higher overall for females than males (50% females
and 38% males); however, coverage has been improving more rapidly among males than
females in recent years. This suggests overall adherence to practice guidelines among
The full impact of HPV vaccination on cancer is yet to be determined, but adolescent
cervical Papanicolaou testing shows a decreased prevalence of vaccine-targeted HPV
Of the three recommended adolescent vaccines, Tdap continues to have the highest overall
coverage. Coverage increased from 86% in 2015 to 88% in 2016 for receipt of at least
one Tdap dose after 10 years of age.
The MenACWY series includes two doses — one given at 11 years of age and a booster
dose given at age 16 years of age. The booster dose was recommended in 2014.
Data from 2016 show only 39% of adolescents received two or more doses, while 82%
of adolescents received at least one dose. This suggests that many adolescents either
do not return at 16 years of age or refuse the second dose. Two-dose vaccine coverage
increased by 6% from 2015 to 2016.
The review did not discuss meningococcal serogroup B (MenB) vaccines, since recommendations
call for use only for certain high-risk groups.
Vaccine coverage varies significantly by geographic location. The most pronounced
geographic variations exist with HPV vaccine coverage for both females and males.
In Rhode Island, 90% of females and 73% of males are covered compared to the national
average of 50% of females and 38% of males.
Tdap coverage by state ranges from 78% to 97% and MenACWY coverage from 54% to 96%.
Overall, adolescent vaccine coverage tends to be higher in the northeastern states
compared to the national average.
Both poverty status and metropolitan statistical area status were linked to differences
in vaccine coverage rates. Race and ethnicity assessments are consistent with findings
from previous years. Black, non-Hispanic adolescents have higher coverage for all
adolescent vaccines when compared to other racial and ethnic groups.
Updates to the 2017 vaccine schedule
Since December 2016, ACIP has recommended the HPV vaccine series as two doses rather
than three for immunocompetent adolescents who initiate the series before 15 years
of age (http://dx.doi.org/10.15585/mmwr.mm6605e1).For adolescents initiating the series at 15 through 26 years of age or who are immunocompromised,
three doses continue to be recommended. The HPV vaccine series may be started at 9
through 10 years of age, according to the new schedule.
Influenza vaccine recommendations also have changed for the 2017-’18 season. The live
attenuated influenza vaccine is not recommended due to lack of effectiveness in recent
years. As in previous years, the CDC and Academy continue to recommend annual influenza
vaccine for all adolescents. For more information on influenza vaccine recommendations
as well as available influenza vaccines, visit http://dx.doi.org/10.15585/mmwr.rr6602a1.
Health care providers should use each visit to review vaccine history, strongly recommend
vaccines, educate parents and adolescents, and address concerns and questions.
Dr. Hasten is a post-graduate training fellow in pediatric and internal medicine infectious
diseases at Emory University School of Medicine and Children’s Healthcare of Atlanta
(CHOA). Dr. Pickering is adjunct professor of pediatrics at Emory University School
of Medicine and CHOA.
In the 2016 NIS-Teen survey, the coverage rate was highest for adolescents for which
of the following vaccines?