National and State-Level Composite Completion of Recommended Vaccines Among Adolescents in the United States, 2015-2018.

Abstract Background Routine adolescent vaccination recommendations in the United States include tetanus, diphtheria, and acellular pertussis, quadrivalent meningococcal conjugate vaccine, and human papillomavirus vaccines. Although coverage for these individual vaccines is known, limited data are available on composite completion for all three vaccines. Methods This cross-sectional analysis of pooled 2015–2018 National Immunization Survey–Teen data used logistic regression to estimate model-adjusted composite vaccination completion nationally and by state among United States adolescents aged 17 years. National Immunization Survey–Teen data were combined with state-level data to estimate a multilevel model identifying factors associated with composite vaccination completion. Results The pooled model-adjusted composite vaccination completion was 30.6% (95% confidence interval [CI], 30.13%–31.04%) nationally, varying from 11.3% in Idaho (6.91%–17.95%) to 56.4% (49.81%–62.82%) in Rhode Island. Individual-level factors with the greatest impact on composite completion were having a provider's recommendation for human papillomavirus vaccination (odds ratio, 3.24; 95% CI, 2.76–3.80) and a check-up visit at age 16–17 years (odds ratio, 2.35; 95% CI, 1.80–3.07), with other individual-level factors associated with completion including being Medicaid insured, female, Hispanic, or non-Hispanic black. State-level quadrivalent meningococcal conjugate vaccination mandates were also associated with an increased likelihood of composite vaccination completion (odds ratio, 1.64; 95% CI, 1.16–2.33). Conclusions Fewer than one-third of 17-year-old individuals have completed all three recommended vaccines, with rates varying by state. Although this study identified implementable strategies to improve composite completion, additional research is needed to further understand factors associated with adolescent vaccination completion.