COVID-19 Vaccination Coverage Among Adolescents Aged 12–17 Years

United States, December 14, 2020-July 31, 2021

Bhavini Patel Murthy, MD; Elizabeth Zell, MStat; Ryan Saelee, MPH; Neil Murthy, MD; Lu Meng, PhD; Seth Meador, MPH; Kirsten Reed, MPH; Lauren Shaw, MS; Lynn Gibbs-Scharf, MPH; A.D. McNaghten, PhD; Anita Patel, PharmD; Shannon Stokley, DrPH; Stephen Flores, PhD; Jonathan S. Yoder, MPH; Carla L. Black, PhD; LaTreace Q. Harris, MPH

Disclosures

Morbidity and Mortality Weekly Report. 2021;70(35):1206-1213. 

In This Article

Abstract and Introduction

Introduction

Although severe COVID-19 illness and hospitalization are more common among adults, these outcomes can occur in adolescents.[1] Nearly one third of adolescents aged 12–17 years hospitalized with COVID-19 during March 2020–April 2021 required intensive care, and 5% of those hospitalized required endotracheal intubation and mechanical ventilation.[2] On December 11, 2020, the Food and Drug Administration (FDA) issued Emergency Use Authorization (EUA) of the Pfizer-BioNTech COVID-19 vaccine for adolescents aged 16–17 years; on May 10, 2021, the EUA was expanded to include adolescents aged 12–15 years; and on August 23, 2021, FDA granted approval of the vaccine for persons aged ≥16 years. To assess progress in adolescent COVID-19 vaccination in the United States, CDC assessed coverage with ≥1 dose* and completion of the 2-dose vaccination series among adolescents aged 12–17 years using vaccine administration data for 49 U.S. states (all except Idaho) and the District of Columbia (DC) during December 14, 2020–July 31, 2021. As of July 31, 2021, COVID-19 vaccination coverage among U.S. adolescents aged 12–17 years was 42.4% for ≥1 dose and 31.9% for series completion. Vaccination coverage with ≥1 dose varied by state (range = 20.2% [Mississippi] to 70.1% [Vermont]) and for series completion (range = 10.7% [Mississippi] to 60.3% [Vermont]). By age group, 36.0%, 40.9%, and 50.6% of adolescents aged 12–13, 14–15, and 16–17 years, respectively, received ≥1 dose; 25.4%, 30.5%, and 40.3%, respectively, completed the vaccine series. Improving vaccination coverage and implementing COVID-19 prevention strategies are crucial to reduce COVID-19–associated morbidity and mortality among adolescents and to facilitate safer reopening of schools for in-person learning.

Data on COVID-19 vaccine administration in the United States are reported to CDC by jurisdictions, pharmacies, and federal entities through immunization information systems (IISs),§ the Vaccine Administration Management System (VAMS), or direct data submission.** Adolescents aged 12–17 years with valid residence in one of 49 states or DC who received ≥1 dose of a COVID-19 vaccine during December 14, 2020–July 31, 2021, and whose data were reported to CDC by August 11, 2021, were included in this analysis.†† COVID-19 vaccine doses administered to persons residing in Idaho were excluded because the state has data-sharing restrictions on information reported to CDC.

Receipt of ≥1 COVID-19 vaccine dose and series completion among adolescents aged 12–17 years was calculated overall and stratified by age (12–13, 14–15, and 16–17 years), sex, and jurisdiction (49 states and DC). As of August 17, 2021, only the Pfizer-BioNTech vaccine had been authorized for use among adolescents aged 12–17 years in the United States. Moderna and Janssen (Johnson & Johnson) COVID-19 vaccines were not authorized under emergency use for this age group during the analysis period; however, for reasons that are not known, many adolescents were reported to have received these vaccines, and doses administered to adolescents were included in this analysis. Vaccination coverage by race and ethnicity was not calculated because of high rates of missing data. Population size by age group and sex was obtained from the U.S. Census Bureau's 2019 Population Estimates Program.[3] Second dose completion was calculated among adolescents who received ≥1 dose of a 2-dose COVID-19 vaccination series and for whom sufficient time to receive a second dose during the analysis period had elapsed.§§ Among adolescents who received the first dose of a 2-dose COVID-19 vaccination series, the proportions of adolescents who had already received the second dose, of those who had not received the second dose but were still within the recommended time interval to receive the second dose, and of those who had not received and were overdue for the second dose were calculated. Tests for statistical significance were not conducted because these data are reflective of the U.S. population (excluding Idaho) and were not based on population samples. All analyses were conducted using SAS software (version 9.4; SAS Institute). This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.¶¶

As of July 31, 2021, 42.4% of adolescents aged 12–17 years had received ≥1 dose of a COVID-19 vaccine (Table 1), and 31.9% had completed the vaccination series (Table 2). Adolescent COVID-19 vaccination coverage with ≥1 dose varied by state (range = 20.2% [Mississippi] to 70.1% [Vermont]), as it did for series completion (range = 10.7% [Mississippi] to 60.3% [Vermont]), with higher vaccination coverage in the Northeast and on the West Coast and lower vaccination coverage in the South (Figure). Coverage was higher among adolescents aged 16–17 years (50.6% for ≥1 dose; 40.3% for series completion) than among those aged 12–13 years (36.0% for ≥1 dose; 25.4% for series completion) and 14–15 years (40.9% for ≥1 dose; 30.5% for series completion). Vaccination coverage was similar among males and females across all age groups.

Figure.

Percentage of adolescents aged 12–17 years who completed the COVID-19 vaccination series*,†— United States,§ December 14, 2020–July 31, 2021
Abbreviation: DC = District of Columbia.
*As of August 17, 2021, only the Pfizer-BioNTech vaccine had been authorized for use among adolescents aged 12–17 years. Moderna and Janssen (Johnson & Johnson) COVID-19 vaccines were not authorized under emergency use for this age group during the analysis period; however, many adolescents had documentation of receipt of these vaccines. Thus, these vaccine doses were included in this analysis if they were administered to adolescents aged 12–17 years.
Series completion was defined as receipt of either both doses of the Pfizer-BioNTech or Moderna vaccines, including those who might have received mismatched products between the first and second dose (i.e., Pfizer-BioNTech for the first dose and Moderna for the second dose or vice versa) or a single dose of the Janssen vaccine.
§COVID-19 vaccine doses administered to adolescents residing in Idaho were excluded because the state has data-sharing restrictions on information reported to CDC.

Overall, 86.8% of adolescents aged 12–17 years who received the first dose of a 2-dose COVID-19 vaccination series*** received the second dose within the recommended interval. A total of 2.4% had not received the second dose but were within the allowable interval, and 10.8% were overdue for the second dose (i.e., >42 days since receipt of the first dose) (Supplementary Table, https://stacks.cdc.gov/view/cdc/109000).

*Receipt of ≥1 COVID-19 vaccine dose is defined as having received either ≥1 of the 2 Pfizer-BioNTech or Moderna vaccine doses, or a single dose of the Janssen (Johnson & Johnson) vaccine. As of August 17, 2021, only the Pfizer-BioNTech vaccine had been authorized for use among adolescents aged 12–17 years. Moderna and Janssen COVID-19 vaccines were not authorized under emergency use for this age group during December 14, 2020–July 31, 2021. However, doses of these vaccines administered to persons aged 12–17 years were included in this analysis. During February 27, 2021–July 31, 2021, a total of 21,919 adolescents aged 12–17 years were reported to have received 1 dose of the Janssen COVID-19 vaccine. During December 14, 2021–July 31, 2021, a total of 27,226 adolescents aged 12–17 years were reported to have received only the first dose of the Moderna COVID-19 vaccine; 66,032 adolescents aged 12–17 years were reported to have received both doses of the Moderna COVID-19 vaccine; 2,190 were reported to have received Pfizer-BioNTech for the first dose but Moderna for the second dose; and 5,726 were reported to receive Moderna for the first dose but Pfizer-BioNTech for the second dose.
Series completion was defined as receipt of either both doses of the Pfizer-BioNTech or Moderna vaccines, including those that might have received mismatched products between the first and second dose (i.e., Pfizer-BioNTech for the first dose and Moderna for the second dose or vice versa) or a single dose of the Janssen vaccine.
§IISs are confidential, computerized, population-based systems that collect and consolidate vaccination data from providers in 64 public health jurisdictions and can be used to track administered vaccines and measure vaccination coverage. The 64 IIS jurisdictions comprise the 50 U.S. states, eight U.S. territories and freely associated states (Puerto Rico, U.S. Virgin Islands, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Marshall Islands, Palau, and the Federated States of Micronesia), and six local jurisdictions (Chicago, IL; Houston, TX; San Antonio, TX; Philadelphia, PA; New York City, NY; and Washington, DC).
https://www.cdc.gov/vaccines/covid-19/reporting/vams/program-information.html
**https://www.cdc.gov/vaccines/covid-19/reporting/overview/IT-systems.html
††Providers are required to document vaccination in their medical records within 24 hours of administration and submit these data to their jurisdiction's IIS within 72 hours of administration.
§§Although the recommended interval between doses is 21 days for the Pfizer-BioNTech vaccine, adolescents whose second doses were administered as early as 17 days after the first dose or >21 days after the first dose were considered to have completed the vaccination series. As of August 17, 2021, the Moderna COVID-19 vaccine had not been authorized for use among adolescents. However, the interval between the 2 Moderna COVID-19 vaccine doses was assessed in the analysis. Although the recommended interval between doses is 28 days for the Moderna vaccine, second doses received as early as 24 days after the first dose or >28 days after the first dose were considered to complete the vaccine series.
¶¶45 C.F.R. part 46.102(l)(2); 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.
***Among persons who received their first dose on or before July 6, 2021, for Pfizer-BioNTech (i.e., >25 days between the first dose and July 31, 2021) or June 29, 2021, for Moderna (i.e., >32 days between the first dose and July 31, 2021). Percentages might not sum to 100% because persons who were not yet due for the second dose were excluded from this analysis.

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