Teenage vaccination held steady, except for HPV at thirteen

Three vaccines are routinely recommended for adolescents, and the **Vaccines
for Children (VFC) programme** provides them at no cost to eligible
children and teenagers.

What the survey found

**Overall, vaccination coverage among VFC-eligible adolescents remained stable
across recent birth years** — with one exception:

**A decline in human papillomavirus vaccine up-to-date coverage by age 13
years among those born in 2010 compared with those born in 2007.**

Stability everywhere else, and a fall in one vaccine, measured at one age.

Why HPV, and why by 13

HPV vaccination is the one adolescent vaccine that is routinely delayed rather
than refused. It is recommended at 11–12, and it is the one parents most often
ask to think about — because it is associated with sexual activity in a way
that a tetanus booster is not.

"Up to date by age 13" is therefore a sensitive measure: it captures
whether the series was completed on schedule rather than eventually. A decline
there can mean refusal, and it can equally mean drift — appointments postponed,
second doses not returned for.

Either way it matters, because HPV vaccination works best before exposure, and
"later" narrows the window it was designed for.

What providers are asked to do

**Health care providers should make strong recommendations for all routine
vaccines, and verify if adolescents — particularly those eligible for the
VFC programme — are up to date with all recommended vaccines.**

Strong recommendation is the term of art, and the evidence behind it is
consistent: how a clinician raises HPV vaccination predicts uptake more than
almost anything else. Offering it in the same breath as the other two, rather
than as a separate question, is the intervention.

*Source: Pingali C, Yankey D, Chen M, et al. National Vaccination Coverage
Among Adolescents Aged 13–17 Years — National Immunization Survey-Teen, United
States, 2023. MMWR, Centers for Disease Control and Prevention.*