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Varicella Vaccination Among US Adolescents

Coverage and Missed Opportunities, 2007-2014

Leung, Jessica, MPH; Reagan-Steiner, Sarah, MD; Lopez, Adriana, MHS; Jeyarajah, Jenny, PhD; Marin, Mona, MD

Journal of Public Health Management and Practice: May/June 2019 - Volume 25 - Issue 3 - p E19–E26
doi: 10.1097/PHH.0000000000000819
Research Reports: Research Full Report
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Context: Since 2007, 2 doses of varicella vaccine have been routinely recommended, with a catch-up second dose recommended for those who received only 1 prior dose.

Objective: To examine varicella vaccination coverage with 2 or more doses and the proportions of adolescents with evidence of immunity to varicella (≥2 doses of vaccine or varicella history) during 2007-2014. To assess timing of second-dose receipt, factors associated with 2 or more vaccine doses, and missed second-dose opportunities during 2014.

Design, Setting, and Participants: We used data from the 2007-2014 National Immunization Survey–Teen (NIS-Teen), which collects information on adolescents aged 13 to 17 years in the United States.

Results: From 2007 to 2014, varicella vaccination coverage with 2 or more doses increased from 8.3% to 66.9% in 13- to 15-year-olds and from 3.6% to 56.7% in 16- to 17-year-olds. The proportions with evidence of immunity also increased from 68.0% to 84.1% (13- to 15-year-olds) and 78.6% to 83.4% (16- to 17-year-olds). In 2014, 13.4% of 13- to 15-year-olds and 3.2% of 16- to 17-year-olds had received their second dose at 4 to 6 years of age. Factors most significantly associated with lower coverage with 2 or more doses were not having an 11- to 12-year well-child visit, not receiving an adolescent vaccine, and residence in a state with no 2-dose immunization school entry requirement. Seventy-seven percent of 1-dose vaccinated adolescents had 1 or more missed opportunities to receive their second dose; if were they not missed, 2-dose coverage would have increased from 79.5% to 94.8%.

Conclusions: Levels of varicella vaccination coverage with 2 or more doses and the proportion of adolescents with evidence of immunity increased from 2007 to 2014, though 16% lacked evidence of immunity in 2014. Although catch-up campaigns have succeeded, missed vaccination opportunities persist.

Division of Viral Diseases (Mss Leung and Lopez and Dr Marin) and Immunization Services Division (Dr Reagan-Steiner), National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and Carter Consulting, Inc, Atlanta, Georgia (Dr Jeyarajah). Dr Jeyarajah is now with Robarts Clinical Trials, London, Ontario, Canada.

Correspondence: Jessica Leung, MPH, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS A-34, Atlanta, GA 30333 (JLeung@cdc.gov).

Author Contribution: Ms Leung conceptualized and designed the study, analyzed and interpreted the data, drafted the initial manuscript, and reviewed and revised the manuscript. Dr Reagan-Steiner conceptualized and designed the study, interpreted the data, and critically reviewed the manuscript. Ms Lopez conceptualized and designed the study, interpreted the data, and critically reviewed the manuscript. Dr Jeyarajah compiled the survey data, interpreted the data, and critically reviewed the manuscript. Dr Marin proposed the study, conceptualized and designed the study, interpreted the data, and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

The authors thank Laurie Elam-Evans, PhD, MPH, and Mary Ann Hall, MPH, for their thoughtful review of the manuscript.

The authors have no conflicts of interest to disclose or sources of funding to disclose.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, US Department of Health and Human Services.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://www.JPHMP.com).

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