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

J Adolesc Health. 2023 Sep;73(3):595-598. doi: 10.1016/j.jadohealth.2023.05.008. Epub 2023 Jun 29.


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.

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

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • COVID-19* / prevention & control
  • Child
  • Diphtheria* / prevention & control
  • Diphtheria-Tetanus-acellular Pertussis Vaccines*
  • Humans
  • Immunization Schedule
  • Meningococcal Vaccines*
  • Neisseria meningitidis*
  • Pandemics / prevention & control
  • Papillomavirus Vaccines*
  • Tetanus* / prevention & control
  • Vaccination
  • Whooping Cough*


  • Diphtheria-Tetanus-acellular Pertussis Vaccines
  • Meningococcal Vaccines
  • Papillomavirus Vaccines