Teen Vaccination in 2024: Tdap and Meningococcal Up, HPV Stuck for a Third Year

The Advisory Committee on Immunization Practices (ACIP) recommends three vaccines for all adolescents at ages 11–12: Tdap (tetanus, diphtheria and pertussis), MenACWY (quadrivalent meningococcal conjugate) and HPV (human papillomavirus). HPV vaccination can start at 9, and a MenACWY booster is due at 16. Through shared clinical decision-making, teens may also get a COVID-19 vaccine and, at 16–23, the MenB vaccine; they should get a yearly flu shot and catch up on missed childhood vaccines. Since 2023, a combined MenABCWY vaccine can be used when MenACWY and MenB are due at the same visit.

CDC's National Immunization Survey-Teen (NIS-Teen) phones parents of teens aged 13–17, then — with permission — asks the teens' vaccination providers for their records. The 2024 estimates rest on provider data for 16,325 teens.

National coverage, 2024

Catch-up and other vaccines also rose: MenB (1+ dose, at age 17) by 4.5 points, and two-dose MMR and three-dose hepatitis B by 1.3 points each. HPV coverage has not increased for three years in a row.

By state

• Tdap coverage was 90% or more in 39 states, MenACWY in 30.
• HPV (1+ dose) was 80% or more in 26 states and the District of Columbia, and at least 65% were up to date in 26 states and DC.
• Being up to date on HPV varied most: from 39.1% in Mississippi to 79.8% in Massachusetts.
• At least one routine adolescent vaccine rose in Florida, Georgia, Kentucky and Virginia.

City, suburb and country

Compared with teens in mostly urban areas (principal cities of metropolitan areas):

Tdap coverage was similar everywhere. The rural–urban gap in HPV vaccination has barely changed since 2016.

Difference in HPV vaccination coverage (1+ dose and up to date) among adolescents aged 13–17, by metropolitan status, over time. CDC / MMWR

A doctor's recommendation matters

Parents reported that a provider had recommended HPV vaccine for 69.4% of urban, 70.9% of suburban and 65.6% of rural teens. Everywhere, coverage (1+ dose) was far higher with a recommendation (77.2%–86.0%) than without (57.2%–68.4%).

But even with a recommendation, rural teens were 8.8 points less likely to have started HPV vaccination than urban teens (suburban teens 3.7 points), and 10.6 points less likely to be up to date. Without a recommendation, rural and suburban teens trailed urban teens by 11.2 and 9.7 points. That suggests other barriers — such as transportation, fewer well-child visits, safety concerns, or different attitudes toward vaccines — which need to be better understood.

What can help

• Providers should discuss and strongly recommend Tdap, MenACWY, HPV and other vaccines, stress the HPV vaccine's role in preventing cancer, and check records at every visit.
• Health departments can use immunization information systems to find low-coverage areas and work with providers and communities to improve access.

Limits

The household response rate was only 21.0%, and 42.8% of completed interviews had adequate provider data, so bias may remain despite weighting. Past error assessments suggest NIS-Teen underestimates coverage — most for up-to-date HPV status (by 5.2 points in 2023), mainly because some vaccinations go unreported.

Sources

Based on Pingali C, Yankey D, Elam-Evans LD, et al., "Vaccination Coverage Among Adolescents Aged 13–17 Years — National Immunization Survey-Teen, United States, 2024," MMWR Morbidity and Mortality Weekly Report, volume 74, Centers for Disease Control and Prevention; a work of the United States government in the public domain.