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

Discussion

Among all U.S. adolescents aged 12–17 years who received the first dose of a 2-dose COVID-19 vaccine series, the vast majority received the second dose, indicating high adherence to completing the COVID-19 vaccine series. However, as of July 31, 2021, only 42.4% of adolescents had received ≥1 dose of a COVID-19 vaccine, and fewer than one third (31.9%) had completed the vaccination series. Further, vaccination coverage varied widely by state, with those in the Northeast and on the West Coast reporting the highest COVID-19 vaccination coverage among adolescents. Vaccination coverage also varied widely by age group, with reported coverage higher among those aged 16–17 years compared with those aged 12–15 years. This is likely because the older age group has been vaccine-eligible for a longer period (i.e., since December 2020).

After the start of the COVID-19 pandemic, many schools shifted to virtual or hybrid learning. Because in-person learning fosters social and emotional development,††† safely returning to schools for in-person learning remains a goal. However, given the rapid emergence and spread of the highly transmissible B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, and the increase in cases and hospitalizations among children and adolescents,[1] ensuring high adolescent vaccination coverage is crucial to a safer return to the classroom. Unvaccinated or undervaccinated adolescents can become ill with COVID-19 and spread the SARS-CoV-2 virus in schools, and by extension, in local communities, placing other populations at risk. School systems can consider implementing layered prevention strategies consistent with CDC's guidance for COVID-19 prevention in schools, including universal indoor masking regardless of vaccination status, improving ventilation, screening testing, physical distancing where feasible, and contact tracing in combination with quarantine and isolation. As the 2021–22 school year begins, concerted public health efforts are needed to increase COVID-19 vaccination coverage among adolescents in addition to implementing COVID-19 prevention strategies based on community transmission.

Public health practitioners can use various measures to increase adolescent COVID-19 vaccination coverage. Building on lessons from the public-private partnership between CDC and retail pharmacies in the Federal Retail Pharmacy Partnership§§§ regarding vaccination clinics offered for selected population groups at different times throughout the response,[4] local public health agencies and pharmacies could partner with school districts and school systems to provide COVID-19 vaccinations to students at schools. Vaccine administration on site at schools is an effective, evidence-based intervention that improves childhood and adolescent vaccination rates for routinely recommended vaccines.[5] State and local governments, school administrators, community leaders, health care professionals, and public health practitioners can facilitate safer return to schools and improve equity among sociodemographic groups by prioritizing COVID-19 vaccination among adolescents and incorporating on-site school vaccinations for eligible students.[6,7] In addition, on-site vaccination clinics might also be planned in coordination with other school-based vaccination programs, such as those for seasonal influenza and routine adolescent vaccination.

Concerted outreach can help inform adolescents and their parents about the importance of COVID-19 vaccination. Effective outreach with tailored communication could help improve vaccine confidence, acceptance, and coverage among adolescents and their parents. In a recent report, only 56% of parents of unvaccinated adolescents aged 12–17 years expressed intent for their adolescent to receive a COVID-19 vaccine.[8] Given that parental vaccination status is a marker for adolescent vaccination status,¶¶¶ vaccine hesitancy or antivaccination sentiments among parents might directly lead to missed opportunities to vaccinate adolescents.[9] Among adolescents and their parents who were surveyed about their intent to receive a COVID-19 vaccine, many reported that having more information about the safety and efficacy of COVID-19 vaccines would increase their likelihood of receiving a vaccine.[8] Public health practitioners can use multimodal outreach efforts involving a variety of traditional and social media platforms to engage adolescents and their parents to improve vaccination acceptance and coverage. Further, state and local governments can consider strategies that encourage receipt by adolescents of all vaccines recommended by the Advisory Committee on Immunization Practices, especially given the declines in routine childhood and adolescent vaccinations during the pandemic.[10]

The findings in this report are subject to at least five limitations. First, vaccination coverage rates were aggregated and analyzed only at the state level. Calculating coverage at more specific levels (e.g., by county or urban-rural classification) could potentially identify geographic areas with low vaccination coverage rates. Second, because Idaho was excluded from the analysis, the findings are not representative of the entire United States. Third, adolescents who received COVID-19 vaccines from different entities that used different methods for submitting data (e.g., if the first dose was administered at a pharmacy and the second dose was given at a mass vaccination site) might not have their first and second doses linked, which could have led to underestimation of the percentage of adolescents who completed the vaccination series. Fourth, if an adolescent had inadvertently received a different recipient ID when receiving their second dose, first and second doses could not be linked. Finally, vaccination coverage could not be calculated on the basis of race and ethnicity because of incomplete reporting.

An estimated 2 million COVID-19 cases and approximately 300 associated deaths have been reported among children aged 5–17 years since the start of the COVID-19 pandemic.[1] As persons in younger age groups become eligible for COVID-19 vaccination, public health practitioners, health care professionals, school administrators, and state and local governments can use evidence-based practices to decrease barriers to vaccination and increase confidence in COVID-19 vaccines, which can help facilitate the safer return to in-person learning at schools and ultimately reduce COVID-19–associated morbidity and mortality.

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