Hepatitis A Vaccination Coverage Among Adolescents Aged 13-17 Years In the United States, National Immunization Survey-Teen, 2009

Background:  The ACIP instituted incremental recommendations for routine Hepatitis A (HepA) vaccination at 2 years based on risk (1996), in selected states (1999), and universally in 2006 at 1 year with vaccination through 18 in areas/communities at high risk of hepatitis A, or for persons who desired protection.

Objectives: We assessed HepA coverage among adolescents and factors independently associated with vaccination.

Methods:  Data from the 2009 National Immunization Survey-Teen (n=20,066) were analyzed to determine ≥1 and ≥2 dose HepA coverage among adolescents 13-17 years. We used bivariate and multivariate analyses to test associations between HepA initiation and sociodemographic characteristics stratified by state groups: Group 1) hepatitis A rates twice national average and universal child vaccination since 1999; Group 2) hepatitis A rates greater than but less than twice national average and recommendations to consider child vaccination since 1999; and Group 3) no recommendation before universal child vaccination at 1 year since 2006.

Results: In 2009, national coverage for ≥1 dose HepA among adolescents was 41.9% (95% CI=40.7%-43.0%).  Seventy-one percent (CI=68.6%-74.1%) of those vaccinated completed the 2-dose series. The frequency of one-dose coverage was highest among Group 1 states 74.3% (CI=71.1-77.1), less for Group 2 states 54.0% (CI=50.5-57.4), and lowest for Group 3 states 27.8% (CI=26.6-29.0). Within each group the adjusted odds ratio (OR) of vaccination initiation were highest for American Indian/Alaskan Natives compared to whites, OR=6.7; CI=2.2-20.3 (Group 1); OR=7.3; CI=2.1-24.9 (Group 2) and for adolescents whose provider recommended HepA, OR=4.0; CI=2.6-6.1 (Group 1); OR=3.3; CI=2.1-5.0 (Group 2); OR=4.5; CI=3.9-5.3 (Group 3). The adjusted OR of HepA initiation were lowest for adolescents in rural compared to urban areas, OR=0.4; CI=0.3-0.5 (Group 3).

Conclusions: There was wide variation in vaccination coverage reflecting incremental recommendations targeting states with highest historical rates of hepatitis A infection. Provider recommendation plays an important role in HepA uptake.