Vaccination Coverage Among Adolescents Aged 13–17 Years

National Immunization Survey -- Teen, United States, 2022

Cassandra Pingali, MPH, MS; David Yankey, PhD; Laurie D. Elam-Evans, PhD; Lauri E. Markowitz, MD; Madeleine R. Valier, MPH; Benjamin Fredua, MS; Samuel J. Crowe, PhD; Carla L. DeSisto, PhD; Shannon Stokley, DrPH; James A. Singleton, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2023;72(34):912-919.

Abstract and Introduction

Abstract

Three vaccines are routinely recommended for adolescents to prevent pertussis, meningococcal disease, and cancers caused by human papillomavirus (HPV). CDC analyzed data from the 2022 National Immunization Survey–Teen for 16,043 adolescents aged 13–17 years to assess vaccination coverage. Birth cohort analyses were conducted to assess trends in vaccination coverage by age 13 years (i.e., before the 13th birthday) and by age 14 years (i.e., before the 14th birthday) among adolescents who were due for routine vaccination before and during the COVID-19 pandemic. Cross-sectional analysis was used to assess coverage estimates among adolescents aged 13–17 years. In 2022, vaccination coverage by age 14 years among adolescents born in 2008 continued to lag that of earlier birth cohorts and varied by sociodemographic factors and access to health care compared with coverage among earlier birth cohorts. Vaccination coverage by age 13 years among adolescents born in 2009 was similar to coverage estimates obtained before the COVID-19 pandemic. Among all adolescents aged 13–17 years, 2022 vaccination coverage levels did not differ from 2021 levels; however, initiation of the HPV vaccination series decreased among those who were insured by Medicaid. Coverage with ≥1 dose of tetanus, diphtheria, and acellular pertussis vaccine and ≥1 dose meningococcal conjugate vaccine was high and stable (around 90%). Providers should review adolescent vaccination records, especially among those born in 2008 and those in populations eligible for the Vaccines for Children program, to ensure adolescents are up to date with all recommended vaccines.

Introduction

In the United States, the Advisory Committee on Immunization Practices (ACIP) recommends that children aged 11–12 years receive tetanus, diphtheria, and acellular pertussis vaccine (Tdap), meningococcal conjugate vaccine (MenACWY), and human papillomavirus (HPV) vaccine (HPV vaccine can be started at age 9 years). A booster dose of MenACWY is recommended at age 16 years, and using shared clinical decision-making, adolescents and young adults aged 16–23 years may also receive serogroup B meningococcal vaccine (MenB). ACIP also recommends that adolescents stay up to date with COVID-19 vaccines,* acquire any missed childhood vaccines (catch-up vaccination), and receive an annual influenza vaccine^†.^[1] Results from 2021 National Immunization Survey–Teen (NIS-Teen) revealed declines in MenACWY^§ and Tdap^¶ coverage among adolescents born in 2008; these persons were due for their routine adolescent vaccines in 2020, during the height of the COVID-19 pandemic.^[2] Ongoing assessment of adolescent vaccination coverage can help guide progress in implementation of ACIP recommendations and identify populations and areas with low coverage.

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Next Section

Abstract and Introduction
Methods
Results
Discussion
References
Sidebar

*COVID-19 vaccination is recommended for all persons aged ≥6 months (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html). Estimates of COVID-19 vaccination coverage are available at https://covid.cdc.gov/covid-data-tracker/#vaccination-states-jurisdictions and https://www.cdc.gov/vaccines/imz-managers/coverage/covidvaxview/interactive/children.html.
^†Influenza vaccination is recommended for all persons aged ≥6 months. Influenza vaccination coverage estimates are available at https://www.cdc.gov/flu/fluvaxview/index.htm.
^§Meningococcal conjugate vaccination coverage represents coverage with the quadrivalent meningococcal conjugate vaccine or meningococcal-unknown type vaccine.
^¶Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine coverage represents coverage with ≥1 Tdap dose at age ≥10 years.

Table 1. Estimated vaccination coverage with selected vaccines and doses among adolescents aged 13–17 years,* by age at interview — National Immunization Survey–Teen, United States, 2022
Vaccine/Population group	Age at 2022 interview, yrs, % (95% CI)^†					Total, % (95% CI)^†
Vaccine/Population group	13 (n = 3,198)	14 (n = 3,399)	15 (n = 3,219)	16 (n = 3,208)	17 (n = 3,019)	2022 (N = 16,043)	2021 (N = 18,002)
Tdap ≥1 dose^§	85.1 (81.7–88.0)	90.7 (88.8–92.3)^¶	91.5 (89.6–93.1)^¶	91.1 (88.9–93.0)^¶	91.4 (89.2–93.2)^¶	89.9 (88.9–90.9)	89.6 (88.6–90.5)
MenACWY**
≥1 dose	84.5 (81.3–87.2)	89.2 (87.1–91.0)^¶	89.0 (86.7–91.0)^¶	89.8 (87.4–91.8)^¶	90.7 (88.7–92.3)^¶	88.6 (87.6–89.6)	89.0 (87.9–90.0)
≥2 doses^††	NA	NA	NA	NA	60.8 (57.5–63.9)	60.8 (57.5–63.9)	60.0 (56.6–63.3)
MenB^§§
≥1 dose	NA	NA	NA	NA	29.4 (26.5–32.4)^¶	29.4 (26.5–32.4)	31.4 (28.2–34.8)
≥2 doses	NA	NA	NA	NA	11.9 (10.0–14.1)	11.9 (10.0–14.1)	NA
HPV^¶¶ vaccine
All adolescents
≥1 dose	68.9 (65.4–72.2)	75.8 (73.0–78.4)^¶	78.5 (75.7–81.1)^¶	79.6 (76.8–82.2)^¶	77.4 (74.5–80.0)^¶	76.0 (74.7–77.3)	76.9 (75.6–78.2)
HPV vaccine UTD***	50.0 (46.4–53.5)	60.3 (57.1–63.4)^¶	65.8 (62.7–68.8)^¶	68.8 (65.8–71.7)^¶	68.3 (65.3–71.2)^¶	62.6 (61.1–64.0)	61.7 (60.2–63.2)
Females
≥1 dose	72.8 (67.7–77.3)	76.5 (72.4–80.2)	79.5 (75.3–83.2)^¶	81.3 (76.8–85.1)^¶	79.0 (75.0–82.5)^¶	77.8 (75.8–79.6)	78.5 (76.6–80.4)
HPV UTD	52.3 (47.1–57.4)	61.7 (57.3–65.9)^¶	68.5 (63.9–72.8)^¶	70.8 (66.2–75.0)^¶	70.9 (66.7–74.8)^¶	64.6 (62.5–66.6)	63.8 (61.5–65.9)
Males
≥1 dose	65.0 (60.0–69.7)	75.1 (71.2–78.7)^¶	77.5 (73.7–80.9)^¶	78.1 (74.3–81.4)^¶	75.9 (71.8–79.5)^¶	74.4 (72.5–76.1)	75.4 (73.5–77.2)
HPV UTD	47.6 (42.8–52.4)	58.8 (54.3–63.2)^¶	63.3 (59.0–67.4)^¶	67.0 (62.9–70.8)^¶	66.0 (61.7–70.0)^¶	60.6 (58.6–62.6)	59.8 (57.6–61.8)
MMR ≥2 doses	90.5 (87.6–92.8)	92.6 (90.4–94.4)	91.0 (88.7–92.8)	92.0 (90.0–93.6)	89.9 (87.3–92.0)	91.2 (90.2–92.1)	92.2 (91.2–93.2)
Hepatitis A vaccine ≥2 doses^†††	84.8 (81.5–87.5)	86.6 (83.9–88.9)	86.7 (84.2–88.8)	84.6 (81.9–87.0)	82.3 (79.7–84.7)	85.0 (83.8–86.1)	85.0 (83.8–86.1)
Hepatitis B vaccine ≥3 doses	90.5 (87.6–92.8)	92.6 (90.6–94.2)	91.0 (88.8–92.8)	91.2 (88.9–93.1)	90.7 (88.3–92.6)	91.2 (90.2–92.1)	92.3 (91.3–93.1)
Varicella
History of varicella^§§§	4.6 (3.4–6.3)	6.4 (5.0–8.1)	7.4 (5.8–9.3)^¶	7.4 (5.9–9.2)^¶	9.3 (7.5–11.4)^¶	7.0 (6.3–7.8)	7.3 (6.5–8.2)
No history of varicella disease
≥1 dose vaccine	93.5 (90.9–95.5)	95.2 (93.5–96.5)	93.4 (91.1–95.1)	94.4 (92.8–95.6)	93.8 (91.4–95.5)	94.1 (93.2–94.8)	94.9 (94.0–95.7)
≥2 doses vaccine	89.4 (86.2–91.9)	91.9 (89.5–93.8)	91.3 (89.1–93.2)	91.1 (89.0–92.9)	90.4 (87.9–92.4)	90.8 (89.8–91.8)	91.5 (90.5–92.5)
History of varicella or receipt of ≥2 varicella vaccine doses	89.9 (86.9–92.3)	92.4 (90.1–94.2)	92.0 (89.9–93.7)	91.8 (89.8–93.4)	91.3 (89.0–93.1)	91.5 (90.5–92.4)	92.2 (91.2–93.1)

Abbreviations: HPV = human papillomavirus; MenACWY = quadrivalent meningococcal conjugate vaccine; MenB = serogroup B meningococcal vaccine; MMR = measles, mumps, and rubella vaccine; NA = not applicable; NIS = National Immunization Survey; Tdap = tetanus, diphtheria, and acellular pertussis vaccine; UTD = up to date.
*Adolescents in the 2022 NIS–Teen were born during January 7, 2004–January 10, 2010.
^†Estimates with 95% CIs widths >20 might not be reliable.
^§Includes percentages receiving Tdap vaccine at age ≥10 years.
^¶Statistically significant difference (p<0.05) in estimated vaccination coverage by age; referent group was adolescents aged 13 years.
**Includes percentages receiving MenACWY or an unknown type of meningococcal vaccine.
^††≥2 doses of MenACWY or unknown type of meningococcal vaccine among adolescents aged 17 years at interview and does not include adolescents who received 1 dose of MenACWY vaccine at age ≥16 years.
^§§Calculated only among adolescents who were aged 17 years at time of interview with vaccine administered based on individual clinical decision.
^¶¶HPV vaccine, nine-valent (9vHPV), quadrivalent (4vHPV), or bivalent (2vHPV). For ≥1 dose and HPV UTD measures, percentages are reported among females and males combined (16,043) and for females only (7,623) and males only (8,420).
***HPV vaccine UTD includes those with ≥3 doses, and those with 2 doses when the first HPV vaccine dose was initiated at age <15 years and there were ≥5 months minus 4 days between the first and second dose (https://www.cdc.gov/vaccines/programs/iis/cdsi.html). This update to the HPV recommendation occurred in December 2016.
^†††In July 2020, ACIP revised recommendations for Hepatitis A vaccination to include catch-up vaccination for persons aged 2–18 years who have not previously received Hepatitis A vaccine at any age. https://pubmed.ncbi.nlm.nih.gov/32614811/
^§§§By parent or guardian report or provider records.

Table 2. Coverage with ≥1 dose of tetanus, diphtheria, and acellular pertussis vaccine, ≥1 dose of quadrivalent meningococcal conjugate vaccine, ≥1 dose of human papillomavirus vaccine, and percentage of adolescents up to date with human papillomavirus vaccination, among adolescents born during 2006–2009,* by age 13 years and 14 years, ^† metropolitan statistical area status, ^§ poverty status, ^¶ race and ethnicity,** and health insurance status ^†† — National Immunization Survey-Teen, United States, 2020–2022
Age group/Characteristic	Vaccination coverage,% (95% CI)§§
	≥1 Tdap				≥1 MenACWY				≥1 HPV				HPV Vaccine UTD
	Birth year				Birth year				Birth year				Birth year
	2006	2007	2008	2009	2006	2007	2008	2009	2006	2007	2008	2009	2006	2007	2008	2009
By age 13 yrs
All adolescents	88.8 (87.7–89.9)	89.6 (88.5–90.7)	86.4 (84.1–88.5)^¶¶	87.1 (83.0–90.7)	87.3 (86.0–88.5)	87.1 (85.5–88.5)	84.1 (81.5–86.4)^¶¶	87.3 (84.1–90.2)	70.4 (68.8–72.0)	72.6 (70.8–74.5)	69.5 (66.8–72.1)	71.4 (67.1–75.6)	50.2 (48.5–51.9)	52.9 (50.8–55.0)	50.0 (47.2–52.8)	52.7 (48.0–57.6)
MSA
MSA, principal city	88.4 (86.4–90.2)	90.0 (88.3–91.5)	86.6 (83.2–89.7)	86.3 (78.5–92.3)	86.7 (84.4–88.9)	89.0 (87.2–90.7)	81.8 (77.3–85.8)^¶¶	87.8 (82.2–92.3)	73.3 (70.7–75.9)	77.9 (75.4–80.3)	69.4 (64.8–73.8)^¶¶	74.8 (67.4–81.7)	52.4 (49.6–55.1)	56.8 (53.6–60.0)	49.2 (44.6–54.0)^¶¶	55.1 (47.3–63.3)
MSA, nonprincipal city	90.0 (88.4–91.4)	89.3 (87.4–91.0)	85.5 (81.9–88.7)	87.6 (82.4–91.8)	89.0 (87.4–90.5)	85.7 (82.9–88.2)	85.6 (82.0–88.8)	87.3 (82.9–91.1)	69.3 (66.9–71.6)	68.8 (65.7–71.8)	69.9 (66.1–73.7)	69.3 (63.3–75.0)	49.6 (47.1–52.1)	50.8 (47.6–53.9)	50.7 (46.9–54.7)	52.5 (46.2–59.2)
Non–MSA	85.6 (82.4–88.4)	89.9 (87.3–92.1)	89.5 (85.4–92.9)	88.6 (79.2–95.0)	81.8 (78.8–84.6)	85.4 (82.3–88.1)	86.2 (82.0–89.9)	84.9 (75.3–92.3)	64.3 (60.4–68.1)	69.3 (65.3–73.2)	67.7 (61.1–74.2)	67.0 (56.3–77.4)	44.6 (40.4–49.1)	47.1 (42.5–52.0)	49.5 (43.3–56.2)	43.3 (32.0–56.6)
Poverty status
At or above federal poverty level	89.1 (87.8–90.3)	89.4 (88.2–90.6)	86.6 (84.1–88.8)^¶¶	88.5 (84.6–91.8)	87.5 (86.0–88.9)	87.3 (85.6–89.0)	85.2 (82.6–87.5)	87.6 (83.8–90.8)	68.8 (67.0–70.5)	71.2 (69.1–73.3)	68.5 (65.6–71.4)	70.2 (65.2–75.0)	49.4 (47.6–51.3)	52.4 (50.1–54.7)	49.5 (46.6–52.5)	51.1 (45.9–56.4)
Below federal poverty level	89.1 (86.9–91.1)	90.6 (87.2–93.3)	83.0 (75.9–88.9)^¶¶	89.5 (82.6–94.5)	86.8 (84.2–89.3)	86.0 (82.0–89.5)	78.1 (69.6–85.6)	89.4 (82.6–94.4) ***	79.0 (75.5–82.2)	79.1 (74.6–83.3)	74.3 (66.8–81.2)	77.7 (68.7–85.6)	54.3 (50.1–58.7)	55.0 (49.4–60.7)	52.6 (44.6–61.1)	57.8 (46.6–69.4)
Race and ethnicity
AI/AN, NH	79.4 (57.3–94.7)	92.5 (85.4–96.9)	91.1 (78.0–97.9)	NA	79.1 (57.1–94.4)	82.4 (67.9–93.0)	83.6 (68.8–94.0)	NA	63.6 (45.8–81.2)	72.5 (52.9–89.1)	69.1 (51.4–85.1)	NA	49.2 (34.3–66.5)	54.4 (35.9–75.1)	51.3 (33.9–71.3)	31.8 (14.2–61.6)
Asian, NH	87.3 (81.7–91.8)	84.0 (76.1–90.4)	87.5 (77.6–94.4)	75.4 (50.2–94.0)	91.4 (87.1–94.8)	88.1 (81.9–93.0)	94.4 (89.5–97.5)	NA	76.8 (70.6–82.4)	76.7 (68.7–83.9)	64.6 (52.2–76.8)	57.6 (34.4–82.6)	58.5 (50.9–66.3)	60.7 (50.6–71.0)	50.7 (39.5–63.1)	49.2 (28.6–74.3)
Black or African American, NH	88.5 (85.6–91.1)	90.3 (87.2–92.9)	84.6 (78.8–89.5)	89.0 (80.8–94.7)	87.8 (84.6–90.6)	86.1 (81.6–89.9)	81.8 (74.7–87.9)	82.6 (72.8–90.5)	76.6 (72.9–80.2)	79.4 (74.3–84.0)	72.6 (65.4–79.4)	70.7 (60.1–80.6)	53.9 (49.4–58.6)	57.3 (51.7–63.1)	54.4 (47.3–61.8)	54.9 (43.1–67.5)
Hispanic or Latino	87.4 (84.1–90.3)	89.2 (86.3–91.7)	84.4 (77.7–90.0)	82.7 (71.3–91.5)	86.8 (83.2–90.1)	86.6 (82.2–90.3)	81.0 (73.4–87.5)	87.8 (79.5–93.8)	72.8 (68.6–76.8)	74.4 (69.6–79.0)	74.5 (67.6–80.9)	78.6 (69.7–86.4)	54.8 (50.5–59.2)	54.8 (49.8–60.1)	52.9 (45.7–60.4)	57.8 (47.2–68.8)
White, NH	89.9 (88.7–91.1)	90.2 (88.8–91.5)	87.7 (85.3–90.0)	91.3 (88.1–93.9)	87.0 (85.5–88.4)	87.2 (85.5–88.7)	85.4 (82.7–87.8)	89.4 (86.1–92.2)	66.8 (64.9–68.6)	69.2 (67.0–71.5)	66.8 (63.6–70.1)	67.0 (61.1–72.7)	46.0 (44.1–47.9)	50.0 (47.6–52.5)	46.7 (43.6–49.8)	47.5 (41.8–53.6)
Health insurance status
Private insurance only	89.6 (88.1–91.0)	91.0 (89.7–92.3)	87.9 (85.3–90.2)^¶¶	89.0 (83.8–93.1)	88.6 (87.2–90.0)	88.3 (86.1–90.3)	86.8 (84.0–89.4)	92.3 (89.1–94.8) ^¶¶,***	68.9 (66.9–70.9)	71.2 (68.5–73.8)	69.8 (66.4–73.2)	73.9 (68.3–79.2)	50.5 (48.4–52.6)	52.7 (49.8–55.5)	50.4 (47.0–53.9)	55.2 (49.1–61.5)
Any Medicaid insurance	88.5 (86.3–90.4)	88.8 (86.6–90.9)	84.5 (80.5–88.2)	86.5 (78.6–92.6)	87.1 (84.6–89.4)	86.1 (83.6–88.4)	82.0 (77.4–86.1)	84.0 (78.2–89.0)	74.2 (71.2–77.1)	75.6 (72.6–78.5)	71.8 (67.3–76.2)	70.6 (63.2–77.8)	52.4 (49.3–55.6)	55.3 (51.8–58.9)	51.9 (47.0–56.9)	52.2 (44.0–60.9)
Other insurance	88.6 (85.5–91.3)	88.8 (85.0–92.1)	94.2 (91.4–96.3)^¶¶	79.0 (66.4–89.4)	85.8 (81.9–89.3)	88.7 (85.0–91.8)	86.7 (76.6–93.9)	75.5 (64.1–85.5)	70.2 (65.4–74.9)	74.0 (68.7–79.0)	66.1 (55.9–76.0)	63.8 (51.7–75.8)	45.0 (39.6–50.8)	50.2 (43.8–56.9)	48.5 (38.2–59.8)	45.6 (33.5–59.7)
Uninsured	80.2 (71.9–87.3)	79.2 (69.1–87.8)	71.1 (49.3–89.7)	82.1 (55.4–97.4)	69.7 (59.7–79.1)	75.3 (63.3–85.8)	63.2 (42.7–83.3)	74.5 (43.4–96.3)	NA	58.0 (46.5–70.0)	46.5 (29.9–66.7)	59.9 (34.1–86.4)	NA	34.9 (25.0–47.3)	26.9 (15.1–45.0)	39.3 (18.4–70.5)
By age 14 yrs^†††
All adolescents	89.3 (88.2–90.4)	90.9 (89.7–91.9)	87.1 (84.9–89.2) ^§§§	NA	88.5 (87.3–89.7)	88.8 (87.2–90.2)	86.0 (83.2–88.6)	NA	74.8 (73.1–76.4)	76.3 (74.4–78.2)	72.5 (69.5–75.5) ^§§§	NA	58.5 (56.7–60.3)	59.6 (57.4–61.9)	53.9 (50.9–56.9) ^{§§§,¶¶¶}	NA
MSA
MSA, principal city	88.9 (86.9–90.7)	91.2 (89.5–92.7)	87.3 (83.8–90.4) ^§§§	NA	88.5 (86.3–90.5)	90.8 (89.1–92.4)	83.3 (78.7–87.3) ^{§§§,¶¶¶}	NA	78.4 (75.8–80.8)	80.3 (77.8–82.7)	71.9 (67.0–76.5) ^{§§§,¶¶¶}	NA	60.9 (58.0–63.8)	63.8 (60.4–67.2)	52.1 (47.2–57.2) ^{§§§,¶¶¶}	NA
MSA, Nonprincipal city	90.2 (88.6–91.7)	90.7 (88.8–92.4)	86.4 (82.7–89.6) ^§§§	NA	89.6 (87.9–91.1)	87.4 (84.6–90.0)	88.3 (84.0–91.8)	NA	73.3 (70.9–75.7)	73.7 (70.4–76.8)	74.0 (69.6–78.3)	NA	57.7 (55.1–60.3)	56.9 (53.6–60.3)	55.3 (51.2–59.6)	NA
Non–MSA	87.2 (84.1–89.9)	90.2 (87.6–92.5)	90.1 (86.1–93.4)	NA	84.0 (81.1–86.7)	86.4 (83.4–89.1)	87.0 (82.8–90.6)	NA	66.9 (63.1–70.8)	72.2 (68.2–76.1)	68.2 (61.6–74.6)	NA	52.2 (47.9–56.7)	55.7 (50.0–61.5)	54.9 (48.3–61.7)	NA
Poverty status
At or above poverty level	89.6 (88.3–90.8)	90.6 (89.3–91.7)	86.7 (84.2–89.0) ^{§§§,¶¶¶}	NA	88.9 (87.5–90.2)	88.9 (87.2–90.5)	86.8 (83.8–89.4)	NA	73.9 (72.1–75.6)	75.2 (73.0–77.3)	71.9 (68.5–75.2)	NA	57.5 (55.6–59.4)	58.9 (56.5–61.4)	53.0 (50.0–56.1) ^{§§§,¶¶¶}	NA
Below poverty level	89.6 (87.4–91.5)	92.4 (88.9–95.2)	86.4 (79.4–91.9)	NA	87.9 (85.2–90.2)	88.6 (84.5–92.1)	80.1 (71.5–87.5)	NA	80.8 (77.3–84.0)	82.0 (77.4–86.2)	75.3 (67.7–82.3)	NA	63.8 (59.4–68.2)	61.2 (55.4–67.0)	55.2 (46.8–64.0)	NA
Race and ethnicity
Asian, NH	87.8 (82.2–92.3)	84.8 (76.9–91.2)	90.3 (79.6–96.7)	NA	92.3 (88.0–95.6)	88.9 (82.7–93.7)	94.6 (89.7–97.6)	NA	80.2 (74.1–85.6)	83.8 (76.5–89.8)	72.6 (56.4–86.7)	NA	67.1 (59.7–74.4)	67.4 (57.8–76.8)	58.1 (44.6–72.2)	NA
AI/AN, NH	NA	94.2 (87.0–98.1)	NA	NA	79.2 (57.2–94.6)	85.2 (70.1–95.1)	NA	NA	63.9 (46.0–81.5)	74.8 (54.6–91.0)	NA	NA	55.2 (38.3–73.7)	63.6 (43.6–83.1)	61.1 (41.6–80.8)	NA
Black or African American, NH	88.7 (85.7–91.2)	93.3 (90.3–95.6)^¶¶¶	85.6 (79.7–90.5)^§§§	NA	88.1 (84.9–90.9)	90.9 (86.9–94.1)	83.5 (76.2–89.6)	NA	79.4 (75.6–82.9)	84.6 (79.5–89.1)	NA	NA	63.1 (58.4–67.8)	66.1 (59.6–72.5)	59.4 (51.7–67.2)	NA
Hispanic or Latino	87.7 (84.4–90.6)	90.6 (87.7–93.1)	86.5 (79.9–91.9)	NA	88.6 (85.2–91.6)	88.2 (83.6–92.0)	82.6 (74.9–89.0)	NA	77.6 (73.5–81.5)	76.9 (71.9–81.6)	75.6 (68.7–81.9)	NA	61.0 (56.6–65.5)	61.0 (55.5–66.6)	56.4 (48.6–64.5)	NA
White, NH	90.7 (89.5–91.8)	90.9 (89.5–92.2)	87.9 (85.5–90.1)^{§§§,¶¶¶}	NA	88.2 (86.7–89.6)	88.1 (86.5–89.7)	87.7 (84.5–90.6)	NA	71.4 (69.5–73.3)	72.7 (70.4–75.0)	70.3 (66.3–74.2)	NA	55.3 (53.2–57.4)	56.6 (54.0–59.2)	50.2 (46.9–53.6) ^{§§§,¶¶¶}	NA
Health insurance status
Private insurance only	90.2 (88.7–91.6)	92.0 (90.7–93.2)	88.0 (85.4–90.3)^§§§	NA	89.7 (88.2–91.1)	89.4 (87.2–91.5)	88.9 (85.3–91.9)	NA	74.3 (72.3–76.3)	75.4 (72.6–78.1)	74.0 (69.8–78.1)	NA	59.1 (56.9–61.3)	60.4 (57.3–63.5)	54.6 (50.8–58.5)^§§§	NA
Any Medicaid insurance	88.9 (86.7–90.8)	90.2 (87.9–92.2)	85.6 (81.5–89.2)^§§§	NA	88.7 (86.4–90.8)	87.8 (85.2–90.0)	84.2 (79.7–88.2)	NA	77.7 (74.7–80.5)	77.8 (74.8–80.7)	72.7 (68.1–77.2)	NA	60.4 (57.1–63.7)	61.3 (57.6–65.1)	56.3 (51.1–61.7)	NA
Other insurance	89.2 (86.0–91.9)	89.8 (85.9–93.0)	95.1 (92.0–97.2)^{§§§,¶¶¶}	NA	86.5 (82.5–90.0)	89.6 (85.9–92.7)	87.0 (76.7–94.3)	NA	72.5 (67.6–77.1)	77.9 (72.6–82.8)	68.9 (57.8–79.3)	NA	52.2 (46.3–58.3)	55.8 (49.2–62.6)	48.9 (38.6–60.3)	NA
Uninsured	80.7 (72.4–87.8)	84.0 (73.7–91.9)	82.3 (59.8–96.3)	NA	71.2 (61.1–80.6)	90.0 (80.2–96.3)^¶¶¶	NA	NA	52.1 (41.6–63.4)	70.4 (57.2–82.6)^¶¶¶	58.1 (39.3–78.0)	NA	38.4 (28.2–50.9)	37.1 (26.9–49.7)	28.3 (16.3–46.1)	NA

Abbreviations: AI/AN = American Indian or Alaska Native; HPV = human papillomavirus; MenACWY = quadrivalent meningococcal conjugate vaccine; MSA = metropolitan statistical area; NA= not applicable; NH = non-Hispanic; Tdap = tetanus, diphtheria, and acellular pertussis vaccine; UTD = up to date.
*Data for the 2006 birth year are from survey years 2019, 2020, 2021, and 2022; data for the 2007 birth year are from survey years 2020, 2021, and 2022; data for the 2008 birth year are from survey years 2021, and 2022; data for the 2009 birth year are from survey year 2022.
^†Includes vaccinations received by age 13 years (before the 13th birthday) and by age 14 years (before the 14th birthday).
^§MSA status was determined from household reported city and county of residence and was grouped into three categories: MSA principal city, MSA nonprincipal city, and non-MSA. MSA nonprincipal city and MSA principal city were as defined by the U.S. Census Bureau (https://www.census.gov/programs-surveys/metro-micro.html). Non-MSAs include urban populations not located within an MSA and completely rural areas.
^¶Adolescents were classified as being below the federal poverty level if their total family income was less than the level specified for the applicable family size and number of children and adolescents aged <18 years. All others were classified as at or above the federal poverty level (https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html). Poverty status was unknown for 435 adolescents.
**Adolescents' race and ethnicity was reported by their parent or guardian. Adolescents identified in this report as White, Black or African American, Asian, American Alaska Native or Indian, Native Hawaiian or other Pacific Islander, or multiple races were reported by the parent or guardian as non-Hispanic. Adolescents identified as having multiple races had more than one race category selected. Adolescents identified as Hispanic or Latino might be of any race. Estimates for Native Hawaiian or other Pacific Islander and multiracial adolescents were suppressed because of small sample size.
^††Adolescents' health insurance status was reported by their parent or guardian. "Other insurance" includes the Children's Health Insurance Program, military insurance, Indian Health Service, and any other type of health insurance not mentioned elsewhere.
^§§Estimates with 95% CIs >20 might not be reliable. Estimates with sample size <30 were suppressed and marked with NA.
^¶¶Statistically significant difference (p<0.05) in estimated vaccination coverage by age 13 years; referent group was 2007 birth year.
***Statistically significant difference (p<0.05) in estimated vaccination coverage by age 13 years; referent group was 2008 birth year.
^†††Adolescents in the 2009 birth cohort reach their 14th birthday in 2023, and thus vaccinations by their 14th birthday in 2023 were not assessed by the 2022 NIS-Teen. These table cells were marked NA.
^§§§Statistically significant difference (p<0.05) in estimated vaccination coverage by age 14 years; referent group was 2007 birth year.
^¶¶¶Statistically significant difference (p<0.05) in estimated vaccination coverage by age 14 years; referent group was 2006 birth year.