COVID-19 Impact on Adolescent Vaccination Administration Rates in the US Military Health System

PURPOSE: The COVID-19 pandemic had far-reaching impacts on the delivery of preventive health care to pediatric patients worldwide, including outpatient vaccination. Our study assessed the repercussions of the pandemic on the delivery of adolescent vaccines.

METHODS: We utilized the TRICARE Management Activity's Military Health System (MHS) Data Repository to measure the delivery of Human Papillomavirus (HPV), Tetanus, Diphtheria, Pertussis (Tdap), Meningococcal Conjugate Vaccine (MCV4), seasonal influenza (flu), and Neisseria meningitidis serogroup B (MenB) vaccines to adolescent children of United States (U.S.) military members during the prepandemic (March 2018-February 2020) and COVID-19 pandemic (March 2020-February 2022) periods, as well as the delivery of COVID-19 vaccine after it became available. We included those patients aged 11-21 years and eligible for TRICARE health care during these periods and indirectly measured vaccine delivery using the number of Current Procedural Terminology (CPT)-coded vaccinations administered per month to eligible adolescents.

RESULTS: We found that the monthly rates of Human Papillomavirus, Tetanus, Diphtheria, Pertussis, and seasonal influenza vaccination declined during the COVID-19 pandemic as compared to the prepandemic period. In contrast, the monthly rates of MCV4 rose during the second year of the pandemic, and MenB vaccination increased over both years. When COVID-19 vaccination was available, dependent adolescents living outside the continental United States had >2-fold higher COVID-19 vaccination rate than those living in the continental US. We also identified broadly higher vaccination rates among the adolescent children of officers as compared to the adolescent children of junior enlisted members, despite universal insurance coverage to preventive health-care services within the Military Health System.

DISCUSSION: Adolescent vaccination rates in military dependents declined during COVID-19, especially among junior enlisted families and western regions, with slow recovery except for meningococcal vaccines.