Determinants of Meningococcal ACWY vaccination in adolescents in the US: completion and compliance with the CDC recommendations

Wendy Y Cheng,Rose Chang,Patricia Novy,Cristi O’Connor,Mei Sheng Duh,Cosmina S Hogea

doi:10.1080/21645515.2019.1632679

Abstract

ABSTRACTSince 2011, the Advisory Committee on Immunization Practices (ACIP) guidelines for routine MenACWY vaccination in the US include a primary dose before age 16 y, preferably at ages 11-12 y, with a booster dose at age 16 y. Data on rates and drivers of meningococcal vaccination completion (receipt of both doses) and compliance with recommendations (receipt of primary dose at ages 11-12 y followed by booster at 16 y) down to state-level are limited.This study evaluated rates and determinants of MenACWY vaccination completion and compliance in adolescents aged 17 y based on data from the annual National Immunization Survey-Teen between 2011 and 2016. Individual- and state-level determinants of completion and compliance were assessed using uni-level and multi-level multivariable regression models. Average national rates were 23.2% and 12.1% for completion and compliance, respectively, with large inter-state variation observed (completion: 8.7–39.7%; compliance: 3.1–26.2%). Beyond the state of residence, factors significantly associated with a higher likelihood of both completion and compliance included being male, up-to-date on other routine vaccines, having private or hospital-based vaccine providers (vs. public) and having >1 child in the household. Factors specifically associated with completion included having >1 annual health-care visit and presence of a booster-dose vaccine mandate, while a history of asthma and high-risk health conditions had a positive association with compliance. State-level determinants of completion and compliance included pediatricians-to-children ratio and the proportion of Immunization Information System use among adolescents, respectively. Outcomes of this study may help guide clinical, policy and educational interventions to further increase MenACWY completion rates and reduce disparities in vaccination.

Highlights

Meningococcal disease is a rare but severe illness caused by Neisseria meningitidis bacteria
MenACWY completion and compliance were higher for adolescents living in the Northeast and across states with existing vaccination mandates
Adolescents with a family income >$75,000, who had an 11–12-year-old well-child exam or who were up-todate on other vaccines including hepatitis A, hepatitis B, varicella, human papillomavirus (HPV), pneumococcal polysaccharide, and tetanus-diphtheria-acellular pertussis (Tdap), had higher completion and compliance rates

Summary

Introduction

Meningococcal disease is a rare but severe illness caused by Neisseria meningitidis bacteria. Due to the rapid onset of disease, high case-fatality rate, substantial long-term sequelae among survivors, and the potential for outbreaks, prevention of meningococcal disease remains a public health priority.[1,2] At least 12 serogroups of Neisseria meningitidis have been identified, among which serogroups A, B, C, W, and Y account for most meningococcal disease burden. Vaccination has proven to be an effective strategy to prevent meningococcal disease.[3] In 2005, the first quadrivalent meningococcal conjugate vaccine against serogroups A, C, W, and Y (MenACWY) was licensed and recommended by the Advisory Committee on Immunization Practices (ACIP) for routine use in healthy adolescents aged 11–12 years.[4] In October 2010, with evidence of waning immunity after a single dose of the vaccine the ACIP updated its recommendation to include a booster dose such that the current routine vaccination schedule for healthy adolescents comprises a primary dose at ages 11–12 years and a booster dose at age 16 years.[1,5,6]

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