HPV vaccination among American teenagers has now gone four straight years without increasing, and coverage for the two other routine adolescent vaccines slipped from the previous year.
That is the finding of a CDC surveillance report in the Morbidity and Mortality Weekly Report, published September 3 and drawing on provider-verified records for 18,692 adolescents aged 13 to 17 in the 2025 National Immunization Survey-Teen.
Among that group, 77.7 percent had received at least one dose of HPV vaccine and 63.4 percent were up to date with the series. Coverage with at least one dose of the tetanus, diphtheria, and pertussis vaccine fell from 91.3 percent to 88.8 percent. Meningococcal ACWY coverage fell from 90.1 percent to 89.0 percent.
The declines in Tdap and MenACWY are small, and both vaccines remain near 90 percent. What makes them worth reporting is where they concentrated. Among 13-year-olds, Tdap coverage dropped from 89.4 percent to 86.0 percent, and among 14-year-olds it fell from 92.1 percent to 88.8 percent. The CDC authors wrote that the declines in the youngest adolescents might be an early indication of falling coverage, and that continued monitoring is needed to determine whether the pattern persists.
A Twelve Point Gap That Poverty Does Not Explain
The geographic findings are the more consequential part of this report for families.
Teens in mostly rural areas were 12.0 percentage points less likely than teens in mostly urban areas to have received at least one HPV dose, and 14.2 points less likely to be up to date with the series. For MenACWY, the rural gap was 3.0 points, and for Tdap, coverage was similar across areas.
The CDC team then split those figures by household income, and the result is the finding that should drive local outreach. The rural-urban difference in HPV vaccination held regardless of poverty level. The MenACWY gap, by contrast, appeared only among adolescents living below the poverty line.
In plain terms, the meningococcal gap looks like a cost and access problem. The HPV gap does not, because it persists among rural families who are not poor.
The authors point to a different explanation. Previous analysis of the same survey found that adolescents in rural areas were less likely to attend an 11- or 12-year well-child visit or to receive a provider recommendation for HPV vaccination. Lower vaccine acceptance in rural communities has been documented separately. The report concludes that the rural pattern reflects multiple factors, including differences in acceptance, provider recommendation practices, and use of preventive care.
Major Metros Are Outperforming Their Own States
Because the survey samples several large cities separately, the data show something national coverage maps usually hide. In four major metro areas, reported HPV coverage ran well above the rate for the rest of the surrounding state.
Chicago reached 88.9 percent for at least one HPV dose and 77.3 percent up to date. The rest of Illinois came in at 72.9 percent and 58.3 percent. Philadelphia reached 87.8 percent and 75.9 percent, against 76.2 percent and 67.4 percent for the rest of Pennsylvania. New York City posted 82.5 percent and 72.4 percent, compared with 76.0 percent and 65.0 percent elsewhere in the state. Houston reached 79.0 percent and 66.7 percent, against 72.1 percent and 56.3 percent for Texas outside Houston and Bexar County. The report does not test these city-versus-state differences for statistical significance, and the confidence intervals around several of them overlap.
State-level variation is wider still. Coverage with at least one HPV dose ranged from 49.5 percent in Mississippi to 94.1 percent in Rhode Island. Series completion ranged from 30.9 percent in Mississippi to 84.5 percent in Rhode Island, roughly a 50-point spread. Mississippi also reported the lowest MenACWY coverage in the country at 61.2 percent.
Coverage decreased from the prior year for at least one vaccine in Arkansas, Florida, Georgia, Iowa, Kentucky, and West Virginia. It increased in Hawaii, Maine, New Jersey, Wisconsin, and Wyoming.
The CDC authors offer one structural explanation for why HPV consistently trails. Tdap is required for school entry in all states, and MenACWY is required in most, they wrote, while few states require HPV vaccination. Both HPV and measles, mumps, and rubella coverage remain below Healthy People vaccination targets.
Reading the Numbers Without Overreading Them
This is survey data, and the report states its limits clearly rather than burying them.
The household response rate was 21.4 percent, and adequate provider records were available for only 42.0 percent of adolescents with completed interviews. A bias assessment found that the Tdap and MenACWY declines might be partly explained by more adolescents having two or more vaccination providers whose questionnaires were not all returned in 2025. The authors say those decreases should be interpreted with caution.
A separate error analysis indicated the survey may understate true coverage, with the largest underestimate falling on HPV series completion at 5.4 percentage points. Both directions of error matter. The declines may be smaller than they look, and the HPV totals may be modestly higher than reported.
Nothing in this report changes clinical guidance. The recommended child and adolescent immunization schedule still calls for Tdap, MenACWY, and HPV vaccination at ages 11 to 12, with the HPV series eligible to start at age 9 and a MenACWY booster at 16.
For parents, the practical step is narrow. Fall sports physicals and back-to-school visits are the natural moment to ask a clinician to review a teen's record rather than assume it is complete, particularly for families who moved between states or changed providers, since split records are exactly what this survey struggled with. Families without insurance can ask about the federal Vaccines for Children program, which covers eligible children through age 18 at participating providers and community health centers.
The CDC recommends that providers use reminder and recall systems and review records at every clinical encounter. Whether the drop among 13- and 14-year-olds continues will not be clear until the 2026 survey results are published next year. Coverage estimates by jurisdiction are updated through the agency's TeenVaxView interactive tool.
Key Questions Answered
What did the CDC report find? HPV vaccination among teens aged 13 to 17 did not increase for a fourth consecutive year, while Tdap and MenACWY coverage declined slightly in 2024 but stayed near 90 percent.
What are the current national rates? 77.7 percent of teens received at least one HPV dose and 63.4 percent completed the series. Tdap coverage was 88.8 percent and MenACWY 89.0 percent.
How large is the rural-urban gap? Rural teens were 12.0 percentage points behind urban teens for one HPV dose and 14.2 points behind for series completion.
Is the rural gap explained by income? Not for HPV. The gap held at every poverty level. The smaller MenACWY gap appeared only among teens living below the poverty line.
Which states are highest and lowest? Rhode Island led with 94.1 percent receiving at least one HPV dose. Mississippi was lowest at 49.5 percent.
Does this change vaccine recommendations? No. The schedule still calls for Tdap, MenACWY, and HPV at ages 11 to 12, with HPV able to start at age 9.
How reliable are these figures? They come from a survey with a 21.4 percent response rate and complete provider records for 42 percent of respondents. The CDC says the Tdap and MenACWY declines should be read with caution.
