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
| Vaccine | 2023 | 2024 |
|---|---|---|
| Tdap, 1+ dose | 89.0% | 91.3% ↑ |
| MenACWY, 1+ dose | 88.4% | 90.1% ↑ |
| HPV, 1+ dose | 76.8% | 78.2% (no significant change) |
| HPV, up to date | 61.4% | 62.9% (no significant change) |
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):
| Coverage, percentage points lower | Mostly suburban | Mostly rural |
|---|---|---|
| MenACWY, 1+ dose | — | 3.6 |
| MenACWY, 2+ doses | — | 10.0 |
| HPV, 1+ dose | 4.7 | 10.5 |
| HPV, up to date | 3.0 | 10.8 |
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.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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