Teen HPV Vaccine Rates Stall for First Time in a Decade

After rising steadily since 2013, new human papillomavirus (HPV) vaccinations in teens stalled for the first time in 10 years, a CDC report showed.

The proportion of 13- to 17-year-olds who received at least one dose of HPV vaccine in 2022 was essentially identical to 2021 (76.0% vs 76.9%, respectively), including when it came to those considered up to date on their coverage (62.6% vs 61.7%), according to researchers led by Cassandra Pingali, MPH, MS, of the National Center for Immunization and Respiratory Diseases.

Rates among teens with private insurance held steady. However, coverage dropped by 3.3 percentage points among Medicaid beneficiaries and was lowest among uninsured teens -- two of the four groups eligible for the Vaccines for Children (VFC) program, Pingali and colleagues detailed in Morbidity and Mortality Weekly Report.

"VFC vaccine ordering data provide additional evidence that HPV vaccination coverage might be declining in VFC-eligible populations," they noted. "VFC provider orders for HPV vaccines decreased 24% during 2020, 9% during 2021, and 12% during 2022 compared with 2019, and provider orders for non-HPV vaccines have rebounded to prepandemic levels."

Using CDC's National Immunization Survey-Teen, the researchers examined patterns to see if vaccination coverage was disrupted as a result of the COVID-19 pandemic, looking at three vaccines routinely recommended for children ages 11 to 12 years: the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine, the meningococcal conjugate vaccine, and the HPV vaccine.

Overall, coverage in 2022 with the Tdap and meningococcal conjugate vaccines was high and stable among teens ages 13 to 17 years, with 89.9% having received at least one dose of Tdap and 88.6% having received at least one dose of the meningococcal conjugate vaccine.

Vaccine coverage varied widely by state, with the following lows and highs across the three vaccines:

• Tdap (at least one dose): from 82.7% in California to 97.3% in Iowa
• Meningococcal conjugate (at least one dose): from 55.5% in Mississippi to 97.9% in Iowa
• HPV (at least one dose): from 61.0% in Mississippi to 94.6% in Rhode Island
• HPV (up to date): from 38.5% in Mississippi to 85.2% in Rhode Island

Their study analyzed data on 16,043 adolescents ages 13 to 17 years (born January 2004 to January 2010) from the 2022 National Immunization Survey-Teen.

The researchers also conducted a birth cohort analysis to assess trends in vaccine initiation, comparing coverage by age 13 and 14 among kids born in 2008 and 2009 -- groups reaching their 12th and 11th birthday in 2020, respectively, and therefore recommended for vaccination -- with prepandemic cohorts (2006 and 2007).

That analysis found lower coverage by age 13 for adolescents born in 2008 compared with those born in 2007 for the Tdap vaccine (at least one dose, 3.2 percentage points lower) and the meningococcal conjugate vaccine (at least one dose, 3.0 percentage points lower), and lower coverage with at least one dose of either the Tdap or HPV vaccines by age 14 (both by 3.8 percentage points).

"In contrast to findings for the 2008 birth cohort, coverage by age 13 years was not lower for the 2009 birth cohort compared with the two earlier birth cohorts, perhaps because these adolescents had an additional year after the peak of the pandemic to receive routinely recommended vaccines before becoming overdue, and because many primary care offices returned to normal operations," the study authors wrote.

Dips for all four vaccine measures in the 2008 versus 2007 birth cohort were seen among those living in largely urban settings, with some lower coverage for Tdap and up-to-date HPV vaccines also seen in white adolescents, those living at or above the federal poverty level, and the privately insured.

"In the wake of the COVID-19 pandemic, many families might have missed well-child appointments when vaccinations were due," the researchers concluded. "Particular focus is needed for subgroups that experienced larger recent declines in vaccination coverage or substantially lower coverage, including those born during 2008 and VFC-eligible populations."

Limitations noted by the authors included selection bias, given low survey participation, and that recent survey error assessments have indicated underestimates of actual coverage.

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