Despite steady coverage of other routine vaccines, US adolescent HPV vaccination remains stagnant at 77.7%, with significant rural-urban disparities and uneven state-level progress highlighting persistent barriers and policy gaps.
The latest federal snapshot of adolescent vaccination shows the US has made no further progress on HPV for a fourth straight year, with coverage still lagging well behind the other routine jabs given in early secondary school. In the 2025 National Immunization Survey-Teen, 77.7% of 13- to 17-year-olds had received at least one HPV dose and 63.4% were up to date with the full series. By contrast, Tdap coverage stood at 88.8% and MenACWY at 89.0%, both still close to 90%.
The most striking divide was geographical. The CDC found that teenagers living in mostly rural areas were 12.0 percentage points less likely than those in mostly urban areas to have had at least one HPV dose, and 14.2 points less likely to be up to date with the series. A smaller but still measurable shortfall was also seen in mostly suburban areas, where first-dose HPV coverage was 2.9 points lower than in mostly urban communities. MenACWY showed a different pattern: its rural deficit was only 3.0 points, and when the figures were broken down by poverty level, that gap remained only among adolescents living below the poverty line.
The state-by-state picture was even more uneven. Rhode Island had the highest first-dose HPV coverage at 94.1%, while Mississippi was lowest at 49.5%. For completion of the series, the spread ran from 84.5% in Rhode Island to 30.9% in Mississippi. Contemporary Pediatrics noted that Tdap varied far less across jurisdictions, ranging from 80.5% in the District of Columbia to 94.6% in Vermont, underlining how unusually fragmented HPV uptake has become. The CDC also said only a limited number of places moved materially from the previous year: Maine and New Jersey increased first-dose HPV coverage, while Hawaii, New Jersey and Wyoming improved the share of teenagers who were up to date; Arkansas and Florida moved the other way on first doses, and Kentucky slipped on completion.
The agency’s authors have pointed to policy as part of the explanation. As CIDRAP reported, they wrote that “The consistently lower HPV vaccination coverage compared with other routine adolescent vaccines might, in part, reflect differences in school entry requirements.” Tdap is required for school entry in all states and MenACWY in most of them, while HPV is mandated in only a small number. That helps explain why a vaccine that depends more heavily on what happens during a clinic conversation has stalled even as the other two routine adolescent vaccines remain high. The National Public Health Information Coalition also highlighted that first-dose HPV coverage slipped slightly, from 78.2% in 2024 to 77.7% in 2025, leaving the country still short of national prevention goals.
The new figures look less like a sudden reversal than the continuation of a plateau that had already set in. A peer-reviewed birth-cohort analysis of 2016 to 2022 NIS-Teen data found that HPV initiation had climbed from 60.4% in 2016 to 76.0% in 2022, but even then remained well behind Tdap at 89.9% and MenACWY at 88.6%. More recent research covering 2021 to 2023 showed completion rates barely moving at all: 62.4% in 2021, 63.9% in 2022 and 62.5% in 2023. That study also found modestly higher completion among girls and among older teenagers, suggesting that catch-up later in adolescence is still doing some of the work that earlier routine vaccination ought to have done.
The shortfall matters beyond the headline numbers. Among 13- to 15-year-olds, only 58.6% had completed the HPV series, still well below the Healthy People 2030 target of 80% for that age group. The same CDC report found that two-dose MMR coverage among adolescents was 92.5%, below the 95% benchmark that public health officials associate with population-level protection against measles outbreaks. In other words, the survey points not only to a stubborn HPV problem, but also to the limits of catch-up vaccination later in childhood.
The CDC has, however, urged caution in interpreting the small declines in Tdap and MenACWY. The 2025 survey analysed 18,692 adolescents born between January 2007 and December 2012. Its household response rate was 21.4%, and adequate provider records were available for 42.0% of completed interviews. The agency said the apparent drops in Tdap and MenACWY may partly reflect a higher share of teenagers with multiple vaccination providers whose questionnaires were not all returned. A separate total survey error assessment for the previous cycle suggested NIS-Teen may also understate true coverage, with the biggest underestimation seen in HPV series completion, at 5.4 percentage points.
That leaves clinicians with a fairly plain brief. The CDC says providers should review immunisation records, use reminder and recall systems, and recommend any due vaccines at every clinical encounter rather than waiting for a separate appointment. Contemporary Pediatrics made the same point in practical terms for paediatric practice: check the record, flag what is missing and offer the vaccine on the day. Because HPV vaccination can begin at age nine, and because earlier vaccination reduces the need for repeated catch-up, the next routine visit may be one of the few chances to close a gap that has now stayed open for four years.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
