Adolescent immunizations: Are we ready for a new wave? Original Research Article

Context Factors associated with vaccination coverage rates for the 20% of U.S. adolescents enrolled in managed care organizations (MCOs) are not known. Objectives To examine recent trends in receipt of two doses of measles–mumps–rubella (MMR2) and three doses of hepatitis B (Hep B3) among U.S. adolescents enrolled in managed care organizations (MCOs); to determine whether specific characteristics of MCOs are associated with higher vaccination rates; and to assess the impact of state middle school immunization requirements on these rates. Design Longitudinal (1996–1999) and cross-sectional (1999) analyses of National Committee for Quality Assurance (NCQA) data to estimate adolescent vaccination coverage rates for MMR2 and Hep B3. In 2002, using 1999 data only, a cross-sectional analysis examined the relationship of specific plan characteristics and state immunization laws with immunization coverage. Main outcome measures Percentage of 13 year olds in MCOs with documented receipt of MMR2 and Hep B3. Results From 1996 to 1999, MMR2 rates increased from 56% to 64%, and from 1997 to 1999, Hep B3 rates increased from 23% to 38%. By 1999, higher rates for both vaccines had been achieved in larger plans (p<0.001 and p<0.003 for MMR2 and Hep B3, respectively), those with the highest NCQA accreditation status (p<0.003), those in New England (p<0.001), and those in states with middle school immunization requirements (p<0.001). Conclusions Despite encouraging increases, adolescent immunization rates are significantly below the Healthy People 2010 goal of 90%. State laws and accreditation incentives are effective. Research is needed to identify additional interventions to increase vaccination coverage in the adolescent population.