1. Progress in adolescent vaccination coverage levels in the United States National Immunization Conference Washington, DC March 31, 2011 Shannon Stokley, MPH Immunization Services Division National Center for Immunization and Respiratory Diseases

2. Overview  Review the National Immunization Survey – Teen  Vaccination coverage levels – Progress over four years – Vaccination at ages 11-12 years – Missed opportunities due to non- simultaneous vaccination – HPV vaccine intentions

3. Timeline of Adolescent vaccine recommendations Nov 1996: ACIP adolescent statement published May 2005: Meningococcal conjugate vaccine recommendations published Mar 2006: Tdap vaccine recommendations published Mar 2007: HPV vaccine recommendations published Jun 2007: 2 nd dose varicella vaccine recommendations published Aug 2008: Influenza recommendations for children 5- 18 years published Jan 2011: Meningococcal booster dose at age 16 yrs published Removal of 5 year interval between Td and Tdap published Removal of 5 year interval between Td and Tdap published

5. National Immunization Survey-Teen Methods  Uses National Immunization Survey (NIS) sample frame methodology – Random digit dial telephone survey – National sample of parents of 13-17 year olds – Provider record check for verification of immunizations  Survey years: 2006 – 2009  All analyses limited to adolescents with provider verified immunization histories  HPV results are among females only

6. NIS-Teen Population  2006 (National only) – Conducted during the 4 th quarter (N=2882)  Adolescents born Oct 1988 – Feb 1994  2007 (National only) – Conducted during the 4 th quarter (N=2947)  Adolescents born Oct 1989 – Feb 1995  2008 (National and State level) – Conducted all 4 quarters (N=17,835)  Adolescents born Jan 1990 – Feb 1996  2009 (National and State level) – Conducted all 4 quarters (N=20,066)  Adolescents born Jan 1991 – Feb 1997

7. Estimated vaccination coverage among adolescents aged 13-17 years, NIS-Teen 2009 CDC. MMWR 2010;59:1018-1023 *Among females that initiated the series at least 24 weeks prior to the interview date, 68% received all 3 doses.

11. Estimated vaccination coverage among adolescents aged 13-17 years – NIS- Teen 2006-2009 *2006: HPV-1 was not reported; 2007: HPV-3 was not reported HP 2020 Objective (13-15yo)

12. Percent of adolescents who received all* vaccines routinely recommended for adolescents by gender and survey year, NIS- Teen 2006-2009 *Males and Females (w/o HPV): all is defined as receipt of ≥1 Td/Tdap and ≥1 MenACWY *Females (w/HPV): all is defined as receipt of ≥1 Td/Tdap, ≥1 MenACWY, and ≥1 HPV

13. Vaccination coverage by age 13 years by birth cohort, NIS-Teen 2009 **Cohort was 12yrs when vaccine licensed **

14. Comparison of actual and potentially achievable vaccination coverage if all indicated vaccines had been administered during the same visit, NIS-Teen 2009 HPV-1 results among females only.

15. Parent-reported receipt of a provider recommendation* by vaccine, NIS-Teen 2007-2009 *Based on responses to the question: “Has a doctor or other health care professional ever recommended that [TEEN] receive [VACCINE]?” **Among adolescent females

16. Percent vaccinated by provider recommendation, 2009 NIS-Teen

17. Intent to vaccinate with HPV among parents of females who have not received any HPV vaccine*, NIS-Teen 2009 *56% of females did not receive any HPV vaccine

18. Main reasons* for not receiving HPV vaccine among respondents who do not intend to vaccinate in the next 12 months, NIS-Teen 2009 *Not mutually exclusive **Did not know much about HPV or HPV vaccine

19. Summary  Vaccination coverage is increasing but is below national targets – Wide variation among states  Vaccination at ages 11-12 years is increasing – HPV at this age lags behind other vaccines  Missed opportunities are common  ~50% of parents report receiving vaccine recommendation  Challenges with HPV acceptance