Concomitant Adolescent Vaccination in the U.S., 2007–2012

Abstract

Introduction Concomitant (same-day) delivery of two or more vaccines to adolescents is effective, safe, and efficient. Increasing concomitant vaccination could improve coverage for recommended adolescent vaccines, but little is known about who receives vaccines concomitantly. Methods Data came from healthcare provider–verified records on 70,144 adolescents (aged 13–17 years) in the 2008–2012 versions of the National Immunization Survey–Teen who had received at least one dose of tetanus, diphtheria, and acellular pertussis (Tdap) booster, meningococcal conjugate vaccine (MenACWY), or human papillomavirus (HPV) vaccine. Separately for each vaccine, multivariable logistic regression identified adolescent and household correlates of concomitant versus single vaccination, stratified by adolescent sex. Vaccination took place in 2007–2012, data collection in 2008–2012, and data analysis in 2015. Results Among vaccinated adolescents, 51%–65% of girls and 25%–53% of boys received two vaccines concomitantly. Concomitant uptake of each vaccine increased over survey years (e.g., 2012 vs 2008: girls’ Tdap booster, OR=1.88, 95% CI=1.56, 2.26; boys’ Tdap booster, OR=2.62, 95% CI=2.16, 3.16), with the exception of HPV vaccination among boys. Additionally, concomitant vaccination was less common as adolescents got older and in the Northeast (all p<0.05). For MenACWY and HPV vaccine, concomitant uptake was less common for girls whose mothers had higher versus lower education and for boys who lived in metropolitan versus non-metropolitan areas (all p<0.05). Conclusions Missed opportunities for concomitant adolescent vaccination persist, particularly for HPV vaccine. Future interventions targeting groups with low rates of concomitant vaccination could improve population-level coverage with recommended vaccines.

Parent-Provider Communication of HPV Vaccine Hesitancy

“…Future research should assess the quality of parent-provider communication when parents express HPV vaccine hesitancy, in the context of concomitant adolescent vaccine delivery. 40 Such research is needed given recent revisions to the Healthcare Effectiveness Data and Information Set (HEDIS) metrics to evaluate vaccine delivery via one combined measure of HPV, meningococcal, and Tdap vaccine administration, as opposed to measuring HPV separately. 41 This change may prompt more providers to bundle their recommendations and increase concomitant delivery of the three vaccines, in alignment with recommendations by Centers for Disease Control and Prevention and AAP.…”

“…41 This change may prompt more providers to bundle their recommendations and increase concomitant delivery of the three vaccines, in alignment with recommendations by Centers for Disease Control and Prevention and AAP. 42 While some evidence suggests that concomitant delivery improves HPV vaccine uptake, 40 the extent to which parents will express hesitancy specifically to the HPV vaccine (versus other adolescent vaccines) is not yet known.…”

Parents' willingness to get human papillomavirus vaccination for their adolescent children at a pharmacy

“…Our finding that parents who believed HPV vaccine was as or more important than other adolescent vaccines were more willing to get the vaccine for their children at a pharmacy suggests that normalizing HPV vaccine may increase demand for this vaccine in pharmacies. Furthermore, because routine concomitant vaccination has been associated with increased HPV vaccine uptake (Moss et al, 2016), pharmacies that offer the adolescent vaccine platform may improve vaccination coverage. Parents of older adolescents, ages 13–17, were also more willing to get HPV vaccine for their children at a pharmacy, an important finding because this population is overdue for HPV vaccination.…”

Missed Opportunities for Human Papillomavirus Vaccine Initiation in an Insured Adolescent Female Population

“…It stands to reason that “normalization” of HPV vaccination—that is, conceptually bundling it with the other adolescent vaccines and presenting that bundle as a package to families—might increase HPV vaccination rates [ 21 ]. The adoption of a 2-dose series for healthy persons in the 11- to 12-year age range also might serve to increase completion rates [ 22 ], although a disconnect between the HPV and other adolescent vaccines is still likely.…”