Trends and disparities in HPV vaccination among U.S. adolescents, 2018–2023

Abstract Background From 2018 to 2023, Human papillomavirus (HPV) vaccination coverage in the United States was shaped by both proactive immunization efforts and the disruptions caused by the COVID-19 pandemic, leading to the first national decline in nearly a decade. This study aimed to assess vaccination trends over time and across regions to identify coverage gaps and inform health policy best practices for achieving optimal HPV vaccination rates. Methods We used provider-verified data from the National Immunization Survey–Teen for adolescents aged 13–17, focusing on vaccine initiation (≥1 dose) and up-to-date (UTD) status, as defined by Centers for Disease Control and Prevention guidelines. We used Cochran-Armitage trend tests to assess changes across the pre-pandemic, pandemic, and post-pandemic periods. We stratified our analyses by sex, race/ethnicity, and state. Results Initiation increased from 68.1% in 2018 to 76.9% in 2021, then declined to 76.8% in 2023. UTD status rose from 51.1 to 62.6% by 2022 but fell to 61.4% in 2023. Females and Hispanic/Black adolescents consistently had higher coverage than males and White adolescents. Eighteen states, mainly in the Northeast and Upper Midwest, achieved ≥80% initiation by 2023, while Southern states lagged. Conclusion Best practices for improving HPV vaccination include: (1) strengthening vaccination infrastructure in low-performing Southern states, (2) targeting male and White adolescents, (3) maintaining robust delivery systems during crises, and (4) replicating high-performing regional models. These strategies can improve vaccine equity and contribute to achieving national targets over time and space.