HPV Vaccine Coverage in Teens Stalled for Second Straight Year, CDC Says

Human papillomavirus (HPV) vaccine coverage among teens remained stalled for a second consecutive year since the pandemic, CDC data showed.

In 2023, 76.8% of adolescents ages 13 to 17 years had received one or more doses of the HPV vaccine and 61.4% were fully up-to-date on the vaccine series, similar to the previous year (76.0% and 62.6%, respectively), according to Cassandra Pingali, MPH, MS, of the CDC’s National Center for Immunization and Respiratory Diseases in Atlanta, and colleagues, writing in Morbidity and Mortality Weekly Report.

Last year, the CDC reported that after rising steadily since 2013, new HPV vaccinations in teens did not increase for the first time in 10 years.

In the new analysis of HPV vaccine and other vaccine data, researchers compared coverage by birth year using 2007 as the reference because it was the last one unaffected by pandemic-related healthcare disruptions.

Most notably, the percentage of teens in the Vaccines for Children (VFC) program who were up-to-date on their HPV vaccine by age 13 was 10.3 percentage points lower among adolescents born in 2010 (42.7%) compared with those born in 2007 (53%). Among non-VFC-eligible teens, those born in 2010 who were up-to-date on HPV vaccines by age 13 decreased by 4.1 percentage points compared with adolescents born in 2007 (48.7% and 52.8%, respectively).

The VFC program, established in 1994, provides vaccines at no cost to children who are Medicaid-eligible, uninsured, underinsured, or American Indian or Alaska Native. Approximately 40% of teens in the U.S. are eligible for the VFC program.

“The decline in the percentage of VFC-eligible adolescents who are HPV [up-to-date] could signal a change in accessibility to vaccination through the VFC program, a change that needs further exploration,” the CDC authors wrote. “This possibility underscores the importance of ongoing efforts to ensure equitable access to vaccination services for all children and adolescents.”

Previously, among those born during 2002 to 2005, coverage with at least one HPV vaccine dose and the percentage of those up-to-date with the series had been higher among VFC-eligible teens than among teens not eligible for the program.

“In 2021, approximately 25% of U.S. households reported that a child or adolescent had missed or delayed a healthcare visit because of the pandemic,” Pingali and colleagues pointed out. “Outreach to parents of adolescents who have yet to return to routine medical care since the pandemic will be critical to verifying that adolescents receive important primary care and vaccinations.”

Other vaccine coverage among teens ages 13 to 17 was generally high and stable, Pingali and colleagues found. During 2023, 89% of adolescents had received at least one tetanus, diphtheria, and pertussis vaccine (Tdap) dose, and 88.4% had received at least one meningococcal ACWY (MenACWY) dose, similar to coverage in 2022. Small increases for meningococcal B and hepatitis A vaccine coverage were noted.

Coverage with one or more doses of Tdap and MenACWY by age 13 was similar for VFC-eligible adolescents born during 2008 through 2010 to those born in 2007. However, VFC-eligible adolescents born from 2003 through 2008 had lower Tdap and MenACWY coverage by age 13 compared with non-VFC-eligible teens. VFC-eligible and non-VFC-eligible teens born in 2009 and 2010 had similar coverage for these two vaccines.

Researchers found that lower vaccination rates among adolescents born in 2008 have persisted, “demonstrating the ongoing impact of disruptions to healthcare during the COVID-19 pandemic,” the CDC researchers commented.

Among those born in 2008, coverage by age 13 with at least one dose of Tdap was 2.3 percentage points lower than teens born in 2007 (86.4% vs 88.7%, respectively). A similar reduction was seen for the MenACWY vaccine. For teens born in 2010, vaccine coverage for Tdap and MenACWY was similar to prepandemic coverage levels.

Researchers monitored vaccination coverage via the National Immunization Survey-Teen mobile telephone survey and received parent or guardian permission to contact vaccination providers to access data. The current study analyzed provider-reported data from 16,658 adolescents born between January 2005 through December 2010.

The authors noted that household response rate was low, potentially introducing selection bias and there were unequal sample sizes among birth years. Also, survey errors may have underestimated actual vaccine coverage.