Vaccination Coverage Among Adolescents Aged 13–17 Years — National Immunization Survey-Teen, United States, 2024

Abstract

Three vaccines are recommended for routine administration to adolescents by the Advisory Committee on Immunization Practices: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap); quadrivalent meningococcal conjugate vaccine (MenACWY); and human papillomavirus (HPV) vaccine. Data from the 2024 National Immunization Survey-Teen were analyzed to determine national, state, and selected local area vaccination coverage in 2024. Household response rate (21.0%) and receipt of adequate provider data for adolescents with completed interviews (42.8%) were comparable to prior survey years. Among 16,325 adolescents aged 13-17 years with adequate provider data included in the survey, coverage with ≥1 Tdap dose increased from 89.0% in 2023 to 91.3% in 2024; coverage with ≥1 MenACWY dose increased from 88.4% to 90.1%. HPV vaccination coverage remained stable for the third consecutive year; 78.2% of adolescents had received ≥1 dose, and 62.9% were up to date with the HPV vaccination series. Coverage with ≥1 Tdap dose was ≥90% in 39 states, with ≥1 MenACWY dose was ≥90% in 30 states, and with ≥1 dose of HPV vaccine was ≥80% in 26 states and the District of Columbia. Since 2016, lower HPV vaccination coverage in nonmetropolitan statistical areas (MSAs) compared with that in MSA principal cities has persisted, with an 11 percentage point difference in coverage with ≥1 HPV vaccine dose and percentage of adolescents up to date with HPV vaccination in 2024. Health care providers can support adolescent health by discussing and recommending vaccines, as well as reviewing patient records to ascertain whether adolescents are up to date with recommended vaccines.

Introduction

Adolescent vaccination is an important tool for supporting health during adolescence and beyond. The Advisory Committee on Immunization Practices (ACIP) recommends that adolescents aged 11–12 years receive tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap); quadrivalent meningococcal conjugate vaccine (MenACWY); and human papillomavirus (HPV) vaccine. HPV vaccination may be started at age 9 years. A booster dose of MenACWY should be administered at age 16 years. On the basis of shared clinical decision-making, adolescents may receive a COVID-19 vaccine,* and persons aged 16–23 years may receive serogroup B meningococcal vaccine (MenB). In addition, adolescents should receive an annual influenza vaccination^† and catch up on any missed childhood vaccines (1). Since 2023, ACIP has recommended that pentavalent meningococcal vaccine (MenABCWY) can be used when both MenACWY and MenB are indicated at the same visit^§ This report summarizes coverage with these vaccines in 2024 (excluding influenza and COVID-19 vaccines and MenABCWY vaccine, as limited data were available for MenABCWY vaccine in 2024) and compares coverage with that in 2023, using data from the National Immunization Survey-Teen (NIS-Teen).

Methods

Survey Methodology

NIS-Teen is an annual two-phase survey that monitors vaccination coverage in the United States among adolescents aged 13–17 years.^¶ The first phase is a random-digit–dialed mobile telephone survey** of parents or guardians (parents) in households with eligible adolescents aged 13–17 years. The NIS-Teen mobile telephone sample is designed to meet target precision requirements using flagged telephone numbers from the NIS-Child sample and excludes telephone numbers in the National Immunization Survey do-not-call list (2). At the end of the household survey, permission is requested to contact the adolescent’s vaccination providers. The second phase of NIS-Teen is a mailed survey to the adolescent’s vaccination providers identified by the parent or guardian (parent) to obtain the adolescent’s vaccination history. NIS-Teen contacts all vaccination providers identified by the parent, including medical offices, health departments, pharmacies, and any other locations where the adolescent might have received vaccinations.

Vaccination Coverage Estimates

Coverage estimates in this report were derived from provider-reported data on 16,325 adolescents aged 13–17 years^†† who were born during January 2006–December 2011.^§§ The household response rate^¶¶ was 21.0%. Adequate provider data was received from providers for 42.8% of adolescents with completed interviews.*** These two rates reflect different types of response mechanisms. The household response rate measures participation by households that completed the household interviews, whereas the adequate provider data rate measures vaccination data availability among those who completed the household interviews. NIS-Teen uses a complex weighting process that includes adjustments for household nonresponse, provider nonresponse, and households without telephones. Weights are calibrated to known population totals by age, sex, race and ethnicity, and geography to improve representation (2). To address low response rates, nonresponse adjustments are incorporated in the weighting to reduce potential bias. In addition, statistical modeling techniques such as imputation and variance estimation methods are used to handle missing data and account for the complex survey design (2). Estimated vaccination coverage among adolescents aged 13–17 years in the 2024 survey year was compared with estimates from the 2023 survey year. Differences in vaccination coverage were determined using z-tests. p-values <0.05 were considered statistically significant. Analyses were conducted using SAS (version 9.4; SAS Institute) and SAS-callable SUDAAN (version 11; RTI International). This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy.^†††

Results

National and State Level Vaccination Coverage Among Adolescents Aged 13–17 Years

In 2024, among adolescents aged 13–17 years, ≥1-dose Tdap^§§§ coverage increased 2.3 percentage points, to 91.3% from 89.0% in 2023, and ≥1-dose MenACWY^¶¶¶ coverage increased 1.7 percentage points, to 90.1% from 88.4% in 2023 (Table 1) (Supplementary Figure). In 2024, 78.2% of adolescents aged 13–17 years had received ≥1 dose of HPV vaccine,**** and 62.9% were up to date with the HPV vaccination series,^†††† similar to 2023 estimates (76.8% and 61.4%, respectively). Coverage with other recommended vaccines and catch-up vaccines^§§§§ also increased: ≥1-dose MenB^¶¶¶¶ coverage increased 4.5 percentage points among adolescents aged 17 years; ≥2-dose measles, mumps, and rubella (MMR) coverage and ≥3-dose hepatitis B (HepB) coverage both increased 1.3 percentage points among adolescents aged 13–17 years compared with coverage in 2023.

Vaccination coverage varied by jurisdiction. The largest variation in coverage by jurisdiction was among adolescents up to date with HPV vaccination, which ranged from 39.1% in Mississippi to 79.8% in Massachusetts (Supplementary Table). In 2024, coverage of ≥90% among adolescents aged 13–17 years was observed for ≥1 dose of Tdap in 39 states and ≥1 dose of MenACWY in 30 states. Coverage with ≥1 dose of HPV vaccine was ≥80% in 26 states and the District of Columbia (DC), and at least 65% of adolescents were up to date with HPV vaccination in 26 states and DC. Compared with 2023, coverage with at least one vaccine routinely recommended for adolescents increased in Florida, Georgia, Kentucky, and Virginia among adolescents aged 13–17 years in 2024.*****

Vaccination Coverage Among Adolescents Aged 13–17 Years, by Metropolitan Statistical Area^{†††††}

In 2024, among adolescents aged 13–17 years, coverage with ≥1 and ≥2 doses of MenACWY was 3.6 and 10.0 percentage points lower, respectively, among those living in nonmetropolitan statistical areas (MSAs) (mostly rural areas) compared with those living in MSA principal cities (mostly urban areas) (Table 2). In addition, coverage with ≥1 dose of HPV vaccine, and the percentage of adolescents who were up to date with HPV vaccination were 4.7 and 3.0 percentage points lower, respectively, in MSA nonprincipal cities (mostly suburban areas) and 10.5 and 10.8 percentage points lower, respectively, in mostly rural areas compared with coverage in mostly urban areas. The gap in HPV vaccination coverage among adolescents aged 13–17 years living in mostly rural areas and those living in mostly urban areas has changed little during the previous 9 years, and the magnitude of the difference remains largely unchanged since 2016 (Figure). Coverage with ≥1 dose of Tdap was similar across the three MSA categories (Table 2).

HPV Vaccination Coverage by MSA Status and Receipt of a Provider Recommendation for HPV Vaccine

In 2024, the parents of 69.4% of adolescents living in mostly urban areas, 70.9% of those living in mostly suburban areas, and 65.6% of those living in mostly rural areas received a provider recommendation (self-reported by parent) for their adolescent to receive HPV vaccine. In all MSA areas, ≥1-dose HPV vaccination coverage was lower among adolescents who did not receive an HPV vaccination recommendation from a provider (range = 57.2%-68.4%) than among those who did receive a provider recommendation (range = 77.2%-86.0%). Among adolescents who received a provider HPV vaccination recommendation, ≥1-dose HPV vaccination coverage was 8.8 percentage points lower in mostly rural areas and 3.7 percentage points lower in mostly suburban areas than in mostly urban areas; similarly, the percentage of adolescents who were up to date with HPV vaccination was 10.6 and 3.3 percentage points lower in mostly rural and mostly suburban areas, respectively, than in mostly urban areas. Similarly, among adolescents whose parent did not receive a provider recommendation for HPV vaccine, ≥1-dose HPV vaccination coverage among those in mostly rural and mostly suburban areas was 11.2 and 9.7 percentage points, respectively, lower than coverage among those living in mostly urban areas.

Discussion

Among adolescents aged 13–17 years, coverage with ≥1 Tdap dose, ≥1 MenACWY dose, ≥1 MenB dose (assessed among adolescents aged 17 years), ≥2 MMR doses, and ≥3 HepB doses increased in 2024; ≥1-dose Tdap coverage and ≥1-dose MenACWY coverage was ≥90% in a majority of states. These findings highlight progress in public health activities to improve vaccination coverage (3,4).

HPV vaccination coverage has not changed among adolescents aged 13-17 years for 3 consecutive years; for the previous 9 years, HPV vaccination coverage has remained lower among adolescents living in mostly rural areas compared with coverage among those in mostly urban areas. Additional activities are needed to improve HPV vaccination coverage among adolescents.

A strong provider recommendation is associated with increased likelihood of being vaccinated (5); however, in this analysis, adolescents living in mostly rural areas were less likely to receive an HPV vaccination recommendation from a provider than were those living in mostly urban areas. In 2024, ≥1-dose HPV coverage and the percentage of adolescents up to date with HPV vaccination were consistently higher among those who received a provider recommendation for vaccination. These findings highlight the influence of provider recommendations and the potential for strong provider recommendations to improve vaccination coverage. Ongoing conversations with families can emphasize the role of the HPV vaccine in cancer prevention and the importance of other vaccines recommended for adolescents.

Although these findings are consistent with previous research examining HPV vaccination coverage by MSA status, reasons for these differences are not well understood (6,7). Even when rural and suburban families received a provider recommendation for HPV vaccination, their adolescent children were less likely to be vaccinated than were those living in mostly urban areas. This might indicate additional barriers to vaccination such as transportation challenges, fewer opportunities for well-child visits, concerns about vaccine safety, or differing attitudes and beliefs that influence vaccine acceptance. A better understanding of these barriers is needed to guide development of strategies that support state programs, health departments, and providers to strengthen outreach and education and ensure that all adolescents, regardless of geographic location, receive information about and access to HPV vaccine and other recommended vaccines.

Limitations

The findings in this report are subject to at least two limitations. First, the household response rate was low, and only 42.8% of those who completed interviews had adequate provider data. Selection bias might exist if the respondents in the survey differ systematically from nonrespondents, and these differences are not accounted for by survey weighting. Although NIS-Teen applies weighting adjustments to reduce bias, direct assessment of systematic differences between respondents and nonrespondents is limited because of lack of data on nonrespondents. Second, although estimates are adjusted for household and provider nonresponse and households without a telephone, bias in the estimates might remain, which might result in overestimations or underestimations of coverage. Each year a total survey error (TSE) assessment is created in conjunction with release of NIS-Teen data. The 2023 TSE assessment indicated that NIS-Teen estimates might underestimate actual coverage, with the largest underestimation occurring for up-to-date HPV vaccination status (−5.2 percentage points), primarily attributed to incomplete ascertainment of vaccination status (e.g., if parents did not report all vaccination providers or if the provider either did not respond to the provider survey or did not report all vaccines received by the adolescent) (8). The 2024 TSE estimates were similar to those from previous years for the vaccines assessed (NORC at the University of Chicago, CDC, unpublished data, 2025).

Implications for Public Health Practice

Health care providers can improve the health and safety of adolescents and their communities through continued education and engagement with families about the importance of vaccines and their role in supporting adolescent health. Health care providers can also routinely review adolescent patients’ immunization records to ascertain whether they are up to date with recommended vaccines. State, local, and territorial health departments can further use NIS-Teen findings by evaluating local vaccination data sources, such as immunization information system data, to identify geographic areas with low coverage to gain a more comprehensive understanding of vaccination coverage in their jurisdiction (9,10). Using these insights, health departments can work with health care providers and communities to improve local vaccine access and increase adolescent vaccination coverage.