HPV Vaccination Rates Vary Widely From State to State

Human papillomavirus (HPV) vaccination rates varied substantially across and within U.S. regions, according to estimates in a retrospective, cross-sectional analysis, suggesting targeted interventions should focus on the needs of individual states.

Comparing adolescents ages 13-17 years across the country against Alabama — where the 21% without at least one dose of the HPV vaccine approximates the national goal — several Northeast states did significantly better, including Rhode Island (adjusted OR 3.05, 95% CI 1.40-6.66), Massachusetts (aOR 2.19, 95% CI 1.24-3.88), and New Hampshire (aOR 1.72, 95% CI 1.03-2.88).

Several Southern states significantly lagged Alabama in likelihood of HPV vaccination, including Mississippi (aOR 0.41, 95% CI 0.26-0.65), Georgia (aOR 0.45, 95% CI 0.27-0.76), Oklahoma (aOR 0.46, 95% CI 0.30-0.72), Kentucky (aOR 0.55, 95% CI 0.35-0.87), and West Virginia (aOR 0.56, 95% CI 0.36-0.87), reported Chinenye Lynette Ejezie, PhD, of Towson University in Maryland, and colleagues in a JAMA Pediatrics research letter.

“Disparities in HPV vaccination are driven not only by broad geographic patterns but also by marked heterogeneity within regions,” Ejezie and colleagues wrote. “By identifying specific states with persistently low uptake, this state-level analysis provides a more precise framework for targeting policy, healthcare delivery, and public health interventions aimed at improving HPV vaccination coverage.”

The researchers used data from the 2023 National Immunization Survey-Teen (NIS-Teen), which collects vaccination information on U.S. adolescents ages 13-17 years. HPV vaccination was defined as receipt of at least one HPV vaccine dose. The analysis included responses from 16,057 adolescents.

The American Academy of Pediatrics recommends routine HPV vaccination for every adolescent beginning between ages 9 and 12 years. The federal Healthy People 2030 initiative aims to have 80% of adolescents complete the two- or three-dose HPV vaccination series. The 2024 NIS-Teen showed that an estimated 78.2% of U.S. adolescents ages 13-17 years had received at least one HPV vaccine dose, but only 62.9% had completed the HPV vaccination series, still short of the Healthy People 2030 goal.

Compared with Alabama’s 21% rate of unvaccinated adolescents, the rates among teens in New Hampshire (15%), Massachusetts (11%), and Rhode Island (8%) were significantly lower. Five Southern states had significantly greater unvaccinated rates than Alabama, including Mississippi (39%), Oklahoma (36%), Georgia (35%), Kentucky (34%), and West Virginia (34%).

Within regions, HPV vaccination rates varied substantially by state. In the South, rates of unvaccinated adolescents ranged from 14% in Delaware and Virginia to 39% in Mississippi. The West saw unvaccinated rates ranging from 14% in Hawaii and 15% in New Mexico to 29% in Alaska and 30% in Idaho, while the Northeast ranged from a low of 8% in Rhode Island to a high of 34% in New Jersey.

In the Midwest, rates of unvaccinated adolescents ranged from 24% in Missouri and 25% in Kansas to 15% in Iowa and 16% in Minnesota and North Dakota.

Study limitations included the possibility of recall bias by parents and caregivers.