National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2018

Tanja Y. Walker, MPH; Laurie D. Elam-Evans, PhD; David Yankey, PhD; Lauri E. Markowitz, MD; Charnetta L. Williams, MD; Benjamin Fredua, MS; James A. Singleton, PhD; Shannon Stokley, DrPH


Morbidity and Mortality Weekly Report. 2019;68(33):718-723. 

In This Article

National Vaccination Coverage

In 2018, 51.1% of adolescents aged 13–17 years were up to date with the HPV vaccine series, and 68.1% had received ≥1 dose of HPV vaccine (Table 1) (Figure). During 2017–2018, the increase in HPV vaccination coverage was attributable to increases among males only (increase of 4.4 percentage points in males who were up to date versus 0.6 in females). Coverage with ≥1 MenACWY dose increased by 1.5 percentage points to 86.6%. Among persons aged 17 years, coverage with ≥2 MenACWY doses increased by 6.5 percentage points to 50.8%. Coverage with ≥1 dose of MenB among persons aged 17 years was 17.2% (95% confidence interval = 14.9%–19.9%). No significant increases were observed for coverage with ≥3 hepatitis B doses; ≥2 measles, mumps, and rubella vaccine doses; and ≥1 and ≥2 varicella vaccine doses among adolescents without a history of varicella disease (Table 1).


Estimated vaccination coverage with selected vaccines and doses* among adolescents aged 13–17 years, by survey year and Advisory Committee on Immunization Practices (ACIP) recommendations — National Immunization Survey–Teen (NIS-Teen),§,¶ United States, 2006–2018
Abbreviations: HPV = human papillomavirus vaccine; MenACWY = quadrivalent meningococcal conjugate vaccine; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine; UTD = up-to-date.
* ≥1 dose Tdap at or after age 10 years; ≥1 dose MenACWY or meningococcal-unknown type vaccine; ≥2 doses MenACWY or meningococcal-unknown type vaccine, calculated only among adolescents aged 17 years at time of interview. Does not include adolescents who received their first and only dose of MenACWY at or after age 16 years; HPV vaccine, nine-valent (9vHPV), quadrivalent (4vHPV), or bivalent (2vHPV). HPV UTD includes those with ≥3 doses and those with 2 doses when the first HPV vaccine dose was initiated before age 15 years and at least 5 months minus 4 days elapsed between the first and second dose.
ACIP revised the recommended HPV vaccination schedule in late 2016. The recommendation changed from a 3-dose to 2-dose series with appropriate spacing between receipt of the first and second dose for immunocompetent adolescents initiating the series before the 15th birthday. Three doses are still recommended for adolescents initiating the series between the ages of 15 and 26 years. Because of the change in recommendation, the graph includes estimates for ≥3 doses HPV from 2011 to 2015 and the HPV UTD estimate from 2016 to 2018. The routine ACIP recommendation for HPV vaccination was made for females in 2006 and for males in 2011. Because HPV vaccination was not recommended for males until 2011, coverage for all adolescents was not measured before that year.
§ NIS-Teen implemented a revised adequate provider data definition (APD) in 2014 and retrospectively applied the revised APD definition to 2013 data. Estimates using different APD definitions might not be directly comparable.
NIS-Teen moved from a dual landline and cell phone sampling frame to a single cell phone sample frame in 2018, and estimates using 2017 data were calculated two ways, using the dual frame and retrospectively using the single cell phone sampling frame.