Racial and Ethnic Disparities in Meningococcal Vaccination Coverage and Disease Burden Among U.S. Adolescents

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PURPOSE: Examining racial disparities in meningococcal vaccination (MenACWY) uptake and disease burden is essential for understanding the potential implications of a revised MenACWY schedule and guiding targeted efforts to reduce health inequities. We assessed associations of socioeconomic factors with MenACWY coverage (≥1 dose), drop-out from the second (booster) dose, and disparities in vaccination coverage and invasive meningococcal disease (IMD) burden among adolescents aged 13-17 years living in noninstitutionalized households in the United States. METHODS: We conducted a retrospective cross-sectional study (2016-2022) using National Immunization Survey-Teen data for vaccine uptake, and Centers for Disease Control and Prevention data for IMD incidence. Segmented logistic regression analyzed MenACWY uptake and drop-out trends. Multivariable models assessed associations with poverty-income ratio, maternal education, and access barriers. Adjusted odds ratios (aORs) compared uptake and drop-out across racial groups, and Poisson regression estimated adjusted relative risks for IMD incidence. RESULTS: Compared to non-Hispanic (NH) White adolescents, NH African American (aOR: 1.33; 95% confidence interval [CI]: 1.23-1.44) and Hispanic (aOR: 1.20; 95% CI: 1.13-1.29) adolescents had higher odds of receiving ≥1 MenACWY dose. Hispanic adolescents had lower odds of drop-out (aOR: 0.79; 95% CI: 0.70-0.89), while NH African American (p = .148) and Other/Multiple races adolescents (p = .098) showed no significant difference. Drop-out was higher among low-income adolescents (p < .001) and those whose mothers did not have college education (aOR: 1.26; 95% CI: 1.14-1.39). Among 16-23-year-olds, IMD incidence was significantly higher in African Americans compared to Whites (adjusted relative risk: 2.66; 95% CI: 1.39-5.07). DISCUSSION: Persistent disparities in MenACWY coverage and disease burden among US adolescents by race and socioeconomic status highlight the need for targeted efforts within the two-dose program.

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