Immunizations for Adolescents (IMA-E)*  

The percentage of persons 13 years of age who had one dose of meningococcal vaccine, one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine, and have completed the human papillomavirus (HPV) vaccine series by their 13th birthday. The measure calculates a rate for each vaccine and two combination rates.

Why It Matters?

This measure focuses on improving immunization rates for vaccines that adolescents should receive by 13 years of age. This measure is based on the best available evidence which recommends vaccination against meningococcal disease, These vaccines are available for adolescents to prevent them from acquiring serious diseases and help protect against disease in populations that lack immunity, such as infants, the elderly and individuals with chronic conditions.

In 2024, data from NIS-Teen showed that 91.3% of adolescents surveyed had received one or more Tdap doses, 90.1% had received a meningococcal vaccine and 62.9% had received the full series of the HPV vaccine ^[7]. A 2015 CDC study concluded that differences in adolescent immunization rates suggested missed opportunities for simultaneous administration of routine vaccines ^[8]. Routinely recommending HPV vaccination at ages 11 and 12 during the same visit, and with the same emphasis used for Tdap and meningococcal vaccines, is critical to improve vaccination rates ^[8].

Meningococcal disease can lead to bacterial meningitis and blood stream infections. Symptoms include headache, lethargy, vomiting, irritability, fever, nuchal rigidity, cranial nerve signs, seizures and coma. Infection is spread by direct, close contact with respiratory and oral secretions of an infected person ^[9]. The infection can develop rapidly in previously healthy children and adolescents. Even with appropriate antibiotic therapy, meningococcal disease has an overall case-fatality ratio of 10 percent–15 and as many as 20% of survivors have permanent complications, such as hearing loss, neurologic damage or loss of a limb ^[10].

A recent study suggests that the MenACWY vaccination program in the U.S. was associated with lower burden of meningococcal disease and that incidence rates in adolescents and young adults would have been substantially higher than those observed during the vaccine era ^[11]. A study examining the value of meningococcal vaccination for adolescents and young adults in the U.S. found that compared to no vaccination, vaccination with two doses of MenACWY and MenB was projected to reduce invasive meningococcal disease (IMD) by 277 per year which results in an incremental cost-effectiveness ratio of $625,322 per quality-adjusted life years (QALY) ^[12]. Without meningococcal vaccination, one study estimated that the occurrence of IMD would be around 500 cases of IMD per year which would result in a significant economic burden. Direct medical costs would amount to $84.8 million and productivity losses are estimated at $238.3 million ^[12].

Diphtheria can present as a respiratory or cutaneous disease ^[13]. Complications include myocarditis, which can lead to heart failure, and neuritis, which may temporarily paralyze motor nerves. Death occurs in 5%–10% of cases, with a higher mortality rate in young children (Pan American Health Organization 2026). Tetanus infection is associated with the painful tightening of skeletal muscles. The resulting muscle spasms can cause fractures, difficulty breathing, arrhythmia and death ^[13]. Without intensive care, almost all cases of tetanus are fatal ^[14]. Acellular pertussis, also known as whooping cough, is a highly communicable respiratory infection characterized by a prolonged cough ^[15].

While there are three combination vaccines (DTaP, Td and Tdap) that offer protection against diphtheria, tetanus and acellular pertussis, only the Tdap vaccine series is recommended for adolescents ^{[1,2,3,4, 5, 6]}. Before the development of these vaccines, diphtheria was a common cause of death in children and adolescents. The diphtheria vaccine has virtually eliminated the disease in the U.S.^[16]. Similarly, widespread use of the pertussis vaccine since the 1940s has decreased U.S. pertussis cases by 75% ^[17]. One study estimated that vaccines have prevented 80.7 million cases of pertussis, 7.5 million cases of diphtheria and 5,000 cases of tetanus between 1994 and 2023 ^[18]. The study further suggests that vaccination for the 1994-2023 birth cohorts will avert $540 billion in direct costs and $2.7 trillion in societal costs. Routine vaccination schedules for adolescents recommend administering a single dose of Tdap to all adolescents at age 11 or 12 ^{[1,2,3,4, 5, 6]}.

Human papillomavirus, or HPV, is a viral infection associated with cervical, anal and oropharyngeal cancer and accounts for approximately 47,984 new cancer cases in the U.S. each year (26,280 among females and 21,704 among males) ^[19]. According to a study looking at direct medical costs of HPV, researchers estimated that the direct medical cost of screening and treating HPV-associated disease in the U.S. is $9.01 billion; of this total cost, 55 percent was for routine cervical cancer screening and follow-up, 44 percent was for treatment of HPV-attributable cancer and less than 2 percent was for treating anogenital warts and for recurrent respiratory papillomatosis ^[20].

Vaccines are available that can prevent infection with the strains of HPV that commonly cause cancer. Since its introduction in 2006, the HPV vaccine has reduced the prevalence of HPV infections in adolescent females (aged 14–19) by 88% ^[21]. A recent CDC study suggests that of the 37,800 cancers that were attributable to HPV each year during 2017 to 2021, 35,000 could have been prevented by the 9-valent HPV vaccine ^[22].

This measure was adapted with financial support from the U.S. Centers for Disease Control & Prevention (CDC).

Historical Results – National Averages