News & Views: Do You Know the Answers to These Questions about Teen Vaccinations?

Can you answer these questions about teen vaccinations?

1. How many doses of HPV vaccine should a healthy 14-year-old receive?

   • Zero doses
   • One dose
   • Two doses
   • Three doses

2. Which of the following adolescent-vaccine doses has the lowest coverage as determined by the 2016 NIS – Teen survey?

   1. Adolescent dose of Tdap
   2. Second dose of meningococcal ACWY
   3. Complete series of HPV (based on age)

3. In which setting do teens have the lowest vaccine coverage rates for HPV and meningococcal vaccines?

   1. Non-metropolitan areas
   2. Metropolitan areas not central city
   3. Metropolitan areas center city

4. How does your state compare when it comes to adolescent vaccine coverage rates?

   1. Top 20 percent
   2. Middle of the pack
   3. Bottom 20 percent

The Centers for Disease Control and Prevention (CDC) recently released the results of the 2016 NIS-Teen survey. The questions presented in the beginning of this article highlight some of the important findings of this annual survey of parents and providers. For complete results as well as detailed information about how the survey is conducted, refer to the August 25, 2017, issue of Morbidity and Mortality Weekly Report.

Question 1: How many doses of HPV vaccine should a healthy 14-year-old receive?

The correct answer is (c) — two doses. In December 2016 the CDC changed the recommendations related to HPV vaccine. Healthy adolescents who begin the series before they are 15 years old only need two doses separated by six to 12 months. However, for those who start the series at 15 years or older and those who have immune-compromising conditions, such as HIV, should continue to get three doses in a prime-prime-boost series (0, 1 to 2 months, and 6 to 12 months).

The recent NIS data continued to show improvements in HPV vaccine coverage, but still there is more work to do:

• 43 percent of teens were considered up to date.
• Although completion rates continue to improve, only about 50 percent of girls are up to date and even fewer boys (about 38 percent).
• First dose rates are still low compared to other adolescent vaccines (60 percent HPV versus 88 percent Tdap and 82 percent meningococcus ACWY).

Question 2: Which of the following recommended doses of adolescent vaccine has the lowest coverage as determined by the 2016 NIS-Teen survey?

The correct answer is (b) — second dose of meningococcal ACWY. While HPV vaccine completion rates are low (43 percent), the number of 16-year-olds getting the booster dose of meningococcus ACWY vaccine is even lower. Only 39 percent of 17-year-olds reported having the booster dose. Although a slight improvement over 2015 data (33 percent), this finding is of concern. The booster dose of meningococcus ACWY was recommended due to waning immunity after receipt of the adolescent dose — right as teens approach the time when they are more likely to be at risk of disease. The CDC’s most recent schedule (2017) added a 16-year-old column to highlight the importance of getting 16–year-olds vaccinated according to the recommendations. Dr. Wexler discussed this change extensively in her February 2017 Technically Speaking article.

Question 3: In which setting do teens have the lowest vaccine coverage rates for HPV and meningococcal vaccines?

The correct answer is (a) — non-metropolitan areas. Teens living outside of metropolitan areas reported similar vaccination coverage rates for Tdap, MMR and hepatitis B vaccines, but tended to report lower coverage when it came to receipt of any doses of meningococcal ACWY or HPV. Interestingly, teens outside of metropolitan areas also reported higher rates of history of varicella disease, similar rates of first dose of varicella vaccine, but lower rates of two-dose completion of the varicella vaccine series. Refer to table 2 of the NIS-Teen report to review additional details related to metropolitan area data as well as to review data related to poverty levels.

Question 4: How does your state compare when it comes to adolescent vaccine coverage rates?

This answer is obviously going to depend on where you live and practice medicine. Even if your state is not in the top 20 percent, check the changes between 2015 and 2016 data to see if state or local initiatives that you may have heard about are having an impact.

Table 3 in the report shows regional and state data for each vaccine.

The CDC posted a press release about the data and prepared state coverage maps related to HPV vaccination.