Minnesota’s medical clinics are getting more toddlers and adolescents up to date on their vaccinations, but the latest state report card shows that the best can do better and the worst are far behind.

An 82-percentage-point gap separated the best- and worst-performing clinics for childhood vaccinations last year, according to MN Community Measurement (MNCM), a nonprofit agency that reports clinic performance on various quality measures. While 85 percent of children at South Lake Pediatrics received recommended shots by age 2 in 2018, only 3 percent of children at Lake Region Healthcare in Fergus Falls received them.

“I always like to focus on that variation and the fact that some providers have been very successful at achieving very high rates,” said Julie Sonier, president of MNCM. “It means that it’s possible.”

Overall clinic ratings were posted last fall on mnhealthscores.org, but MNCM has since issued a series of reports focusing on clinics’ performance in key areas, including the “Combo 10” series of vaccinations that children are supposed to receive by age 2. The combination includes shots to protect against measles, polio, hepatitis and influenza.

On average, 60 percent of children received these vaccinations on schedule in 2018, compared to 54 percent in 2017, the data showed. Sonier said the immunization requirements changed recently, so the improved performance shows that clinics are catching up.

The measure for adolescent immunizations changed as well last year, with the addition of the HPV vaccination, by the time a child reaches 13, to prevent cervical and other cancers.

Clinic performance levels for adolescents plummeted because of the addition of this somewhat controversial vaccination. In 2017, clinics kept 86 percent of adolescents up to date on immunizations, assessing only whether they received tetanus boosters and shots to prevent meningitis. In 2018, with the HPV requirement, only 26 percent of adolescents were considered up to date.

The HPV vaccine has generated objections from some parents because it is designed to protect against a cancer-causing virus that is primarily spread through sexual activity. The American Cancer Society, however, supported the addition of HPV to the state measure, noting that it prevents six types of cancer.

“In the future, we hope to see more 13-year-olds receive the HPV shot at the same time they are vaccinated for the other shots in the combo,” said Matt Flory of the society’s Minnesota chapter.

Clinic scores for adolescent immunizations last year ranged from 11 percent at Grand Itasca Clinic in Grand Rapids to 64 percent at Mayo Clinic in Rochester.