Spatio-temporal Patterns in Individual and Concomitant Adolescent Vaccine Uptake in the State of Georgia, 2006-2017 Open Access
Kettlitz, Alessia (Spring 2023)
Abstract
Objective: The objective of this study was to examine spatio-temporal patterns in adolescent tetanus, diphtheria, and acellular pertussis (Tdap), quadrivalent meningococcal conjugate (MCV4), and human papillomavirus (HPV) vaccination coverage, for individual vaccines as well as receipt of multiple vaccines, in Georgia between the years of 2006-2017.
Methods: We conducted a secondary retrospective quantitative data analysis of state immunization records and census data sets. The population of interest was adolescents born between the years 1995-2008 and living in the state of Georgia between the years 2006-2017. We identified vaccine doses administered using data from Georgia state’s immunization information system. We used Census data to estimate the denominator to estimate population-level proportion estimates of vaccine coverage, by sex and health district, over time.
Results: In 2017, among adolescents born between 1995-2008, Tdap and MCV4 vaccination rates were similar, while HPV vaccine coverage lagged by 20-30 percentage points in comparison. While 36.5% had received all adolescent vaccines, 24.6% only received the Tdap and MCV4 vaccines, potentially indicating HPV vaccine hesitance. More recent birth cohorts had higher vaccine coverage than older birth cohorts (e.g., 41.3% Tdap/MCV4/HPV for those born in 1997/1998 compared to 54.5% Tdap/MCV4/HPV for those born in 2002/2003). There was geographic variation in complete vaccination, with some Health Districts exhibiting high uptake of Tdap/MCV4/HPV, suggesting high vaccine delivery overall, while others had high uptake of Tdap/MCV4 without HPV, indicating high vaccine delivery but potential HPV vaccine hesitance, while others exhibited low uptake of all adolescent vaccines, suggesting overall vaccine delivery issues.
Conclusions: These results indicate a need for studies with improved methods to evaluate adolescent vaccination in Georgia, as well as further research into identifying why some populations have different patterns of vaccine uptake. Future evaluations, with more recent data, can help monitor these trends while also accounting for the impact of the COVID-19 pandemic on adolescent vaccine uptake in Georgia.
Table of Contents
Chapter 1: Introduction 1
Introduction 1
Background & Ramifications 1
Purpose Statement & Research Questions 3
Significance Statement 4
Chapter 2: Literature Review 5
Overview 5
Adolescent Vaccination Coverage in the U.S. and Georgia 8
National Immunization Survey-Teen 8
Georgia Adolescent Immunization Survey 10
Other Data Sources for Estimating Adolescent Vaccine Coverage 13
HPV Vaccination Coverage Among Adolescents 15
Concomitant Adolescent Vaccination 18
Determinants of Vaccination Coverage 19
Adolescent Vaccine Hesitancy in the United States 21
Conclusion 24
Chapter 3: Results 26
Title Page 26
Key Points 27
Abstract 28
Introduction 30
Methodology 31
Overview 31
Data Sources & Instruments 31
Population and Sample 32
Procedures 32
Data Analysis 34
Results 34
Individual Vaccine Coverages 34
Overall Vaccine Coverages by Health District 34
Concomitant Vaccination Over Time 35
Concomitant Vaccination Over Time Stratified by Sex 35
Concomitant Vaccination Stratified by Health District 36
Discussion 36
Limitations 38
Conclusion 39
Tables and Figures 40
Chapter 5: Public Health Implications, Recommendations, and Conclusion 44
Recommendations 44
Conclusion 45
References 47
Appendix 54
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