Meningococcal vaccination disparities in the United States (2010-2021): Findings from the National Immunization Survey-Teen and a commercial insurance database.

Abstract

In the United States, while meningococcal vaccines are available and recommended for adolescents and young adults, coverage remains low and disparities persist. We evaluated meningococcal serogroups A, C, W, Y (MenACWY) and B (MenB) vaccine uptake, completion, and compliance using a cross-sectional analysis of National Immunization Survey-Teen (NIS-Teen) data (2015-2021) and a cohort analysis of commercial claims data (2010-2021). Regression models were used to identify factors associated with vaccine uptake. Included in the NIS-Teen MenACWY and MenB analyses were 138,952 and 177,077 patients, respectively. Included in the claims MenACWY and MenB analyses were 953,905 and 818,424 patients, respectively. In 2021, MenACWY uptake was 86.4% (95% confidence interval [CI]: 83.6-88.8%) among ≤13-year-olds (NIS-Teen) and 63.2% (62.8-63.5%) among 11-12-year-olds (claims). MenB was 33.7% (30.5-37.1%) among ≤17-year-olds (NIS-Teen), 41.6% (41.2-42.0%) among 16-18-year-olds (claims), and 15.0% (14.7-15.4%) among 19-23-year-olds (claims). The states with the lowest and highest MenB uptake by ≤17-year-olds in 2021 (NIS-Teen) were Minnesota (10.1% [3.9-23.6%]) and North Dakota (69.9% [52.1-83.2%]). Factors associated with MenACWY uptake included living in a state with a vaccine mandate, Black or Hispanic race (versus White), and well-child visit attendance. Factors associated with MenB uptake included having Medicaid (versus private insurance) and Hispanic race (versus White). The findings suggest that meningococcal vaccination coverage disparities persist across vaccines, age, geography, and race and ethnicity. Higher MenACWY (versus MenB) coverage suggests the benefit of routine recommendations. Annual well-child visits and simplified vaccination schedules could reduce vaccination access barriers.