Teen Vaccination Coverage in the United States, 2022

The Advisory Committee on Immunization Practices recommends three vaccines at age 11–12: Tdap (tetanus, diphtheria and acellular pertussis), MenACWY (meningococcal conjugate) and HPV (human papillomavirus, which can be started at 9). A MenACWY booster is recommended at 16, and teens and young adults aged 16–23 may also get serogroup B meningococcal vaccine through shared decision-making with a clinician. Teens should also catch up on any missed childhood vaccines and get a yearly flu shot. CDC's National Immunization Survey–Teen measured how teens were doing in 2022, including whether coverage had recovered from the COVID-19 pandemic.

The survey

The NIS-Teen is a telephone survey of households with teens aged 13–17 in all 50 states, the District of Columbia, selected local areas and some U.S. territories. Parents give consent for their teen's vaccine providers to be contacted, and the providers report vaccination histories. The 2022 estimates were based on provider-reported records for 16,043 teens. The household response rate was 23.0%, and 38.8% of teens with completed interviews had adequate provider data.

Coverage in 2022

Coverage with every recommended vaccine was similar to 2021:

But for the first time since 2013, HPV vaccination starts did not rise. From 2015 to 2021, teens insured by Medicaid had been more likely than privately insured teens to have started the HPV series. In 2022 their coverage dropped by 3.3 percentage points while private coverage held steady, leaving the two groups about even. Uninsured teens remained the least likely to have started.

Coverage varied widely by place:

• Tdap: from 82.7% in California to 97.3% in Iowa.
• MenACWY: from 55.5% in Mississippi to 97.9% in Iowa.
• HPV, at least one dose: from 61.0% in Mississippi to 94.6% in Rhode Island.
• HPV, up to date: from 38.5% in Mississippi to 85.2% in Rhode Island.

The pandemic cohort

Teens born in 2008 turned 12 in 2020 and were due for their adolescent vaccines at the height of the pandemic. By age 13, their coverage was 3.2 percentage points lower for Tdap and 3.0 lower for MenACWY than among teens born in 2007. By age 14, it was 3.8 points lower for Tdap, 3.8 lower for at least one HPV dose, and 5.7 lower for being up to date with HPV — showing the cohort had not caught up by 2022.

CDC chart from the report: coverage by age, by birth year.

The gaps were not the same everywhere. Among teens born in 2008, compared with those born in 2007, Tdap coverage by 14 was 3 to 4 points lower and HPV up-to-date status 5 to 6 points lower among teens at or above the poverty level, non-Hispanic White teens and privately insured teens. Tdap coverage was 4.3 points lower in mostly suburban areas and 4.6 points lower among teens on Medicaid, and in mostly urban areas all four measures were 3.9 to 11.7 points lower, suggesting pandemic disruptions hit cities harder.

Teens born in 2009 were doing as well by 13 as those born before the pandemic, perhaps because they had an extra year after the peak to get vaccinated before falling behind, and because many primary care offices had returned to normal.

Why it matters

Declining HPV starts among Medicaid-insured and uninsured teens — two of the four groups eligible for the Vaccines for Children (VFC) program — point to a need for outreach. VFC ordering data back that up: provider orders for HPV vaccine were 24% lower in 2020, 9% lower in 2021 and 12% lower in 2022 than in 2019, while orders for other vaccines had returned to prepandemic levels.

Many families may have missed well-child visits during the pandemic when vaccines were due. The authors urge providers to review teens' vaccination records, especially for those born in 2008 and those eligible for VFC, and make sure they are up to date with Tdap, MenACWY and HPV vaccines.

Limitations

• The low household response rate may introduce selection bias.
• Weighting adjusts for nonresponse and households without phones, but some bias may remain. Assessments of total survey error suggest the NIS-Teen may underestimate coverage, most of all for Tdap (by 5.0 percentage points), with no sign that its accuracy changed from 2021 to 2022 for routine adolescent vaccines.

Sources

• Cassandra Pingali, David Yankey, Laurie D. Elam-Evans, Lauri E. Markowitz, Madeleine R. Valier, Benjamin Fredua, Samuel J. Crowe, Carla L. DeSisto, Shannon Stokley and James A. Singleton, "Vaccination Coverage Among Adolescents Aged 13–17 Years — National Immunization Survey–Teen, United States, 2022," Morbidity and Mortality Weekly Report, CDC: https://www.cdc.gov/mmwr/volumes/72/wr/mm7234a3.htm