National Immunization Survey-Teen Research Articles

Routine Vaccination Coverage in an Adolescent Transgender Population in a Large Tertiary Care Center in the United States

To address healthcare disparities among transgender and gender diverse (TGD) adolescents, we examined vaccination coverage in those receiving gender-affirming care. Our study analyzed de-identified data (2013-2022) from a tertiary care clinic. Comparing vaccination rates of 203 TGD adolescent patients to age-matched peers in New York State using CDC National Immunization Survey-Teen data. We found TGD patients had similar vaccination coverage to the general adolescent population. Notably, TGD patients had significantly higher up-to-date human papillomavirus vaccination coverage (76.4%, CI=69.9, 82.0) than the NYS adolescent population (60.5%, CI=53.0, 67.5). This suggests TGD adolescents at gender-affirming clinics maintain or exceed vaccination rates of their cisgender counterparts. Future research should explore vaccination rates for TGD individuals without access to gender-affirming care.

Trends in HPV Vaccination Before Age 13 Years in the US National Immunization Survey–Teen

This survey study uses data from the National Immunization Survey–Teen to examine human papillomavirus (HPV) vaccination rates in adolescents aged 13 to 17 years, including rates of series completion before age 13 years.

Obscured inequity: How focusing on rates of disparities can conceal inequities in the reasons why adolescents are unvaccinated.

Traditional sociodemographic disparities in adolescent vaccination initiation for the HPV, Tdap, and MenACWY vaccines have declined in the United States of America. This decline raises the question of whether inequities in access have been successfully addressed. This paper synthesizes research on the resource barriers that inhibit vaccination alongside research on vaccine hesitancy where parents actively refuse vaccination. To do so, I classify the primary reason why teens are unvaccinated in the National Immunization Survey-Teen 2012-2022 into three categories: resource failure, agentic refusal, and other reasons. I use three non-exclusive subsamples of teens who are unvaccinated against the HPV (N = 87,163), MenACWY (N = 54,726), and Tdap (N = 10,947) vaccines to examine the relative importance of resource failure reasons and agentic refusal reasons for non-vaccination across time and teens' sociodemographic characteristics. Results indicate that resource failure reasons continue to explain a substantial portion of the reasons why teens are unvaccinated and disproportionately affect racially/ethnically and economically marginalized teens. Thus, even as sociodemographic inequalities in rates of vaccination have declined, inequities in access remain consequential.

1143. Meningococcal Vaccination Coverage Disparities in the United States: An Analysis with 2016-2021 National Immunization Survey-Teen Data

Abstract Background The US Advisory Committee on Immunization Practices recommends meningococcal vaccination against serogroups A, C, W, and Y (MenACWY) for 11–12 year-olds (y/o) with a booster at 16; and against serogroup B (MenB) for 16–23 y/o under shared clinical decision making (SCDM). We used a large US survey to assess vaccination coverage across vaccines, geography and race/ethnicity. Methods This was a cross-sectional analysis using 2016-2021 National Immunization Survey-Teen survey data on MenACWY (≥1 dose [d]) in 13 y/o, MenACWY (≥2 d) and MenB (≥1 d) in 17 y/o. Data were collected via phone interviews with provider confirmation. We assessed coverage throughout the calendar year for MenACWY (≥1 d) and MenB (≥1 d) after the interview date, and for MenACWY (≥2 d) at the interview date. Results MenACWY coverage (≥1 d) in 13 y/o evolved from 82.71% (2016) to 86.42% (2021). MenACWY coverage (≥1 d) in 13-17 y/o changed from 83.36% (2016) to 89.82% (2021). MenB coverage (≥1 d) in 17 y/o changed from 5.63% (2016) to 34.05% (2021). Geographic coverage was more variable moving from MenACWY (≥1 d) in 13 y/o (74.44% Pacific region 2016 to 91.00% New England region 2021) to MenACWY (≥2 d) in 17 y/o (21.05% East South Central region 2016 to 75.68% Mid-Atlantic region 2021) and MenB (≥1 d) in 17 y/o (2.34% Pacific region 2016 to 45.29% South Atlantic region 2021). MenACWY coverage (≥1 d) in 13 y/o was consistent across race/ethnicity, while 17 y/o Hispanic had lower MenACWY coverage (≥2 d) in 2021 (50.63%). For MenB (≥1 d) in 17 y/o, coverage varied by race/ethnicity; coverage in Hispanic and Non-Hispanic (NH) Black populations increased from 5.55% and 7.55% to 33.58% and 42.33% over 5 years, respectively. In NH White population, coverage yearly increased from 5.29% to 33.88%, while it only progressed from 5.34% to 27.17% in other NH + Multiple race population. Conclusion Meningococcal vaccination disparities persist across vaccines, ages, geography, and race/ethnicity (MenB only). Disparities increase with age, and with SCDM- versus routinely- recommended vaccines (MenB vs. MenACWY). Top performing states show that better coverage is possible (∼70% MenB coverage in North Dakota vs. 34% nationally in 2021), pointing at the need to reduce access barriers to vaccination, e.g., via simplified vaccine recommendations/schedules. Disclosures Oscar Herrera-Restrepo, PhD, GSK: Stocks/Bonds Sara Poston, PharmD, GSK: Stocks/Bonds

A Multivariate Probit Regression of the Uptake of Adolescent Vaccines Among Racial/Ethnic Minority Adolescents Before and During the COVID-19 Pandemic

PurposeThe uptake of adolescent vaccines has improved over the years. However, research of the effects of the COVID-19 pandemic on this uptake among racial/ethnic minority adolescents has been limited. This study was conducted to compare the probability of uptake of the human papillomavirus (HPV); tetanus, diphtheria, and acellular pertussis (Tdap); and quadrivalent meningococcal conjugate (MenACWY) vaccines among racial/ethnic minority adolescents ages 13–17 years in 2019, 2020, and 2021. MethodsUsing a cross-sectional design to examine data from the National Immunization Survey–Teen (2019–2021), multivariate probit regression was used to model variation in uptake of these three adolescent vaccines (n = 38,128). The outcome measures were HPV, Tdap, and MenACWY vaccine uptake. ResultsThe probability of uptake of HPV vaccine was higher in 2020 (Coef = 0.09 [95% confidence interval (CI), 0.03–0.16]) and 2021 (Coef = 0.07 [95% CI, 0.00–0.15]) than in 2019. The probability of uptake of MenACWY vaccine was higher in 2020 (Coef = 0.08 [95% CI, 0.02–0.15]) than in 2019. The probability of uptake of recommended vaccines varied among racial/ethnic minorities with non-Hispanic Black adolescents exhibiting higher probability of uptake of HPV vaccine (Coef = 0.10 [95% CI, 0.01–0.19]) than Tdap vaccine. U.S. Census region and insurance status were associated with the uptake of all recommended vaccines. DiscussionProgress in the uptake of these recommended vaccines may not have been interrupted by the COVID-19 pandemic. Also, disparities in uptake of the recommended vaccines still exist despite increased uptake during the pandemic. Future research should examine the disparities as well as examine regional differences in the uptake of these three adolescent vaccines.

The Prevalence of HPV Vaccination among Racial/Ethnic Minority Adolescents During the COVID-19 Pandemic.

Human papillomavirus (HPV) vaccination among adolescents has steadily improved over the past several years. However, research conducted to determine whether the COVID-19 pandemic disrupted this positive trend in HPV vaccine initiation among racial/ethnic minority adolescents is limited. Therefore, this study was conducted to determine if the COVID-19 pandemic and the resulting changes in the U.S. health care sector affected the increasing HPV vaccine initiation among non-Hispanic Black and Hispanic adolescents aged 13-17 years. Using a cross-sectional design to examine data from the National Immunization Survey-Teen (2019-2021), logistic regression and moderation analysis were used to model race-specific variations in HPV vaccine initiation (n = 49,031). Two-sided P values of up to .05 were considered significant. Hispanic (adjusted odds ratio [aOR], 1.35 [95% CI, 1.16-1.57]) and non-Hispanic Black (aOR, 1.29 [95% CI, 1.10-1.51]) adolescents had higher odds of HPV vaccine initiation than did non-Hispanic White adolescents. Additionally, the odds of HPV vaccine initiation were higher in 2021 (aOR, 1.22 [95% CI, 1.08-1.38]) than in 2019. Other variables-age, region, sex, insurance status, and poverty status-were also associated with HPV vaccine initiation. These findings demonstrate that during the COVID-19 pandemic, racial and ethnic minorities had higher odds of receiving the HPV vaccine. Therefore, more research of the impact of the pandemic on HPV vaccine initiation among non-Hispanic White and racial/ethnic minority adolescents is needed.

Barriers to human papillomavirus vaccine uptake: role of state religiosity and healthcare professionals' participation in a state vaccine program.

Despite the known benefits of preventing human papillomavirus (HPV)-related cancers, HPV vaccine coverage is low in the United States. Grounded in Social Ecological theory, we assessed the macro-level (state) and meso-level (organization) factors associated with HPV vaccine initiation and up-to-date. Data from 2020 National Immunization Survey-Teen were used to study a sample of 20 163 US adolescents (aged 13-17 years). The data were collected from each teen's parents or guardians and health-care professionals. Weighted prevalence estimates were calculated, and multivariable regression analyses were conducted. The prevalence of HPV vaccine initiation was 75.1% and of remaining up-to-date was 58.6%. At the macro level, teens living in states with high and moderate religiosity had lower odds of HPV vaccine initiation (high religiosity adjusted odds ratio [AOR] = 0.63, 95% confidence interval [CI] = 0.50 to 0.78; moderate religiosity AOR = 0.68, 95% CI = 0.55 to 0.85) and up-to-date (high religiosity AOR = 0.69, 95% CI = 0.56 to 0.85; moderate religiosity AOR = 0.74, 95% CI = 0.61 to 0.91) than states with low religiosity. At the meso level, when none of their healthcare professionals ordered vaccine from the state, teens had lower odds of initiation (AOR = 0.68, 95% CI = 0.53 to 0.87) and up-to-date (AOR = 0.76, 95% CI = 0.60 to 0.95) than teens whose healthcare professionals ordered vaccine from the state. In addition, race and ethnicity, age, mother's education level, household income, well-child examination status, and doctor's recommendation were significantly associated with HPV vaccine uptake. A multiprong approach is needed to address religious and systemic barriers to HPV vaccination and expand healthcare professionals' access and enrollment in state vaccine initiatives, such as the Vaccine for Children program.

Vaccination Coverage Among Adolescents Aged 13-17 Years - National Immunization Survey-Teen, United States, 2022.

Three vaccines are routinely recommended for adolescents to prevent pertussis, meningococcal disease, and cancers caused by human papillomavirus (HPV). CDC analyzed data from the 2022 National Immunization Survey-Teen for 16,043 adolescents aged 13-17 years to assess vaccination coverage. Birth cohort analyses were conducted to assess trends in vaccination coverage by age 13 years (i.e., before the 13th birthday) and by age 14 years (i.e., before the 14th birthday) among adolescents who were due for routine vaccination before and during the COVID-19 pandemic. Cross-sectional analysis was used to assess coverage estimates among adolescents aged 13-17 years. In 2022, vaccination coverage by age 14 years among adolescents born in 2008 continued to lag that of earlier birth cohorts and varied by sociodemographic factors and access to health care compared with coverage among earlier birth cohorts. Vaccination coverage by age 13 years among adolescents born in 2009 was similar to coverage estimates obtained before the COVID-19 pandemic. Among all adolescents aged 13-17 years, 2022 vaccination coverage levels did not differ from 2021 levels; however, initiation of the HPV vaccination series decreased among those who were insured by Medicaid. Coverage with ≥1 dose of tetanus, diphtheria, and acellular pertussis vaccine and ≥1 dose meningococcal conjugate vaccine was high and stable (around 90%). Providers should review adolescent vaccination records, especially among those born in 2008 and those in populations eligible for the Vaccines for Children program, to ensure adolescents are up to date with all recommended vaccines.

County-level correlates of completed HPV vaccination in Indiana

The Healthy People 2030 goal is for 80% of all adolescents to complete their HPV vaccination series. Per the 2021, National Immunization Survey-Teen (NIS-Teen), 61.7% of adolescents have completed the series, and Indiana lags below the national average (55.2%). The present study estimated the 2-dose HPV vaccine series completion rates across Indiana counties among individuals aged 9–14 years who received their first dose of vaccine and determined what factors were associated with series completion at the county level. The association of county-level sociodemographic and health measures with series completion was also examined. Data were extracted from the Indiana Immunization Information System (IIS), administered by the Indiana Department of Health. All vaccine providers are required to report all immunizations to the system for any patient under age 19 years. All Indiana children ages 9–14 years at the time of first dose who had initiated HPV vaccination in 2017 or 2018 were included. Two-dose series completion was evaluated through October of 2020, allowing a minimum gap of 22 months from first dose administration. All statistical analyses were conducted at the county-level. The Indiana HPV vaccination series completion rate among individuals that received the first dose was on average 73% across counties, ranging from 55.7% to 90.4%. Higher series completion was positively associated with primary care providers per capita, participation in mammography screening among Medicare enrollees, median household income, life expectancy, percentage of residents with some college, percentage of adults up-to-date with colonoscopy screening, and percentage of adults with flu vaccine. There was wide variability in series completion across Indiana counties. HPV series completion was associated with county-level sociodemographic and health measures, particularly variables reflecting difficulties with access to care and lack of financial resources.

Individual, systemic and state factors associated with provider recommendation of HPV vaccination: Findings from NIS-Teen, 2020

ABSTRACT The most important determinant of HPV vaccination uptake is healthcare provider recommendation, yet not all eligible patients receive HPV vaccination recommendations. We used data from the 2020 National Immunization Survey-Teen to determine individual, systemic, and state factors associated with provider recommendation of HPV vaccination. A total of 18,534 teens were included, with 81.4% receiving provider recommendations for HPV vaccination. HPV vaccination recommendation was higher among females compared to males (AOR: 1.57; 95% CI: 1.27–1.93), teens who received a well-child exam at 11 or 12 years compared to those who did not (AOR: 2.10; 95% CI: 1.61–2.74), and teens whose mothers had college, some college or at least a high school education compared to those with less than high school education. In addition to individual factors, provider recommendation of HPV vaccination was higher in hospitals (AOR: 1.51; 95% CI: 1.00–2.29) and STD/school/teen clinics (AOR: 2.47; 95% CI: 1.05–5.78) compared to public facilities. However, the odds of provider recommendation were lower when none of the teen’s providers ordered vaccines from the state compared to when all teen providers ordered vaccines from the state (AOR: 0.69; 95% CI: 0.52–0.93). Moreover, the state’s mean prevalence of provider recommendations of HPV vaccination was 7.2% lower (Coefficient: −0.072; 95% CI: −0.107 – −0.036) in states with high religious ideology compared to those with low religious ideology. Interventions to increase provider recommendation of HPV vaccination should take a multiprong and comprehensive approach that addresses religious and systemic barriers to HPV vaccination recommendation.

Parent-reported provider recommendation of HPV vaccination among minority adolescents before and during the COVID-19 pandemic: Findings from the National Immunization Survey-Teen, 2019–2021

Provider recommendation of human papillomavirus (HPV) vaccination among adolescents has steadily improved over the years, however, limited research has been conducted to examine if the COVID-19 pandemic disrupted this positive trend in parent-reported provider recommendation among minority adolescents. Therefore, we conducted the present study to determine if there is an association between the pandemic and parent-reported provider recommendation of HPV vaccine among non-Hispanic black and Hispanic adolescents. We also examined whether any changes in parent-reported provider recommendation in the years 2019, 2020, and 2021 differed by race or ethnicity. Using a cross-sectional design to examine data from the National Immunization Survey-Teen (2019–2021), a moderation analysis and logistic regression analysis were performed to model race-specific variation in parent-reported provider recommendation (n = 50,739). We found that Hispanic parents had lower odds (aOR = 0.80 [0.71, 0.91]) of reporting receiving a recommendation compared to non-Hispanic white parents. We also found that the odds of parent-reported provider recommendation were higher in 2020 (aOR = 1.15 [1.03–1.29]) than in 2019. Other variables–age, region, sex, health insurance status, and poverty status–were all associated with parent-reported provider recommendation. These findings demonstrated that the pandemic may not have triggered any race-related gap in the recommendation of HPV vaccines, however, more pandemic-resilient public health efforts are needed to improve parent and provider communication regarding HPV vaccination of adolescents.

Trends in Reasons for Human Papillomavirus Vaccine Hesitancy: 2010-2020.

We sought to identify trends in the main reasons United States parents of unvaccinated children gave for not intending to vaccinate their adolescent children against HPV from 2010 to 2020. As interventions designed to increase vaccine uptake have been implemented across the United States, we predicted that reasons for hesitancy have changed over this period. We analyzed data from the 2010 to 2020 National Immunization Survey-Teen, which included 119 695 adolescents aged 13 to 17 years. Joinpoint regression estimated yearly changes in the top five cited reasons for not intending to vaccinate using annual percentage changes. The five most frequently cited reasons for not intending to vaccinate included "not necessary," "safety concerns," "lack of recommendation," "lack of knowledge," and "not sexually active." Overall, parental HPV vaccine hesitancy decreased by 5.5% annually between 2010 and 2012 and then remained stable for the 9-year period of 2012 through 2020. The proportion of parents citing "safety or side effects" as a reason for vaccine hesitancy increased significantly by 15.6% annually from 2010 to 2018. The proportion of parents citing "not recommended," "lack of knowledge," or "child not sexually active" as reasons for vaccine hesitancy decreased significantly by 6.8%, 9.9%, and 5.9% respectively per year between 2013 and 2020. No significant changes were observed for parents citing "not necessary." Parents who cited vaccine safety as a reason for not intending to vaccinate their adolescent children against HPV increased over time. Findings support efforts to address parental safety concerns surrounding HPV vaccination.

Trends in Adolescent Human Papillomavirus Vaccination and Parental Hesitancy in the United States.

Human papillomavirus (HPV) vaccination coverage remains suboptimal in the United States, underscoring the importance of monitoring trends in vaccine hesitancy. Cross-sectional data from the 2011-2020 National Immunization Survey-Teen were used to assess trends in HPV vaccination initiation among 13-17-year-olds, parental intent to initiate vaccination, and primary reasons for parental hesitancy. Among all sex and race and ethnicity groups, the prevalence of HPV vaccination initiation increased over time, but parental intent to vaccinate against HPV for unvaccinated teens remained consistently low (≤45%). Among hesitant parents, "safety concerns" increased in nearly all demographic groups, with the greatest increases observed for non-Hispanic white female and male teens and no change for non-Hispanic black female teens. In 2019-2020, parents of unvaccinated non-Hispanic white teens were least likely to intend on vaccinating their teens, and the most common reason for hesitancy varied by sex and race and ethnicity (eg, "safety concerns" for white teens and "not necessary" for black female teens). Although HPV vaccination initiation increased over time, a substantial fraction of parents remain hesitant, and trends in their reason varied by sex and race and ethnicity. Health campaigns and clinicians should address vaccine safety and necessity.

Early Initiation of HPV Vaccination and Series Completion in Early and Mid-Adolescence.

Routine human papillomavirus (HPV) vaccination has been recommended in the United States since 2006 but rates remain suboptimal. State-based studies suggest that initiation in late childhood at ages 9 to 10 years compared with the recommended early adolescent ages of 11 to 12 years improves series completion. No study with national scope has explored the early initiation-HPV series completion relationship. This study addresses this knowledge gap and explores whether early initiation might improve series completion by increasing time to target completion age (time pathway) or by moving initiation to an earlier developmental stage (development pathway). Using data from the National Immunization Survey-Teen 2017-2020, a retrospective cohort of 19 575 15 to 17 year olds who initiated HPV vaccination between ages 9 and 12 years was assembled. Time pathway endpoints were series completion by ages 13 and 15 years. The development pathway endpoint was completion within 3 years of initiation. Early initiators were more likely to complete by ages 13 (74.0% vs 31.1%, P < .001) and 15 (91.7% vs 82.7%, P < .001) years but less likely to complete within 3 years (82.3% vs 84.9%, P = .007). The association of early initiation to completion was maintained in multivariable analyses for time pathway endpoints (age 13 years adjusted odds ratios [AOR] = 6.16; 95% confidence interval [CI], 5.45-6.96, age 15 years = AOR 2.56; 95% CI, 2.14-3.14) but not the development pathway endpoint (AOR = 0.93; 95% CI, 0.80-1.07). Moving routine HPV vaccination to ages 9 to 10 may improve vaccination coverage rates in early and mid-adolescence. Providers should be vigilant to patient interactions after HPV series initiation to optimize public health benefits of vaccination.

Associations of Maternal Age, Education, and Marital Status with HPV Vaccine Uptake and Hesitancy among United States Youth: A Cross-Sectional Analysis of the 2020 National Immunization Survey

Study ObjectiveHuman papillomavirus (HPV) vaccination is proven to reduce the risk of HPV-associated cancers and lesions. Factors associated with HPV vaccine receipt or rejection have been studied, but specific maternal characteristics driving uptake among teens requires further investigation. The aim of this study was to examine maternal characteristics influencing teen vaccine uptake and intent to vaccinate. Study DesignCross-sectional analysis MethodsWe analyzed data on 27,320 teens aged 13-17 using the 2020 National Immunization Survey-Teen. We constructed regression models to determine the associations, via relative risk, between child vaccination status and maternal characteristics. ResultsCompared with mothers with less education, those with a college degree were significantly more likely to have their children receive HPV vaccination (RR = 1.18; 95% CI, 1.11-1.26). Compared to mothers under 35 years, those aged 35-44 (RR 1.07; 95% CI 1.01-1.14) and over 45 (RR = 1.13; 95% CI, 1.07-1.21) were more likely to provide HPV vaccination to their child. Among children not previously vaccinated (n = 12,098; N = 5,752,355), educated mothers were significantly less likely to report intent to vaccinate their child in the next year. There was no significant difference in vaccination rates in mothers who were married compared with never married (RR = 0.99; 95% CI, 0.97-1.02). ConclusionMaternal education was the strongest predictor of teens receiving the HPV vaccine. Among mothers with teens not previously vaccinated, intent to obtain the HPV vaccine for their child was higher among mothers with less education compared with college-level educated mothers. Understanding maternal characteristics driving HPV vaccine hesitancy can inform targeted approaches to improve vaccine uptake in children. Additionally, adequate and consistent health messaging on the safety, efficacy, and benefits of HPV vaccination from health providers and public health agencies could increase uptake among adolescents and teens of vaccine-hesitant mothers.

Human Papillomavirus Vaccination Uptake in the Rio Grande Valley: Results from a Pilot Community-Based Educational and School-Based Vaccination Program and Its Expansion.

Human papillomavirus (HPV) vaccine is a safe and effective strategy for reducing HPV morbidity and mortality. Schools have become an increasingly attractive setting for delivering vaccinations and supporting vaccination health literacy and decisional support. This study assesses the effectiveness of a community-based, physician-led HPV education campaign (starting in 2016) and onsite middle school-based HPV vaccination program across six school districts (2017, 2019, 2020) in a rural, medically underserved Texas area (Rio Grande Valley). Pre- and post-intervention HPV vaccination rates were tracked against the 2016 National Immunization Survey-Teen target rates (initiation: 49.3%; completion: 32.9%). Summary statistics were stratified by gender, school district, and grade level. The study reached 19,951 students who received HPV vaccines directly or indirectly through our program (10,289 females; 9662 males) (August 2016-August 2022). Of those, 2145 students (1074 females; 1071 males) were vaccinated directly through our program. The overall HPV up-to-date (UTD) rates were 58.8%. The overall median age at HPV vaccine initiation and HPV-UTD (range) was 11 years (9-21) and 12 years (9-20). The overall median interval between HPV vaccine doses (range) was 291 days (146-2968). Recommending HPV vaccine initiation at younger ages increases HPV vaccine completion and providing access to HPV vaccines encourages on-time vaccination and completion.

Descriptive epidemiology of age at HPV vaccination: Analysis using the 2020 NIS-Teen

ABSTRACT Human papillomavirus (HPV) vaccination uptake in the United States remains suboptimal, and continues to trail that of tetanus, diphtheria, and acellular pertussis (Tdap) vaccination and quadrivalent meningococcal conjugate vaccination (MCV4). This is despite these three vaccines all being recommended for routine adolescent use within the 2005–2006 time period. One strategy to improve HPV vaccination is starting the vaccine series at the first opportunity – currently as young as 9 years of age. Little is known about the epidemiology of age at HPV vaccination, and the frequency of vaccination occurring at 9–10 years of age. Using 2020 National Immunization Survey-Teen (NIS-Teen) data, we analyzed age at HPV vaccine initiation and proportion of initiators completing the HPV vaccine series relative to age at initiation. Overall, 4.0% of US adolescents initiated HPV vaccination at 9–10 years of age, with higher initiation among younger birth cohorts (4.8% for 13-year-olds and 5.1% for 14-year-olds) than older cohorts (3.1% for both 16 and 17 year-olds). Age cohorts maximized HPV vaccine completion after 3–4 years. Among those initiating at ages 9–10, 93% of 13-year-olds completed the series. Among those initiating at 11–12, completion rates rose from 66% among 13-year-olds to 90.2% among 16-year-olds. Among those initiating at age 13–14, completion rose from 61% among 15-year-olds to 84.9% among 17-year-olds. This manuscript serves as a starting point of comparison for future epidemiologic evaluations of HPV vaccination at the first opportunity.

Abstract A124: Disparities in HPV vaccine uptake and provider recommendation by provider facility type

Abstract Background: Approximately 46,000 cases of human papillomavirus (HPV) attributable cancers are diagnosed annually in the United States. The HPV vaccine can prevent over 90% of HPV-attributable cancers, yet national uptake remains lower than the Healthy People 2030 target goal of 80% completion. To devise targeted interventions to increase the uptake of HPV vaccines, it is crucial to understand the vaccination rates across various health care settings. We examined the association between provider facility type and provider recommendation and HPV vaccine uptake among adolescents in the US. Methods: We conducted secondary data analysis of the 2020 National Immunization Survey–Teen data (n=20,162), which provides current, population-based estimates of vaccination coverage among adolescents. Provider facility type was classified as public facilities (i.e., public health department-operated clinic, community health center, rural health clinic, tribal/Indian health facility), hospital-based facilities, private facilities, and mixed facilities (i.e., vaccination provided in more than one of the above-mentioned locations). Self-reported provider recommendation was dichotomized as yes/no. HPV vaccine initiation was defined as the receipt of ≥1 dose of the HPV vaccine, and completion was defined as the receipt of ≥2 doses (if the adolescent received first dose before age 15) or ≥3 doses (if the adolescent was at least 15 years old). Weighted, multivariable logistic regression models estimated the odds of receiving provider recommendation and initiating and completing the HPV vaccine by provider facility type, adjusting for adolescents age, gender, race, poverty level, number of doctor visits per year, and mother’s age, marital status, and education. Results: Approximately 81% of adolescents received a provider recommendation for the HPV vaccine and 47.5% received their vaccination at providers based in private facilities. The prevalence of HPV vaccine initiation was 75.1% and completion was 58.6%. In the adjusted analyses, adolescents who received their vaccination from public facilities (aOR=0.63; 95% CI: 0.51–0.78) were less likely to receive provider recommendation for the vaccine compared to those who received their vaccination at private facilities. Similarly, adolescents who received their vaccination from public facilities were less likely to initiate (aOR=0.73; 95% CI: 0.59–0.90) and complete (aOR=0.62; 95% CI: 0.52–0.77) the HPV vaccination compared to those who received their vaccination at private facilities. There was no difference between hospital and mixed vs. private facilities for both provider recommendation and vaccination. Conclusions: Both the recommendation for and uptake of the vaccine regimen were less common in public facilities than private facilities. Given the populations served in public facilities and the health disparities that exist in these populations, a greater focus is needed on recommendation for vaccination and follow through. Citation Format: Eric Adjei Boakye, Mrudula Nair, Amy Williams, Elizabeth Alleman, Christine Joseph, Dina Abouelella, Oluwole A. Babatunde, Nosayaba Osazuwa-Peters. Disparities in HPV vaccine uptake and provider recommendation by provider facility type [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A124.

Abstract A130: Trends and factors associated with receipt of human papillomavirus (HPV) vaccine in private, public and alternative settings

Abstract Introduction: Hospitals and private healthcare facilities are the primary setting for administering the human papillomavirus (HPV) vaccine. A goal of the President's Cancer Panel on HPV vaccination is to maximize access to vaccination services through expansion of alternative settings for receiving the HPV vaccine, such as in public health settings, schools and pharmacies. It is unclear whether utilization of these alternative settings for HPV vaccination is increasing, and which factors are associated with accessing these alternative avenues. Methods: In a cross-sectional analysis, we utilized the National Immunization Survey-Teen data from 2014 to 2020 (n = 59,140) to describe trends and factors associated with HPV vaccine uptake in private, public, and alternative settings. We calculated average annual percent change (AAPC) between 2014 and 2020, estimating the proportion of HPV vaccine across settings. Using multinomial logistic regression, we estimated the odds of receipt of HPV vaccine in public health settings and other alternative settings compared to private healthcare settings, adjusting for sociodemographic covariates. Results: We found a non-significant decrease in proportion of individuals receiving vaccines at public health settings (17.7% in 2014 vs. 13.5% in 2020; AAPC = -3.2), and a non-significant increase in private healthcare settings (79.2% in 2014 vs. 83.9% in 2020; AAPC = 0.6). We also found a non-significant decrease in the proportion of individuals receiving vaccines in alternative settings such as schools and pharmacies (3.1% in 2014 and 2.6% in 2020; AAPC = -0.9). Adjusted multinomial logistic regression analyses found several sociodemographic/socioeconomic factors associated with receiving HPV vaccine at public health facilities versus private/hospital settings. The log odds of receiving vaccinations at a public facility vs. a private facility increases almost four times moving from above poverty (earning≥ $75,000) to below poverty (aOR = 3.74; 95% CI 3.06, 4.57). The log odds of receiving HPV vaccines at a public facility compared to a private facility decreased by 26% for White teenagers vs. Black teenagers (aOR = 0.74; 95% CI 0.64, 0.86), and by 24% (aOR = 0.76; 95% CI 0.58, 0.98) for log odds of receiving vaccine at alternative settings for White teenagers vs. Black teenagers. There was also an association between educational level and log odds of receiving vaccines at a public facility (high school or less vs. college graduate aOR = 0.38; 95% CI 0.31, 0.46), and people without physician recommendations were significantly more likely to receive vaccines at public versus private settings (aOR = 1.71, 95% CI 1.41, 2.08). Conclusions: Sociodemographic and socioeconomic factors such as race, poverty, education, and access to physician HPV recommendations are all associated with receiving the HPV vaccine at public health facilities versus private settings. This information is important in targeting increased vaccine uptake among individuals with less access to care due to these factors. Citation Format: Melissa Christina White, Oyomoare L. Osazuwa-Peters, Dina K. Abouelella, Justin M. Barnes, Eric Adjei Boakye, Trinitia Y. Cannon, Tammara L. Watts, Nosayaba Osazuwa-Peters. Trends and factors associated with receipt of human papillomavirus (HPV) vaccine in private, public and alternative settings [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A130.

Celebrating 25 Years of Varicella Vaccination Coverage for Children and Adolescents in the United States: A Success Story.

Tracking vaccination coverage is a critical component of monitoring a vaccine program. Three different surveillance systems were used to examine trends in varicella vaccination coverage during the United States vaccination program: National Immunization Survey-Child, National Immunization Survey-Teen, and immunization information systems (IISs). The relationship of these trends to school requirements and disease decline was also examined. Among children aged 19-35 months, ≥1 dose of varicella vaccine increased from 16.0% in 1996 to 89.2% by the end of the 1-dose program in 2006, stabilizing around at least 90.0% thereafter. The uptake of the second dose was rapid after the 2007 recommendation. Two-dose coverage among children aged 7 years at 6 high-performing IIS sites increased from 2.6%-5.5% in 2006 to 86.0%-100.0% in 2020. Among adolescents aged 13-17 years, ≥2-dose coverage increased from 4.1% in 2006 to 91.9% in 2020. The proportion of adolescents with history of varicella disease declined from 69.9% in 2006 to 8.4% in 2020. In 2006, 92% of states and the District of Columbia (DC) had 1-dose daycare or school entry requirements; 88% of states and DC had 2-dose school entry requirements in the 2020-2021 school year. The successes in attaining and maintaining high vaccine coverage were paramount in the dramatic reduction of the varicella burden in the United States over the 25 years of the vaccination program, but opportunities remain to further increase coverage and decrease varicella morbidity and mortality.