Missed Opportunities for Adolescent Immunizations at Well-Care Visits During the COVID-19 Pandemic.

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Publication Date



DOI: 10.1016/j.jadohealth.2023.05.008; PMCID: PMC10307534


PURPOSE: The Coronavirus Disease 2019 pandemic disrupted healthcare, but the impact on vaccination missed opportunities (MOs, vaccine-eligible visits without vaccination) is unknown. We evaluated pandemic-related trends in MOs at adolescent well-care visits for three vaccines: human papillomavirus; quadrivalent meningococcal conjugate; and tetanus, diphtheria, and acellular pertussis (Tdap).

METHODS: We analyzed electronic health record data from 24 pediatric primary care practices in 13 states from 1/1/2018 to 12/31/2021. Segmented logistic regression estimated risk differences for MOs during the pandemic relative to prepandemic trends.

RESULTS: Among 106,605 well-care visits, we observed decreases in MOs prepandemic followed by an increase in MOs during the pandemic for all three vaccines. Relative to prepandemic, MOs increased for human papillomavirus (+15.9%, 95% confidence interval [CI]: 11.7%, 20.1%), meningococcal conjugate (+9.4%, 95% CI: 5.2%, 13.7%), and tetanus, diphtheria, and acellular pertussis (Tdap) (+ 8.2%, 95% CI: 4.3%, 12.1%).

DISCUSSION: Increases in vaccine MOs during the pandemic equaled or exceeded pre-pandemic decreases. Reducing MOs in adolescent well-care could raise vaccine coverage.

Journal Title

The Journal of adolescent health : official publication of the Society for Adolescent Medicine





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MeSH Keywords

Humans; Adolescent; Child; Diphtheria-Tetanus-acellular Pertussis Vaccines; Pandemics; Tetanus; Diphtheria; Whooping Cough; Immunization Schedule; COVID-19; Vaccination; Neisseria meningitidis; Meningococcal Vaccines; Papillomavirus Vaccines


COVID-19 pandemic; Missed opportunities; Pediatric research in office settings (PROS); Vaccination

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