Rural–Urban Gap Persists in Adolescent HPV Vaccination

Human papillomavirus (HPV) vaccination coverage among US adolescents aged 13–17 years did not increase for the fourth consecutive year and remained below coverage for tetanus, diphtheria, and acellular pertussis (Tdap) and quadrivalent meningococcal conjugate (MenACWY) vaccines, according to a CDC report published in MMWR.

The analysis used provider-reported data from the 2025 National Immunization Survey-Teen for 18,692 adolescents. The two-phase survey begins with a random-digit–dialed mobile telephone interview; with parental consent, vaccination providers are contacted to obtain medical-record data. CDC used survey weighting to address nonresponse and gaps in the mobile telephone sampling frame.

In 2025, 77.7% received at least 1 HPV vaccine dose and 63.4% were up to date with the series. Coverage dropped to 88.8% for at least 1 Tdap dose and 89.0% for at least 1 MenACWY dose, from 91.3% and 90.1%, respectively, in 2024. Both remained near 90%.

Geographic differences were widest for HPV vaccination. Compared with mostly urban areas, mostly rural areas had coverage that was 12.0 percentage points lower for at least 1 HPV dose and 14.2 points lower for being up to date. The rural–urban HPV gap persisted across poverty levels. Across jurisdictions, at least 1-dose HPV coverage ranged from 49.5% in Mississippi to 94.1% in Rhode Island, while up-to-date coverage ranged from 30.9% to 84.5%.

The Council of American Survey Research Organizations response rate was 21.4%, and only 42.0% of adolescents with completed interviews had adequate provider data. Investigators said residual nonresponse bias and incomplete vaccination histories could have affected estimates and cautioned that declines in Tdap and MenACWY might partly reflect missing provider questionnaires. CDC said clinicians can support efforts to address barriers to vaccination by reviewing vaccination records, using reminder and recall systems, discussing recommended vaccines with families, and administering vaccines that are due during clinical encounters.

Source: Pingali C, Yankey D, Elam-Evans LD, et al. Vaccination coverage among adolescents aged 13–17 years—National Immunization Survey-Teen, United States, 2025. MMWR Morb Mortal Wkly Rep. 2026;75(34):530-538. doi:10.15585/mmwr.mm7534a1