BACKGROUND/PURPOSE: The United States (US) Advisory Committee on Immunization Practices recommends that adolescents aged 16-23 years receive meningococcal B (MenB) vaccination based on shared clinical decision-making, with a preferred age of 16-18 years. Because the vaccine is not included as part of routine vaccination, coverage among US adolescents is generally low. This study aimed to identify factors associated with MenB vaccination, focusing on sociodemographic and health care resource use characteristics, as well as geographic region of residence.
METHODS: A retrospective analysis of pooled 2016-2018 National Immunization Survey-Teen data was conducted, including adolescents with adequate provider-reported vaccination data who were aged 17 years at the time of the survey. MenB vaccination coverage (defined as the proportion of adolescents who received ≥1 dose of MenB vaccine at any age) was estimated overall and by individual-level characteristics, including whether the adolescents were up-to-date with quadrivalent meningococcal conjugate (MenACWY) vaccination (defined as receipt of a primary dose at 11-15 years and a booster dose at 16-17 years). Associations between MenB vaccination and individual-level characteristics were further evaluated using multivariable logistic regression, with covariates chosen using a systematic variable selection process. Adjusted odds ratios with corresponding 95% confidence intervals (CIs) and p-values were calculated. MenB vaccination coverage was estimated by geographic region (defined based on an individual’s state of residence, grouped by census divisions), and adjusted for the selected individual-level characteristics. Analyses were weighted based on the survey’s sampling design to be representative of all US adolescents aged 17 years, with coverage estimates representing averages over 2016-2018.
RESULTS: A total of 10,995 adolescents met the inclusion criteria. An estimated 12.0% of US adolescents have received ≥1 dose of MenB vaccination (males: 11.3%; females: 12.7%) and 5.2% have received ≥2 doses. MenB vaccination coverage was higher among adolescents up-to-date vs. not up-to-date with MenACWY vaccination (20.4% [CI: 18.3-22.7%] vs. 5.2% [CI: 4.2-6.6%], respectively [p<0.0001]). Factors significantly associated with higher likelihood of receiving ≥1 dose of MenB (Figure 1) include: having Medicaid vs. private/other insurance, aged 16-17 at last check-up, receiving a health care provider (HCP) recommendation for human papillomavirus (HPV) vaccine, up-to-date with HPV vaccination, up-to-date with MenACWY vaccination, and residence in South Atlantic or Mountain census divisions vs. New England. Figure 2 illustrates model-adjusted MenB vaccination coverage by geographic region.
CONCLUSION: Being up-to-date with other adolescent vaccinations and utilization of health care services by older adolescents is associated with a higher likelihood of MenB vaccination, highlighting the importance of regular health care visits at ages 16-17 years. Future research should explore reasons for geographic disparities in MenB vaccination and barriers to vaccination among older adolescents, including understanding HCP attitudes and practices regarding MenB vaccination.
