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.