Discussion
Although coverage among adolescents aged 13–17 years with ≥1 dose of Tdap and ≥1 dose of MenACWY decreased from 2024 to 2025, coverage with both vaccines remained approximately 90%. These decreases were similar in magnitude to the increases in coverage with these vaccines observed in 2024 compared with 2023 (4), resulting in coverage levels in 2025 similar to those observed during 2019−2023, and might reflect year-to-year variation in survey estimates around a high and stable level of coverage. However, the declines observed from 2024 to 2025 among adolescents aged 13 and 14 years might be an early indication of declining vaccination coverage. Continued monitoring is needed to determine whether this pattern persists.
HPV vaccination coverage among adolescents aged 13−17 years in 2025 continues to be lower than coverage with ≥1 dose of Tdap and ≥1 dose of MenACWY. HPV vaccination coverage did not increase for the fourth consecutive year. The consistently lower HPV vaccination coverage compared with other routine adolescent vaccines might, in part, reflect differences in school entry requirements. Tdap is required for school entry in all states, and MenACWY is required in most states; however, few states require HPV vaccination (5). Geographic differences in coverage were larger for HPV vaccination than for ≥1 dose of Tdap or MenACWY, with an approximate 40 percentage point difference between the highest and lowest ≥1-dose HPV vaccination coverage jurisdictions and an approximate 50 percentage point difference in the percentage of adolescents who are up to date with the HPV vaccination series. Coverage with ≥1 dose of HPV vaccine was generally highest in New England and along the West Coast.
Coverage with both HPV and measles, mumps, and rubella (MMR) vaccines remained below Healthy People 2030 targets. In 2025, 58.6% of adolescents aged 13–15 years had completed the HPV vaccination series, which is below the Healthy People 2030 target of 80% of adolescents aged 13–15 years receiving the recommended number of HPV vaccine doses. Similarly, coverage with ≥2 doses of MMR vaccine among adolescents aged 13–17 years was 92.5% in 2025, below the Healthy People 2030 target of 95% coverage at kindergarten entry, suggesting that catch-up vaccination among adolescents did not meet the Healthy People 2030 target, the estimated population-level immunity necessary to prevent measles outbreaks.
Differences in vaccination coverage were also observed by MSA status. Coverage with ≥1 MenACWY dose was 3.0 percentage points lower among adolescents living in mostly rural areas compared with those living in mostly urban areas. After stratification by poverty level, this difference persisted only among adolescents living below the poverty level, suggesting that economic or access-related barriers might contribute to lower MenACWY coverage among rural adolescents. Coverage with ≥1 dose of HPV vaccine and the percentage of adolescents who were up to date with the HPV vaccination series were both approximately 10 percentage points lower in mostly rural areas than in mostly urban areas. Differences were observed across poverty levels, suggesting that lower HPV vaccination coverage in rural areas is not explained by poverty alone. Other studies have documented lower HPV vaccine acceptance in rural communities (6,7). Differences in access to health care might also contribute to lower HPV vaccination coverage in rural areas compared with urban areas. In a previous analysis of NIS-Teen data, adolescents living in mostly rural areas were less likely than those living in mostly urban areas to attend an 11- or 12-year well-child visit or receive a provider recommendation for HPV vaccination (8). Lower attendance at 11- or 12-year well-child visits and fewer provider recommendations for HPV vaccination among adolescents living in mostly rural areas might contribute to the lower HPV vaccination coverage in rural communities (4,8,9). These findings suggest that lower HPV vaccination coverage in rural communities reflects multiple factors, including differences in vaccine acceptance, provider recommendation practices, and use of preventive health care services.
Limitations
The findings in this report are subject to at least two limitations. First, the CASRO response rate was low, and only 42.0% of adolescents had adequate provider data. Although data were adjusted using survey weights for household and provider nonresponse, residual nonresponse bias might have remained if respondents differed systematically from nonrespondents. Second, incomplete adolescent vaccination histories resulting from underascertainment of provider records could have biased coverage estimates. A bias assessment of the 2025 NIS-Teen data indicated that the observed declines in Tdap and MenACWY coverage might be partly attributable to a higher percentage of adolescents with two or more vaccination providers for whom provider questionnaires were not returned by all nominated providers in 2025. Therefore, these decreases should be interpreted with caution. The decreases were small, and coverage with both vaccines remained high. The 2024 total survey error report further indicated that NIS-Teen estimates might underestimate true vaccination coverage, with the largest underestimation observed for the percentage of adolescents who were up to date with the HPV vaccination series (−5.4 percentage points) (10).
Implications for Public Health Practice
Continued efforts are needed to increase adolescent vaccination coverage with recommended vaccines and reduce geographic differences in coverage, particularly with HPV vaccine. Efforts to address barriers to vaccination, including improving access to preventive care, strengthening provider communication regarding recommendations, and increasing vaccine confidence, could help improve coverage. Health care providers can support these efforts by reviewing patient vaccination records for needed vaccines, using reminder and recall systems to notify families when adolescents are due or overdue for recommended vaccines, discussing recommended vaccines with families, and during all clinical encounters, administering all recommended vaccines due.
