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2023 National Immunization Survey -Teen (NIS -Teen)
Data Summary
Cassandra (Sandy) Pingali, MPH, MS
Epidemiologist
Surveillance and Epidemiology Branch (SEB)
Immunization Services Division (ISD)
NCIRD
ACIP Meeting
April 15th, 2025National Center for Immunization and Respiratory Diseases
National Immunization Survey -Teen Methodology
•Two phase survey
-1stphase: random digit dialed cell phone survey of
parents in households with teens age 13 -17 years
-2ndphase: mailed survey of vaccination providers
•Household survey collects socio -demographics, health
insurance status, and consent for provider survey.
•Provider survey collects the types of vaccinations, number
of doses, dates of administration, and other administrative
data about the health care facility.
-Teens are classified as being up to date based on the
ACIP -recommended numbers of doses for each vaccine.
•Sample size of 2023 NIS -Teen survey included data
collected from parents/guardians of 16,568 adolescents.
-Born January 2005 -December 2010
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Coverage with Routine Vaccines
Recommended for Adolescents
2023 National Immunization Survey -Teen
Estimated vaccination coverage with selected vaccines and doses among adolescents aged 13 -17 years, by
survey year —National Immunization Survey -Teen, United States, 2006 -2023
Coverage with ≥1 Tdap and ≥1 MenACWY has been high and stable since 2018. However, coverage
with ≥1 HPV vaccine and proportion HPV up to date is lower compared to other routine vaccines. 0102030405060708090100
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023Percent Vaccinated (%)
Survey Year≥1 Tdap
≥1 MenACWY
≥2 MenACWY
≥1 HPV
≥3 HPV
HPV UTDSingle cellular telephone
sampling frame estimates
4Pingali C, Yankey D, Chen M, et al. National Vaccination Coverage Among Adolescents Aged 13 –17 Years — National Immunization Sur vey-Teen, United States, 2023. MMWR Morb Mortal Wkly Rep 2024;73:708 –714.
Estimated vaccination coverage with selected vaccines and doses among adolescents aged 13 -17 years, by survey year —
National Immunization Survey -Teen, United States, 2022 and 2023
VACCINE2023
(n=16,568)2022
(n=16,043)SIGNIFICANT
Increase or
Decrease ?PERCENTAGE
POINT
DIFFERENCE
COMPARED TO
2022
% (95% CI) % (95% CI)
≥1 Tdap 89.0 (87.9 -90.0) 89.9 (88.9 -90.9) - -0.9
≥1 MenACWY 88.4 (87.3 -89.4) 88.6 (87.6 -89.6) - -0.2
≥2 MenACWY* 59.7 (56.2 -63.2) 60.8 (57.5 -63.9) - -1.1
HPV Females and Males Combined
≥1 HPV 76.8 (75.4 -78.1) 76.0 (74.7 -77.3) - 0.8
HPV UTD 61.4 (59.9 -63.0) 62.6 (61.1 -64.0) - -1.1
HPV Females Only
≥1 HPV 78.5 (76.7 -80.2) 77.8 (75.8 -79.6) - 0.8
HPV UTD 64.0 (61.9 -66.1) 64.6 (62.5 -66.6) - -0.6
HPV Males Only
≥1 HPV 75.1 (73.0 -77.1) 74.4 (72.5 -76.1) - 0.8
HPV UTD 59.0 (56.7 -61.2) 60.6 (58.6 -62.6) - -1.6
*Assessed among adolescents aged 17 years; MenACWY estimate does not include the 17 -year -old adolescents who received their firs t
MenACWY dose at ≥16 years and do not need a second vaccine dose.
5Pingali C, Yankey D, Chen M, et al. National Vaccination Coverage Among Adolescents Aged 13 –17 Years — National Immunization Sur vey-Teen, United States, 2023. MMWR Morb Mortal Wkly Rep 2024;73:708 –714.
Simultaneous administration of HPV vaccine with other recommended vaccines among
adolescents aged 13 –17 years who initiated HPV vaccine, by age at interview — National
Immunization Survey –Teen (NIS -Teen), United States, 2023
VaccinationsAdolescents who received ≥1 HPV vaccine
(N = 12,995)Weighted %
(95% C.I.)
Received 1+ HPV vaccine 12,995 -
Received HPV vaccine only in a single visit 3,874 30.5 (29.0 -32.1)
Received HPV vaccine and one or more vaccine (s) in a
single visit (Tdap, MenACWY , and/or flu vaccine)9,121 69.5 (67.9 -71.0)
Received Tdap and MenACWY and HPV vaccines in a
single visit6,579 47.8 (46.0 -49.5)
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Coverage with Routine Vaccines
Recommended for Adolescents by
Sociodemographic Factors and Access to
Healthcare
2023 National Immunization Survey -Teen
Estimated vaccination coverage with selected vaccines among adolescents aged 13 -17 years, by metropolitan statistical area
(MSA status) – National Immunization Survey -Teen (NIS -Teen), United States, 2023
89.2 89.180.1
64.489.1 88.6
74.8
60.887.6 85.2
72.5
53.1
0102030405060708090100
≥1 Tdap ≥1 MenACWY ≥ 1 HPV HPV UTDPercent Vaccinated
MSA Principal City (Mostly Urban) MSA Non-Principal City (Mostly Suburban) Non-MSA (Mostly Rural)**
*
*
Coverage with ≥1 HPV vaccine and proportion HPV UTD is lower in mostly suburban and mostly rural areas
compared to mostly urban areas. * Statistically significant difference (p<0.05); referent group was MSA principal city
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Estimated vaccination coverage with selected vaccines among adolescents aged 13 -17 years, by health insurance status –
National Immunization Survey -Teen (NIS -Teen), United States, 2023
90.1 89.4
76.5
63.288.6 88.479.1
62.888.4 85.375.4
56.679.8 80.6
59.9
31.4
0102030405060708090100
≥1 Tdap ≥1 MenACWY ≥ 1 HPV HPV UTDPercent Vaccinated
Private Insurance Any-Medicaid Other Insurance Uninsured* *
*
**
* Statistically significant difference (p<0.05); referent group was private insurance
•Overall, vaccination coverage was lower among uninsured adolescents than privately insured
adolescents for all vaccines.
•Those with “other” insurance had a lower percentage HPV UTD than privately insured adolescents.
•Adolescents with private and any Medicaid insurance had similar vaccination coverage, including
coverage with the HPV vaccine. 9
Estimated vaccination coverage with ≥1 human papillomavirus (HPV) vaccine among adolescents 13 -17 years, by Health
Insurance Status — National Immunization Survey –Teen (NIS -Teen), United States, 2015 -2023.
020406080100
2015 2016 2017 2018 2019 2020 2021 2022 2023Percent Vaccinated
Survey Year
Private Only Any-Medicaid
Historically, adolescents insured by Medicaid had higher coverage with ≥1 HPV vaccine compared to privately
insured adolescents. However, in 2022 and 2023, adolescents with private and any Medicaid insurance had similar
≥ 1 HPV vaccine coverage.
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Estimated vaccination coverage with selected vaccines among adolescents aged 13 -17 years, by race and ethnicity – National
Immunization Survey -Teen (NIS -Teen), United States, 2023
88.9 87.4
74.0
60.688.1 89.077.3
59.089.5 89.481.0
63.688.6 85.777.167.590.0 92.4
79.5
64.689.1 88.277.2
60.9
020406080100
≥1 Tdap ≥1 MenACWY ≥ 1 HPV HPV UTDPercent Vaccinated
White, NH Black, NH Hispanic AIAN, NH Asian, NH Multiracial, NH*
*
* Statistically significant difference (p<0.05); referent group was White, NH adolescents
•Although historically, Black and Hispanic adolescents have had higher coverage with ≥1 HPV vaccine than
White adolescents, in 2023, only Hispanic adolescents had higher coverage.
•In 2023, coverage with ≥1 MenACWY was higher among Asian adolescents compared to White adolescents.
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Estimated vaccination coverage with ≥1 dose of HPV vaccine among adolescents aged 13 –17 years, National
Immunization Survey –Teen (NIS -Teen), United States, 2023
AK
HI
DC 60%-74%
77%-78%
79%-83%
84%-93%
U.S coverage with ≥1 dose HPV vaccine was 77%.
Mississippi had the lowest coverage (60%), and Rhode Island had the highest coverage with ≥1 HPV vaccine (93%).
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Initiation of HPV Vaccine by Age
Age at Initiation of HPV Vaccine — National Immunization Survey –Teen (NIS -Teen), United States, 2018 and
2023.
3.842.5
21.732
5.757.1
1423.3
0102030405060708090100
9-10 years 11-12 years 13-17 years Never VaccinatedPercent Initiating HPV Vaccination
2018 2023
•HPV vaccine initiation at ages 9 -10 years and 11 -12 years has increased from 2018 to 2023.
•HPV vaccine initiation at age 13 -17 years has decreased from 2018 to 2023.
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Overall Summary
•In 2023, 76.8% of adolescents aged 13 -17 years had initiated the HPV vaccine and 61.4% were HPV UTD.
•This is the second consecutive year that HPV vaccination coverage did not increase among adolescents aged
13-17 years.
•HPV vaccination coverage remains lower than coverage for Tdap and MenACWY vaccines.
•In 2023, 5.7% of adolescents initiated the HPV vaccine at ages 9 -10 years and 57.1% of adolescents initiated
the HPV vaccine at ages 11 -12 years.
•The HPV vaccine is commonly given with other vaccines with 48% receiving the HPV vaccine, and Tdap
vaccine, and MenACWY vaccine in a single visit. Only 31% of adolescents received an HPV vaccine without
any other vaccine.
•HPV vaccination coverage varies by sociodemographic factors, access to healthcare, and by state. 2023 NIS -Teen HPV Coverage Data Summary
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For more information, contact CDC
1-800-CDC-INFO (232 -4636)
TTY: 1 -888-232-6348 www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
Thank you!
• David Yankey
• Michael Chen
• Madeleine Valier
• Laurie Elam -Evans
• Jim Singleton
• Shannon Stokley
• Lauri Markowitz
• Carla DeSisto
• Sarah Schillie
• Michelle Hughes