National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13\u201317 Years \u2014 United States, 2013

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Laurie D. Elam-Evans, PhD1, David Yankey, MS1, Jenny Jeyarajah, MS1, James A. Singleton, PhD1, C. Robinette Curtis, MD1, Jessica MacNeil, MPH2, Susan Hariri, PhD3 (Author affiliations at end of text)

The Advisory Committee on Immunization Practices (ACIP) recommends that adolescents routinely receive 1 dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine, 2 doses of meningococcal conjugate (MenACWY) vaccine, and 3 doses of human papillomavirus (HPV) vaccine (1,2).* ACIP also recommends administration of \"catch-up\"\u2020 vaccinations, such as measles, mumps, and rubella (MMR), hepatitis B, and varicella, and, for all persons aged \u22656 months, an annual influenza vaccination (1). ACIP recommends administration of all age-appropriate vaccines during a single visit (3). To assess vaccination coverage among adolescents aged 13\u201317 years, CDC analyzed data from the 2013 National Immunization Survey-Teen (NIS-Teen).\u00a7 This report summarizes the results of that analysis, which show that from 2012 to 2013, coverage increased for each of the vaccines routinely recommended for adolescents: from 84.6% to 86.0% for \u22651 Tdap dose; from 74.0% to 77.8% for \u22651 MenACWY dose; from 53.8% to 57.3% for \u22651 HPV dose among females, and from 20.8% to 34.6% for \u22651 HPV dose among males. Coverage varied by state and local jurisdictions and by U.S. Department of Health and Human Services (HHS) region. Healthy People 2020 vaccination targets for adolescents aged 13\u201315 years (4) were reached in 42 states for \u22651 Tdap dose, 18 for \u22651 MenACWY dose, and 11 for \u22652 varicella doses. No state met the target for \u22653 HPV doses.\u00b6 Use of patient reminder and recall systems, immunization information systems, coverage assessment and feedback to clinicians, clinician reminders, standing orders, and other interventions can help make use of every health care visit to ensure that adolescents are fully protected from vaccine-preventable infections and cancers (5), especially when such interventions are coupled with clinicians' vaccination recommendations.

Vaccination coverage was assessed using 2013 NIS-Teen data for adolescents aged 13\u201317 years in the 50 states, the District of Columbia, selected local areas,** Guam, and the U.S. Virgin Islands, using a random-digit\u2013dialed sample of landline and cell phones.\u2020\u2020 Telephone interviews were conducted with the parent or guardian of age-eligible adolescents to obtain information about the adolescent's demographic characteristics and to request vaccination provider contact information.\u00a7\u00a7 After receiving a respondent's consent, a questionnaire was mailed to each vaccination provider to obtain provider-confirmed immunization information. In 2013, national estimates were based on responses for 18,264 adolescents (8,710 females and 9,554 males).\u00b6\u00b6 Details of NIS-Teen methodology, including methods for synthesizing provider-reported immunization histories and weighting, have been described previously.*** NIS-Teen data from 2006\u20132013 were used in this report to describe vaccination coverage over time. Weighted linear regression\u2020\u2020\u2020 was used to assess coverage trends for vaccines recommended routinely for adolescents. T-tests were used to assess vaccination coverage differences by survey year (2013 compared with 2012), age, sex, race/ethnicity, and poverty status for all vaccines included in this report. Results were considered statistically significant at p<0.05.

National Vaccination Coverage

During 2006\u20132013, NIS-Teen data show that coverage trends differed substantially for Tdap, MenACWY, and HPV vaccination (Figure). Coverage estimates for \u22651 Tdap dose and \u22651 MenACWY dose increased significantly each year from 2006 to 2013, with average increases of 10.4 percentage points (95% confidence interval [CI] = 7.8\u201313.1) for Tdap and 8.9 percentage points (CI = 6.5\u201311.3) for MenACWY. Coverage for \u22651 HPV dose increased an average of 4.5 percentage points (CI = 2.7\u20136.3) annually from 2007 to 2013 for females, and by 9.9 percentage points (CI = 4.8\u201315.0) from 2010 to 2013 for males. In 2013, Tdap and MenACWY coverage estimates were 86.0% and 77.8%, respectively (Table 1). From 2012 to 2013, coverage with \u22651, \u22652, and \u22653 HPV doses increased for both sexes. Coverage with \u22651 HPV dose in 2013 was 57.3% for females and 34.6% for males. No statistically significant changes occurred from 2012 to 2013 in coverage for \u22652 doses of MMR vaccine or \u22653 doses of hepatitis B vaccine. However, coverage for \u22652 doses of varicella vaccine increased from 74.9% to 78.5% among adolescents with no history of disease (Table 1).

Coverage with the second MenACWY dose was calculated as the proportion of adolescents aged 17 years on date of interview who received a second MenACWY dose on or after their 16th birthday, among those who had received a first dose before their 16th birthday (only second doses received on or after their 16th birthday and at least 8 weeks after the first dose were counted). All of these adolescents were aged 16 years after the MenACWY second dose was recommended by ACIP in October 2010 (n = 2,310) (6). The MenACWY 2-dose completion rate was 29.6% (CI = 26.4%\u201333.0%).

Vaccination Coverage by Selected Characteristics

In 2013, among females, \u22651 HPV dose coverage was significantly higher among adolescents aged 15\u201317 years compared with younger adolescents (Table 1). However, \u22651 HPV dose coverage for males did not vary by age. In 2013, as found previously, most vaccination coverage rates were similar by sex; however, females had greater vaccination coverage than males for \u22651, \u22652, and \u22653 HPV doses and 3-dose HPV series completion\u00a7\u00a7\u00a7 (Table 1). Also, females had significantly higher vaccination coverage than males for \u22652 varicella doses (80.0% [CI = 78.1%\u201381.7%] versus 77.2% [CI = 75.2%\u201379.0%]).

In 2013, there were no racial or ethnic differences in vaccination coverage for \u22651 Tdap, \u22653 hepatitis B, or \u22652 varicella (Table 2). However, \u22651 MenACWY dose coverage was higher among Hispanic and Asian adolescents compared with white adolescents. Among females, \u22651, \u22652, and \u22653 HPV dose coverage was higher among Hispanic compared with white adolescents. Among males, \u22651, \u22652, and \u22653 HPV dose coverage was higher among black and Hispanic adolescents compared with white adolescents. Black adolescent females had lower HPV 3-dose series completion compared with white adolescent females and, in contrast to findings in 2012, series completion among Hispanic females was similar to coverage among white adolescent females. There were no statistically significant racial/ethnic differences among males for HPV 3-dose series completion. In 2013, vaccination coverage did not vary by poverty level\u00b6\u00b6\u00b6 for \u22651 Tdap, \u22651 MenACWY, \u22652 MMR, \u2265 3 hepatitis B, \u22652 varicella, or HPV 3-dose series completion (for males or females) (Table 2). However, those living below the poverty level had higher \u22651, \u22652, and \u22653 HPV dose coverage (for males) and \u22651 and \u22652 HPV dose coverage (for females), compared with their counterparts living at or above the poverty level. These findings in 2013 data that females had no difference in 3-dose HPV completion by poverty status were not observed in 2012 (7).

State and Regional Vaccination Coverage

In 2013, there was wide variation among states in coverage (Table 3). Coverage for \u22651 Tdap ranged from 60.2% (Mississippi) to 95.5% (Rhode Island), whereas coverage estimates for \u22651 MenACWY ranged from 40.4% (Arkansas) to 93.7% (North Dakota). Among females, coverage for \u22651 HPV doses ranged from 39.9% (Kansas) to 76.6% (Rhode Island) and for \u22653 HPV doses ranged from 20.5% (Utah) to 56.5% (Rhode Island). For males, coverage for \u22651 HPV doses ranged from 11.0% (Utah) to 69.3% (Rhode Island) and for \u22653 HPV doses ranged from 7.3% (Nevada) to 43.2% (Rhode Island). Coverage for \u22652 MMR doses ranged from 83.2% (West Virginia) to 97.4% (New Hampshire and Louisiana). Coverage for \u22652 varicella doses ranged from 50.6% (South Dakota) to 95.8% (Connecticut).

Coverage with \u22651 HPV doses in females increased from 2012 to 2013 in five states (Illinois, Michigan, New Hampshire, New Mexico, and South Carolina), with percentage point increases ranging from 12.0 (Illinois) to 18.5 (South Carolina). HPV coverage with \u22651 doses in females also increased by 6.0 percentage points (CI = 0.1\u201312.0) in HHS Region IV (southeastern states) and by 7.8 percentage points (CI = 2.1\u201313.4) in HHS Region V (north central states) (Table 3).

Healthy People 2020 Targets

The Healthy People 2020 national targets for vaccination coverage among adolescents aged 13\u201315 years are 80.0% for \u22651 Tdap dose, \u22651 MenACWY dose, and \u22653 HPV doses (among females) and 90.0% for \u22652 varicella doses (4). Among adolescents aged 13\u201315 years, vaccination coverage in 2013 was 87.5% (CI = 86.4%\u201388.6%) for \u22651 Tdap dose, 78.1% (CI = 76.7%\u201379.4%) for \u22651 MenACWY dose, 32.7% (CI = 30.3%\u201335.2%) for \u22653 HPV doses (among females), and 80.7% (79.2%\u201382.1%) for \u22652 varicella doses. From 2012 to 2013, vaccination coverage for these national targets increased by 2.2\u20134.6 percentage points. The number of states meeting or exceeding the target was 42 for \u22651 Tdap dose (up from 36 in 2012), 18 for \u22651 MenACWY dose (up from 12 in 2012), 11 for \u22652 varicella doses (up from 9 in 2012), and for \u22653 HPV doses among females, none.

Discussion

From 2012 to 2013, coverage for adolescents aged 13\u201317 years increased for all vaccinations routinely recommended for adolescents, with increases ranging from 1.4 percentage points for \u22651 Tdap dose to 13.8 percentage points for \u22651 HPV dose in males. Nationally, the Healthy People 2020 vaccination coverage target for adolescents aged 13\u201315 years was reached for Tdap (87.5%) for the third survey year, and progress continues for MenACWY (78.1%) and varicella (80.7%). These high vaccination coverage levels confirm that established targets of 80%\u201390% are achievable for adolescents for vaccination and vaccination series, just as they are for young children. However, coverage for \u22653 HPV doses among females aged 13\u201315 years in 2013 was 32.7%, and trends measured by 2013 and earlier NIS-Teen data demonstrate that the 80% Healthy People 2020 target will be difficult to achieve without changes in clinical practices, leaving adolescents vulnerable to develop the cancers that safe, effective HPV vaccines can prevent. Accelerating progress in HPV vaccination will require the collaboration of numerous stakeholders (e.g., clinicians, parents, adolescents, and public health professionals) to overcome barriers to use of HPV vaccines (8). A variety of factors, including knowledge, attitudes, and behaviors among clinicians and parents likely contribute to lower HPV vaccination initiation compared with Tdap and MenACWY vaccinations. Addressing barriers to HPV vaccination at the recommended ages of 11\u201312 years could reduce missed opportunities to administer all recommended adolescent vaccines during the same clinical encounter. Another analysis of 2013 NIS-Teen data indicates that for adolescent females born in 2000, coverage with at least 1 dose of HPV vaccine before age 13 years could have reached 91.3% if opportunities to administer HPV vaccine when other vaccines were given had not been missed (9).

Although HPV vaccination of adolescent females increased by only 3.5 percentage points from 2012 to 2013, this increase was significantly greater than that observed from 2011 to 2012, when first dose HPV coverage among adolescent females stagnated. Whether increased health promotion activities aimed at clinicians (e.g., http://www.cdc.gov/vaccines/youarethekey) and parents initiated during 2013 account for the modest increase is not known. Vaccination coverage increases in 2013 were primarily observed in the last quarter of the year, which could reflect the impact of health promotion activities initiated during the summer and fall of 2013.

The high number of measles cases reported in the United States in 2014 (580 cases through July 18) (http://www.cdc.gov/measles/index.html) is a reminder of the importance of achieving and maintaining high 2-dose MMR vaccination coverage among children and adolescents throughout the country. Whereas eight states had 2-dose coverage >95%, 13 states and the District of Columbia had 2-dose coverage <90%, reflecting a vulnerability to measles transmission.

In 2013, there were racial and ethnic differences for some vaccines (MenACWY, MMR, and HPV). Compared with whites, vaccination coverage among Hispanics was higher for \u22651 MenACWY dose and each HPV dose among males and females, but lower for \u22652 MMR doses. Vaccination coverage was similar by poverty level except for HPV vaccination, with higher coverage with \u22651, \u22652, and \u22653 HPV doses for males and \u22651 and \u22652 HPV doses for females among those living below poverty level compared with those living at or above the poverty level. The higher coverage among some racial/ethnic minorities and those living below poverty level might be partly attributable to the continued effectiveness of the Vaccines for Children program (VFC), which provides recommended vaccines at no cost to eligible children.**** However, the significantly lower rates of HPV vaccine series completion in black females compared with white females warrants investigation of possible differences (e.g., access to quality care, such as access to clinicians with reminder-recall systems) that might limit vaccine series completion in some populations. Learning what factors are fostering achievement of increasing and comparatively higher HPV vaccination coverage among Hispanic adolescents might inform strategies for the general population. The similar or higher vaccination coverage among adolescents living below the poverty threshold contrasts with findings for coverage with some early childhood vaccinations (10). Among children aged 19\u201335 months, poverty has been associated with lower coverage of newer vaccines (e.g., rotavirus), and some vaccines that require doses during the second year of life (e.g., DTaP and PCV) (10).

Geographic differences in coverage continue to vary by vaccine. Factors contributing to state or regional differences might include different state school vaccination requirements, different stages of vaccine policy implementation, increased vaccine demand in response to local disease, differing parental knowledge and attitudes toward or access to vaccination, inconsistent clinician adherence to and knowledge about vaccine recommendations, and other factors. Although there was an overall increase in HPV vaccination coverage among females, there was continued wide variability among states and HHS Regions. HPV coverage among females increased significantly from 2012 to 2013 in only five states (Illinois, Michigan, New Hampshire, New Mexico, and South Carolina) for \u22651 HPV dose and in four states (Illinois, Mississippi, New Mexico, and South Carolina) for \u22653 HPV doses. These states have undertaken diverse initiatives that likely contributed to the significant increases in HPV vaccination coverage, including 1) developing partnerships with state chapters of the American Academy of Pediatrics and with the Academy of Family Physicians to promote HPV immunization, 2) working actively with Immunization Coalitions and Cancer Collaboratives to incorporate HPV immunization into strategic plans and ensuring that clinical and immunization conferences highlight HPV vaccination topics, 3) developing an HPV Vaccine Task Force to discuss and facilitate HPV vaccination health promotion activities and interventions, 4) providing peer-to-peer physician HPV vaccination training onsite, and 5) increasing provider assessment and feedback visits focused on increasing vaccination coverage among adolescents. Understanding the extent to which vaccination programs and policies, provider practices, and parental knowledge and access influence these geographic differences might help inform public health action.

The findings in this report are subject to at least three limitations. First, the household response rates for landline and cell phone samples were 51.1% and 23.3%, respectively. Furthermore, only 59.5% of landline and 54.5% of cell phone completed interviews had adequate vaccine provider data. Therefore, estimates might have been biased, even after weighting adjustments for nonresponse and exclusion of households without telephones. A total survey error model of 2011 NIS-Teen that included comparison with provider-reported data collected from a sample of National Health Interview Survey participants indicated coverage estimates were approximately 2, 3, and 6 percentage points too high for Tdap, MenACWY, and HPV (among females) vaccinations, respectively, as a result of noncoverage and nonresponse error.\u2020\u2020\u2020\u2020 Estimates of bias do not include errors in vaccination status (e.g., underascertainment from incomplete vaccination provider identification and unknown medical record completeness) (7). Second, although response rates have been stable in recent years and weights have been adjusted to reflect the increasing prevalence of cell phone\u2013only households over time, it is possible that nonresponse bias might have changed over time, which could affect interpretation of comparisons across data years. Finally, some of the state-specific and racial/ethnic-specific analyses might be unreliable because of small sample sizes (7). Estimates with confidence half-widths wider than 10 are less reliable, and this impacts estimates for some racial and ethnic populations. For HPV coverage analyses by state and sex, small sample sizes decrease the power to detect differences.

High Tdap coverage levels among adolescents aged 13\u201317 years indicate that similar coverage levels are attainable for other vaccines recommended for adolescents. Improved adherence of clinicians and parents to the ACIP recommendation to administer all age-appropriate vaccines during a single visit could substantially increase lagging vaccination coverage levels. At each encounter with a clinician, every adolescent's immunization history should be reviewed to ensure complete vaccination consistent with ACIP recommendations. Additionally, clinicians should provide strong, consistent recommendations for all ACIP-recommended vaccines. HPV vaccine should be recommended with the same emphasis and at the same time as the other vaccines for adolescents. Recommended strategies to improve vaccination coverage include use of combinations of strategies such as patient reminder and recall systems, standing orders, and use of immunization information systems (5). Coverage levels should continue to be monitored to describe coverage disparities, to use estimates to identify target populations for interventions to increase coverage, and to inform development of additional policies that will support further efforts to reduce vaccine-preventable diseases, including cancers.

1Immunization Services Division, National Center for Immunization and Respiratory Diseases; 2Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases; 3Division of Sexually Transmitted Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC (Corresponding contributor: Laurie D. Elam-Evans, lxe1@cdc.gov, 404-718-4838)

References

Akinsanya-Beysolow I, Advisory Committee on Immunization Practices (ACIP), ACIP Child/Adolescent Immunization Work Group. Advisory Committee on Immunization Practices recommended immunization schedules for persons aged 0 through 18 years\u2014United States, 2014. MMWR 2014;63:108\u20139.
CDC. Recommendations on the use of quadrivalent human papillomavirus vaccine in males\u2014Advisory Committee on Immunization Practices (ACIP), 2011. MMWR 2011;60:1705\u20138.
CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011;60(No. RR-2).
US Department of Health and Human Services. Healthy People 2020. Washington, DC: US Department of Health and Human Services; 2012. Available at http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId-23.
Community Preventive Services Task Force. Increasing appropriate vaccination. Atlanta, GA: Community Preventive Services Task Force; 2014. Available at http://www.thecommunityguide.org/vaccines/index.html.
CDC. Updated recommendations for use of meningococcal conjugate vaccines\u2014Advisory Committee on Immunization Practices (ACIP), 2010. MMWR 2011;60:72\u20136.
CDC. National and state vaccination coverage among adolescents aged 13\u201317 years\u2014United States, 2012. MMWR 2013;62:685\u201393.
Holmon DM, Bernard V, Roland KB, Watson M, Liddon N, Stokley S. Barriers to human papillomavirus vaccination among U.S. adolescents: a systematic review of the literature. JAMA Pediatr 2014;168:76\u201382.
Stokley S, Jeyarajah J, Yankey D, et al. Human papillomavirus vaccination coverage among adolescents, 2007\u20132013, and postlicensure vaccine safety monitoring, 2006\u20132014\u2014United States. MMWR 2014;63:620\u20134.
CDC. National, state, and local area vaccination coverage among children aged 19\u201335 months\u2014United States, 2012. MMWR 2013;62:733\u201340.

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* Adolescents who receive their first MenACWY vaccine dose as routinely recommended at age 11\u201312 years should receive a second dose at 16 years. Adolescents who receive their first dose at ages 13\u201315 years should receive a second dose at age 16\u201318 years, with a minimum interval of \u22658 weeks between doses. Adolescents who receive a MenACWY vaccine dose at age \u226516 years do not need a second dose.

\u2020 Catch-up vaccination is recommended for some vaccines routinely recommended in childhood. MMR vaccine is recommended for any adolescents who have not had 2 doses of MMR vaccine. Catch-up vaccination for varicella is recommended for persons aged 7\u201318 years without evidence of immunity (MMWR 2007;56 [No. RR-4]). Adolescents should have received 2 doses of varicella vaccine. Catch up vaccination for hepatitis B is recommended for any unvaccinated persons, and they should complete a 3-dose series. However, a 2-dose series (doses separated by at least 4 months) of adult formulation Recombivax HB is licensed for use in children aged 11\u201315 years (1).

\u00a7 Eligible participants were born during January 1995\u2013February 2001. Except as noted, coverage for \u22651 and \u22652 varicella doses were obtained among persons with no history of varicella disease. HPV vaccination coverage represents receipt of any HPV vaccine and does not distinguish between bivalent or quadrivalent vaccines. Some adolescents, both males and females, might have received more than the 3 recommended HPV doses. Influenza vaccination coverage estimates are not included in this report but are available online at http://www.cdc.gov/flu/fluvaxview/index.htm.

\u00b6 HP2020 objectives and targets were established for females only in 2010 (4), before ACIP's 2011 recommendation for routine use of the quadrivalent HPV vaccine among males aged 11\u201312 years (2). In April 2014, the federal HP2020 work group approved a new HP2020 objective to reach an 80% vaccination target with 3 doses of HPV vaccine among adolescent males aged 13\u201315 years (Office of Policy, Office of the Director, National Center for Immunization and Respiratory Diseases, CDC, unpublished data, April 2014).

** Local areas that received Federal Section 317 immunization funds were sampled separately: Chicago, Illinois; New York, New York; Philadelphia County, Pennsylvania; Bexar County, Texas; and Houston, Texas.

\u2020\u2020 All identified cell phone households were eligible for interview. Sampling weights adjusted to correct for dual-frame (landline and cell phone) sampling, nonresponse, noncoverage, and overlapping samples of mixed telephone users. A description of NIS-Teen dual-frame survey methodology and its effect on reported vaccination estimates is available at http://www.cdc.gov/vaccines/stats-surv/nis/dual-frame-sampling-082812.htm.

\u00a7\u00a7 The Council of American Survey Research Organizations (CASRO) response rate for the landline and cell phone samples were 51.1% and 23.3%, respectively. For completed interviews, 6,039 by landline (59.5%) and 12,225 by cell phone (54.5%) had adequate provider data. Overall, 33% of completed interviews with adequate provider data were from landlines, and 67% were from cell phones. For USVI, the landline and cell phone sample CASRO rate was 60.6% and 31.5%, respectively. For Guam, landline and cell phone sample CASRO was 45.6% and 21.0%, respectively. The CASRO response rate is the product of three other rates: 1) the resolution rate (the proportion of telephone numbers that can be identified as either for business or residence), 2) the screening rate (the proportion of qualified households that complete the screening process), and 3) the cooperation rate (the proportion of contacted eligible households for which a completed interview is obtained).

\u00b6\u00b6 Adolescents from the U.S. Virgin Islands (156 females and 176 males) and from Guam (164 females and 199 males) were excluded from the national estimates.

*** Additional information available at ftp://ftp.cdc.gov/pub/health_statistics/nchs/dataset_documentation/nis/nisteenpuf12_dug.pdf.

\u2020\u2020\u2020 Annual estimates of vaccination coverage were regressed on survey year via a weighted linear regression, with regression weights calculated using the inverse of the estimated variance of the vaccination coverage point estimate.

\u00a7\u00a7\u00a7 The completion rate for 3-dose HPV vaccination series represents the percentage of adolescents who received \u22653 doses among those who had \u22651 HPV dose and \u226524 weeks between the first dose and the interview date.

\u00b6\u00b6\u00b6 Adolescents were classified as below the federal poverty level if their family's total income was less than the federal poverty level specified for their family size and number of children aged <18 years. All others were classified as at or above the poverty level. Poverty status was unknown for 432 adolescents. Additional information available at http://www.census.gov/hhs/www/poverty.

**** Children aged \u226418 years who are Medicaid-eligible, uninsured, or American Indian/Alaska Native (as defined by the Indian Health Care Improvement Act) are eligible to receive vaccines from providers through the VFC program. Children categorized as \"underinsured\" (because their health plans do not include coverage for recommended vaccinations) are eligible to receive VFC vaccines if they are served by a rural health clinic or federally qualified health center or under an approved deputization agreement. Additional information is available at http://www.cdc.gov/vaccines/programs/vfc/providers/eligibility.html.

\u2020\u2020\u2020\u2020 Additional information available at http://www.amstat.org/meetings/jsm/2012/onlineprogram/abstractdetails.cfm?abstractid=304324.

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What is already known on this topic?

The Advisory Committee on Immunization Practices (ACIP) recommends that adolescents receive 1 dose of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine, 2 doses of meningococcal conjugate (MenACWY) vaccine, and 3 doses of human papillomavirus (HPV) vaccine. ACIP also recommends administration of these and all age-appropriate vaccines during a single visit. During 2006\u20132012, national vaccination coverage for \u22651 Tdap and \u22651 MenACWY increased steadily, with Tdap coverage in 2011 reaching national target levels for adolescents. During 2007\u20132011, coverage for \u22651 HPV vaccine dose among females increased steadily, but from 2011 to 2012, there were no changes in coverage. Coverage for \u22651 HPV vaccine dose among males increased from 2011-2012.

What is added by this report?

From 2012 to 2013, vaccination coverage among U.S. adolescents increased to 86.0% for \u22651 dose of Tdap vaccine, 77.8% for \u22651 dose of MenACWY vaccine, 57.3% for \u22651 dose of HPV vaccine among females, and 34.6% for \u22651 dose of HPV vaccine among males. Vaccination coverage levels continued to vary widely among states. Although HPV vaccination coverage increased among both females and males, levels are still low and reflect many missed opportunities. Five states had substantial increases in HPV coverage from 2012 to 2013, suggesting greater progress is feasible.

What are the implications for public health practice?

Lower vaccination coverage for HPV compared with Tdap and MenACWY vaccines indicates clinicians, parents, and adolescents are missing opportunities for infection and cancer prevention. Clinician recommendations strongly influence the decisions of parents to vaccinate their children; to maximize coverage, clinicians should clearly and consistently recommend all ACIP-recommended vaccines, including HPV. Health care systems interventions, including use of client reminder and recall systems, immunization information systems, clinician reminders, and standing orders, should be employed to improve protection of adolescents from vaccine-preventable infections and future cancers.

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FIGURE. Estimated vaccination coverage with selected vaccines and doses among adolescents aged 13\u201317 years, by survey year \u2014 National Immunization Survey-Teen, United States, 2006\u20132013

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Abbreviations: Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis; MenACWY = meningococcal conjugate; HPV = human papillomavirus.

* \u22651 dose Tdap vaccine on or after age 10 years.

\u2020 \u22651 dose MenACWY vaccine.

\u00a7 HPV vaccine, either bivalent or quadrivalent, among females. The Advisory Committee on Immunization Practices (ACIP) recommends either bivalent or quadrivalent vaccine for females.

\u00b6 HPV vaccine, either bivalent or quadrivalent, among males. ACIP recommends the quadrivalent vaccine for males; however, some males might have received bivalent vaccine.

Alternate Text: The figure above shows estimated vaccination coverage with selected vaccines and doses among adolescents aged 13-17 years, by survey year, in the United States during 2006-2013. During this period, National Immunization Survey-Teen data show that vaccination coverage trends differed substantially for tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine; meningococcal conjugate vaccine; and human papillomavirus vaccine.

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TABLE 1. Estimated vaccination coverage with selected vaccines among adolescents aged 13\u201317 years,* by age at interview \u2014 National Immunization Survey\u2013Teen (NIS-Teen), United States, 2013
Vaccine	Age at interview (yrs)	Total
13 (n = 3,735)	14 (n = 3,841)	15 (n = 3,645 )	16 (n = 3,783 )	17 (n = 3,260 )	2013 (N = 18,264 )	2012\u2020 (N = 19,199 )
%	(95% CI)	%	(95% CI)	%	(95% CI)	%	(95% CI)	%	(95% CI)	%	(95% CI)	%	(95% CI)
Tdap\u00a7 \u2265 1 dose	87.2	(\u00b11.9)	87.0	(\u00b12.1)	88.4	(\u00b11.7)	84.3	(\u00b12.1)	83.0	(\u00b12.7)\u00b6	86.0	(\u00b10.9)**	84.6	(\u00b10.9)
MenACWY\u2020\u2020 \u22651 dose	76.1	(\u00b12.4)	78.2	(\u00b12.3)	80.0	(\u00b12.3)\u00b6	77.8	(\u00b12.5)	76.7	(\u00b12.9)	77.8	(\u00b11.1)**	74.0	(\u00b11.1)
HPV\u00a7\u00a7 vaccination
Females
\u22651 dose	50.6	(\u00b14.1)	55.1	(\u00b14.2)	58.8	(\u00b14.3)\u00b6	60.0	(\u00b14.5)\u00b6	62.3	(\u00b14.5)\u00b6	57.3	(\u00b11.9)**	53.8	(\u00b11.9)
\u22652 dose	39.2	(\u00b14.2)	43.3	(\u00b14.2)	48.7	(\u00b14.5)\u00b6	51.1	(\u00b14.6)\u00b6	56.8	(\u00b14.5)\u00b6	47.7	(\u00b12.0)**	43.4	(\u00b11.9)
\u22653 doses	25.8	(\u00b13.8)	32.1	(\u00b13.9)\u00b6	39.4	(\u00b14.6)\u00b6	43.1	(\u00b14.5)\u00b6	48.2	(\u00b14.5)\u00b6	37.6	(\u00b11.9)**	33.4	(\u00b11.7)
Males
\u22651 dose	33.5	(\u00b14.5)	35.1	(\u00b14.4)	36.2	(\u00b14.1)	35.9	(\u00b14.0)	32.1	(\u00b14.1)	34.6	(\u00b11.9)**	20.8	(\u00b11.5)
\u22652 dose	23.4	(\u00b14.3)	24.3	(\u00b14.0)	23.8	(\u00b13.8)	23.2	(\u00b13.7)	22.9	(\u00b13.5)	23.5	(\u00b11.7)**	12.7	(\u00b11.3)
\u22653 doses	11.7	(\u00b12.7)	13.6	(\u00b13.3)	15.3	(\u00b13.5)	13.7	(\u00b13.1)	15.1	(\u00b13.0)	13.9	(\u00b11.4)**	6.8	(\u00b11.0)
HPV\u00a7\u00a7 3-dose series completion\u00b6\u00b6
Females	56.1	(\u00b16.7)	64.7	(\u00b15.7)	72.1	(\u00b15.0)\u00b6	75.9	(\u00b15.6)\u00b6	79.5	(\u00b14.6)\u00b6	70.4	(\u00b12.5)**	66.7	(\u00b12.6)
Males	41.6	(\u00b19.4)	47.1	(\u00b19.3)	51.0	(\u00b18.7)	48.8	(\u00b18.2)	53.4	(\u00b18.5)	48.3	(\u00b14.0)	45.1	(\u00b15.0)
MMR*** \u22652 doses	92.6	(\u00b11.4)	93.1	(\u00b11.4)	91.4	(\u00b12.1)	92.0	(\u00b11.6)	89.7	(\u00b12.3)\u00b6	91.8	(\u00b10.8)	91.4	(\u00b10.8)
Hepatitis B \u22653 doses	94.7	(\u00b11.3)	94.0	(\u00b11.3)	92.5	(\u00b11.9)	93.1	(\u00b11.5)	91.4	(\u00b12.2)\u00b6	93.2	(\u00b10.7)	92.8	(\u00b10.7)
Varicella
History of varicella\u2020\u2020\u2020	15.6	(\u00b12.1)	19.5	(\u00b12.4)\u00b6	25.1	(\u00b12.5)\u00b6	30.6	(\u00b12.8)\u00b6	37.1	(\u00b13.0)\u00b6	25.4	(\u00b11.2)**	30.6	(\u00b11.2)
Among adolescents with no history of varicella
\u22651 dose vaccine	97.4	(\u00b10.8)	95.4	(\u00b11.6)\u00b6	94.6	(\u00b12.0)\u00b6	94.0	(\u00b11.9)\u00b6	91.9	(\u00b13.3)\u00b6	94.9	(\u00b10.9)	94.7	(\u00b10.8)
\u22652 doses vaccine	83.1	(\u00b12.2)	80.2	(\u00b12.5)	78.7	(\u00b13.0)\u00b6	76.6	(\u00b13.1)\u00b6	71.6	(\u00b14.0)\u00b6	78.5	(\u00b11.3)**	74.9	(\u00b11.4)
History of varicella or received \u22652 doses varicella vaccination	85.7	(\u00b11.9)	84.1	(\u00b12.1)	84.0	(\u00b12.3)	83.7	(\u00b12.3)	82.2	(\u00b12.8)\u00b6	84.0	(\u00b11.0)	82.6	(\u00b11.0)
Abbreviations: CI = confidence interval; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis; MenACWY = meningococcal conjugate; HPV = human papillomavirus; MMR = measles, mumps, and rubella. * Adolescents (N = 18,264) in the 2013 NIS-Teen were born January 11, 1995, through February 13, 2001. \u2020 Estimates for overall NIS-Teen data for 2012 are provided as a comparison with overall 2013 NIS-Teen data. \u00a7 Includes percentages receiving Tdap vaccine at or after age 10 years. \u00b6 Statistically significant difference (p<0.05) in estimated vaccination coverage by age: reference group was adolescents aged 13 years. Statistically significant difference (p<0.05) compared with 2012 NIS-Teen overall estimates. \u2020\u2020 Includes percentages receiving MenACWY or meningococcal-unknown type vaccine. \u00a7\u00a7 HPV vaccine, either quadrivalent or bivalent may be used for females, and only quadrivalent may be used for males. Percentage reported among females (n = 8,710) and males (n = 9,554). Some adolescents might have received more than the recommended 3 doses of HPV vaccine. \u00b6\u00b6 The completion rate for the 3-dose HPV vaccination series represents the percentage of adolescents who received \u22653 doses among those who had \u22651 HPV vaccine dose with at least 24 weeks between the first dose and the interview date. The calculation was limited to 4,611 females and 2,580 males who met the criteria of having received \u22651 HPV vaccine dose and having at least 24 weeks between the first dose and the interview date. * \u22652 doses of MMR vaccine. \u2020\u2020\u2020 By parent/guardian report or provider records.

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*TABLE 2. Estimated vaccination coverage among adolescents aged 13\u201317 years, by race/ethnicity,**\u2020 poverty level,\u00a7 and selected vaccines and doses \u2014 National Immunization Survey\u2013Teen (NIS-Teen), United States, 2013
Vaccines	Race/Ethnicity	Poverty status
White, non-Hispanic (n = 12,064)	Black, non-Hispanic (n = 1,647 )	Hispanic (n = 2,741 )	American Indian/Alaska Native, non-Hispanic (n = 284)	Asian, non-Hispanic (n = 561 )	Multiracial (n = 886 )	Below poverty level (n = 3,078 )	At or above poverty level (n = 14,754)
%	(95% CI)\u00b6	%	(95% CI)	%	(95% CI)	%	(95% CI)	%	(95% CI)	%	(95% CI)	%	(95% CI)	%	(95% CI)
Tdap** \u22651 dose	85.9	(\u00b11.1)	84.1	(\u00b13.0)	87.1	(\u00b12.4)	85.3	(\u00b17.2)	89.7	(\u00b13.6)	85.4	(\u00b14.9)	85.2	(\u00b12.3)	86.4	(\u00b11.0)
MenACWY \u2020\u2020 \u22651 dose	75.6	(\u00b11.3)	77.0	(\u00b13.3)	83.4	(\u00b12.8)\u00a7\u00a7	71.7	(\u00b111.1)	83.8	(\u00b17.1)\u00a7\u00a7	76.3	(\u00b15.1)	78.4	(\u00b12.6)	77.5	(\u00b11.2)
HPV\u00b6\u00b6 vaccination
Females
\u22651 dose	53.1	(\u00b12.3)	55.8	(\u00b15.2)	67.5	(\u00b15.0)\u00a7\u00a7	73.3	(\u00b114.7)\u00a7\u00a7	57.0	(\u00b111.4)	57.6	(\u00b19.3)	66.8	(\u00b14.3)\u00a7\u00a7	54.6	(\u00b12.2)
\u22652 dose	44.0	(\u00b12.2)	45.6	(\u00b15.2)	57.7	(\u00b15.4)\u00a7\u00a7	57.3	(\u00b115.2)	47.2	(\u00b111.2)	46.2	(\u00b19.5)	55.2	(\u00b14.6)\u00a7\u00a7	45.3	(\u00b12.2)
\u22653 doses	34.9	(\u00b12.1)	34.2	(\u00b14.8)	44.8	(\u00b15.6)\u00a7\u00a7	43.2	(\u00b114.2)	40.4	(\u00b111.0)	40.3	(\u00b19.3)	41.5	(\u00b14.6)	36.4	(\u00b12.1)
Males
\u22651 dose	26.7	(\u00b11.9)	42.2	(\u00b15.5)\u00a7\u00a7	49.6	(\u00b15.2)\u00a7\u00a7	38.6	(\u00b114.0)	26.3	(\u00b18.9)	34.5	(\u00b17.3)\u00a7\u00a7	46.7	(\u00b14.5)\u00a7\u00a7	30.8	(\u00b12.0)
\u22652 dose	18.5	(\u00b11.7)	27.5	(\u00b14.8)\u00a7\u00a7	34.5	(\u00b15.3)\u00a7\u00a7	24.8	(\u00b111.4)	19.5	(\u00b18.0)	19.1	(\u00b15.2)	28.7	(\u00b14.0)\u00a7\u00a7	22.0	(\u00b11.9)
\u22653 doses	11.1	(\u00b11.3)	15.7	(\u00b13.8)\u00a7\u00a7	20.3	(\u00b14.5)\u00a7\u00a7	NA	NA	9.1	(\u00b14.5)	12.5	(\u00b14.2)	16.7	(\u00b13.0)\u00a7\u00a7	13.0	(\u00b11.6)
HPV\u00b6\u00b6 3-dose series completion***
Females	71.8	(\u00b12.9)	63.7	(\u00b17.3)\u00a7\u00a7	69.5	(\u00b16.1)	60.1	(\u00b116.9)	77.2	(\u00b112.1)	75.1	(\u00b113.8)	66.2	(\u00b15.7)	71.9	(\u00b12.8)
Males	51.1	(\u00b14.7)	44.8	(\u00b18.8)	47.4	(\u00b19.0)	48.4	(\u00b120.0)	40.0	(\u00b118.8)	49.3	(\u00b113.9)	44.3	(\u00b17.2)	50.4	(\u00b14.8)
MMR\u2020\u2020\u2020 \u22652 doses	92.8	(\u00b10.8)	91.1	(\u00b12.4)	90.2	(\u00b12.3)\u00a7\u00a7	93.5	(\u00b15.2)	90.8	(\u00b16.0)	89.8	(\u00b13.7)	91.7	(\u00b11.7)	91.8	(\u00b10.9)
Hepatitis B \u22653 doses	93.8	(\u00b10.8)	93.2	(\u00b12.1)	92.8	(\u00b12.0)	93.4	(\u00b15.3)	87.8	(\u00b16.6)	91.7	(\u00b13.1)	93.2	(\u00b11.6)	93.1	(\u00b10.9)
Varicella
History of varicella\u00a7\u00a7\u00a7	26.8	(\u00b11.4)	22.6	(\u00b13.5)\u00a7\u00a7	24.6	(\u00b13.0)	36.6	(\u00b110.6)	24.2	(\u00b16.7)	18.5	(\u00b13.9)\u00a7\u00a7	29.0	(\u00b13.0)\u00a7\u00a7	24.0	(\u00b11.2)
Among adolescents with no history of varicella
\u22651 dose vaccine	95.3	(\u00b10.8)	94.3	(\u00b12.6)	94.5	(\u00b12.5)	95.7	(\u00b13.7)	94.3	(\u00b16.7)	94.4	(\u00b13.0)	94.7	(\u00b11.9)	95.2	(\u00b11.0)
\u22652 dose vaccine	77.7	(\u00b11.5)	77.9	(\u00b13.6)	80.3	(\u00b13.5)	78.7	(\u00b19.8)	85.2	(\u00b18.1)	76.7	(\u00b16.4)	77.3	(\u00b13.0)	79.0	(\u00b11.5)
History of varicella or received \u22652 doses varicella vaccination	83.7	(\u00b11.1)	82.9	(\u00b13.0)	85.2	(\u00b12.7)	86.5	(\u00b16.4)	88.8	(\u00b16.3)	81.0	(\u00b15.4)	83.8	(\u00b12.3)	84.0	(\u00b11.1)
Abbreviations: CI = confidence interval; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis; MenACWY = meningococcal conjugate; HPV = human papillomavirus; NA = not available (estimate not reported because unweighted sample size for the denominator was <30 or 95% CI half width/estimate >0.6); MMR = measles, mumps, and rubella. * Adolescents (N = 18,264) in the 2013 NIS-Teen were born January 11, 1995, through February 13, 2001. \u2020 Adolescent's race/ethnicity was reported by parent or guardian. Adolescents identified in this report as white, black, Asian, American Indian/Alaska Native or multiracial were reported by the parent or guardian as non-Hispanic. Adolescents identified as multiracial had more than one race category selected. Adolescents identified as Hispanic might be of any race. Native Hawaiian or other Pacific Islanders were not included in the table because of small sample sizes. \u00a7 Adolescents were classified as below poverty level if their total family income was less than the federal poverty level specified for the applicable family size and number of children aged <18 years. All others were classified as at or above the poverty level. Additional information available at http://www.census.gov/hhes/www/poverty.html. Poverty status was unknown for 432 adolescents. \u00b6 Estimates with 95% CI half-widths >10 might not be reliable. Includes percentages receiving Tdap vaccine at or after age 10 years. \u2020\u2020 Includes percentages receiving MenACWY and meningococcal-unknown type vaccine. \u00a7\u00a7 Statistically significant difference (p<0.05) in estimated vaccination coverage by race/ethnicity or poverty level; referent groups were non-Hispanic white adolescents and adolescents living at or above poverty level, respectively. \u00b6\u00b6 HPV vaccine, either quadrivalent or bivalent may be used for females, and only quadrivalent may be used for males. Percentage reported among females (n = 8,710) and males (n = 9,554). Some adolescents might have received more than the 3 recommended HPV vaccine doses. * The completion rate for the 3-dose HPV vaccination series represents the percentage of adolescents who received \u22653 doses among those who had \u22651 HPV vaccine dose with at least 24 weeks between the first dose and the interview date. The calculation was limited to 4,611 females and 2,580 males who met the criteria of having received \u22651 HPV vaccine dose and having \u226524 weeks between the first dose and the interview date. \u2020\u2020\u2020 Includes \u22652 doses of MMR vaccine. \u00a7\u00a7\u00a7 By parent/guardian report or provider records.

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TABLE 3. Estimated vaccination coverage with selected vaccines and doses* among adolescents aged 13\u201317 years\u2020 by HHS region and state/selected local area \u2014 National Immunization Survey\u2013Teen (NIS-Teen), United States, 2013
Regional/State/Local area	\u22652 MMR\u00a7	\u22652 VAR\u00b6	\u22651 Tdap**	\u22651 MenACWY\u2020\u2020	Females (n = 8,264)	Males (n = 9,554)
\u22651 HPV\u00a7\u00a7	\u22652 HPV\u00b6\u00b6	\u22653 HPV***	\u22651 HPV\u00a7\u00a7	\u22652 HPV\u00b6\u00b6	\u22653 HPV***
% (95% CI)\u2020\u2020\u2020	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)
United Sates overall	91.8 (\u00b10.8)	78.5 (\u00b11.3)\u00a7\u00a7\u00a7	86.0 (\u00b10.9)\u00a7\u00a7\u00a7	77.8 (\u00b11.1)\u00a7\u00a7\u00a7	57.3 (\u00b11.9)\u00a7\u00a7\u00a7	47.7 (\u00b12.0)\u00a7\u00a7\u00a7	37.6 (\u00b11.9)\u00a7\u00a7\u00a7	34.6 (\u00b11.9)\u00a7\u00a7\u00a7	23.5 (\u00b11.7)\u00a7\u00a7\u00a7	13.9 (\u00b11.4)\u00a7\u00a7\u00a7
HHS Region I	95.7 (\u00b11.4)	90.9 (\u00b12.3)	92.7 (\u00b11.7)	87.7 (\u00b12.1)	61.9 (\u00b14.6)	51.8 (\u00b14.8)	41.8 (\u00b14.7)	51.4 (\u00b14.6)\u00a7\u00a7\u00a7	36.9 (\u00b14.5)\u00a7\u00a7\u00a7	23.0 (\u00b13.9)\u00a7\u00a7\u00a7
Connecticut	97.3 (\u00b12.4)	95.8 (\u00b13.2)	90.8 (\u00b14.3)	90.6 (\u00b14.2)	56.0 (\u00b19.2)	49.0 (\u00b19.3)	40.1 (\u00b19.1)	52.3 (\u00b19.2)\u00a7\u00a7\u00a7	36.4 (\u00b18.9)\u00a7\u00a7\u00a7	23.4 (\u00b17.9)\u00a7\u00a7\u00a7
Maine	88.8 (\u00b14.4)\u00b6\u00b6\u00b6	71.0 (\u00b17.2)	83.0 (\u00b14.7)	71.2 (\u00b15.6)	60.2 (\u00b18.8)	55.4 (\u00b18.9)	45.8 (\u00b18.8)	42.2 (\u00b18.5)\u00a7\u00a7\u00a7	31.1 (\u00b17.9)\u00a7\u00a7\u00a7	17.6 (\u00b16.0)
Massachusetts	95.8 (\u00b12.6)	91.1 (\u00b14.2)	94.9 (\u00b12.6)	89.6 (\u00b13.6)	62.3 (\u00b18.3)	48.9 (\u00b18.6)	39.3 (\u00b18.4)	52.8 (\u00b18.2)\u00a7\u00a7\u00a7	37.8 (\u00b18.0)\u00a7\u00a7\u00a7	21.8 (\u00b17.0)
New Hampshire	97.4 (\u00b12.2)	91.6 (\u00b14.1)	94.7 (\u00b12.9)	85.6 (\u00b14.4)	68.0 (\u00b18.3)\u00a7\u00a7\u00a7	57.2 (\u00b18.6)\u00a7\u00a7\u00a7	43.2 (\u00b18.6)	41.4 (\u00b18.4)\u00a7\u00a7\u00a7	28.5 (\u00b17.9)\u00a7\u00a7\u00a7	17.8 (\u00b16.7)
Rhode Island	95.6 (\u00b12.9)	93.2 (\u00b13.6)	95.5 (\u00b12.9)	92.0 (\u00b13.5)	76.6 (\u00b18.1)	68.5 (\u00b18.7)	56.5 (\u00b19.3)	69.3 (\u00b18.5)\u00a7\u00a7\u00a7	58.0 (\u00b19.0)\u00a7\u00a7\u00a7	43.2 (\u00b19.0)\u00a7\u00a7\u00a7
Vermont	94.5 (\u00b12.7)	90.9 (\u00b14.5)	91.8 (\u00b13.7)	79.2 (\u00b15.3)	60.2 (\u00b19.0)	53.5 (\u00b19.2)	42.7 (\u00b19.1)	41.3 (\u00b18.8)\u00a7\u00a7\u00a7	26.3 (\u00b18.0)	21.7 (\u00b17.7)\u00a7\u00a7\u00a7
HHS Region II	93.8 (\u00b12.0)	79.1 (\u00b13.6)	88.2 (\u00b12.6)	86.1 (\u00b12.6)	56.5 (\u00b15.3)	50.2 (\u00b15.4)	40.8 (\u00b15.4)	36.6 (\u00b15.1)\u00a7\u00a7\u00a7	28.1 (\u00b14.8)\u00a7\u00a7\u00a7	17.5 (\u00b14.1)\u00a7\u00a7\u00a7
New Jersey	94.9 (\u00b13.2)	79.2 (\u00b16.6)	85.5 (\u00b15.3)	91.8 (\u00b14.1)	45.8 (\u00b19.7)	39.1 (\u00b19.6)	31.4 (\u00b19.2)	32.4 (\u00b18.9)\u00a7\u00a7\u00a7	25.7 (\u00b18.4)\u00a7\u00a7\u00a7	14.2 (\u00b17.0)
New York	93.3 (\u00b12.5)	79.1 (\u00b14.3)	89.5 (\u00b12.9)	83.3 (\u00b13.4)	61.7 (\u00b16.2)	55.6 (\u00b16.4)	45.4 (\u00b16.6)	38.6 (\u00b16.1)\u00a7\u00a7\u00a7	29.3 (\u00b15.8)\u00a7\u00a7\u00a7	19.1 (\u00b15.1)
NY-City of New York	90.9 (\u00b14.2)	80.6 (\u00b16.3)\u00a7\u00a7\u00a7	88.9 (\u00b14.5)	83.0 (\u00b15.2)	64.2 (\u00b19.0)	56.1 (\u00b19.4)	45.2 (\u00b19.6)	46.2 (\u00b19.6)\u00a7\u00a7\u00a7	36.0 (\u00b19.3)\u00a7\u00a7\u00a7	29.6 (\u00b19.0)
NY-Rest of State	94.8 (\u00b13.1)	78.1 (\u00b15.9)	89.8 (\u00b13.8)	83.6 (\u00b14.4)	60.1 (\u00b18.5)	55.3 (\u00b18.7)	45.6 (\u00b18.9)	33.8 (\u00b17.9)\u00a7\u00a7\u00a7	25.1 (\u00b17.5)	12.5 (\u00b15.9)
HHS Region III	92.6 (\u00b12.0)	80.4 (\u00b13.4)	85.8 (\u00b12.7)	79.7 (\u00b13.2)	55.1 (\u00b15.5)	48.0 (\u00b15.4)	37.8 (\u00b15.1)	36.5 (\u00b15.0)\u00a7\u00a7\u00a7	24.5 (\u00b14.5)\u00a7\u00a7\u00a7	14.6 (\u00b13.7)\u00a7\u00a7\u00a7
Delaware	95.3 (\u00b12.4)	79.8 (\u00b16.3)	84.4 (\u00b14.6)	81.8 (\u00b15.1)	68.7 (\u00b18.1)	59.4 (\u00b18.7)	51.7 (\u00b18.9)	37.1 (\u00b18.5)	25.0 (\u00b17.5)	18.1 (\u00b16.8)
Dist. of Columbia	85.9 (\u00b18.6)	82.1 (\u00b110.2)	83.1 (\u00b18.3)	91.3 (\u00b17.0)	55.6 (\u00b114.6)	43.0 (\u00b114.4)	30.2 (\u00b112.3)	67.7 (\u00b113.9)\u00a7\u00a7\u00a7	40.2 (\u00b114.5)\u00a7\u00a7\u00a7	24.5 (\u00b113.0)\u00a7\u00a7\u00a7
Maryland	93.8 (\u00b13.9)	78.9 (\u00b17.1)	83.2 (\u00b16.2)	78.0 (\u00b16.6)	50.0 (\u00b111.5)	45.5 (\u00b111.4)	33.4 (\u00b110.7)	34.2 (\u00b110.2)\u00a7\u00a7\u00a7	23.1 (\u00b19.0)	NA
Pennsylvania	93.8 (\u00b12.8)	92.1 (\u00b13.4)	89.9 (\u00b13.5)	90.4 (\u00b13.6)	59.5 (\u00b18.1)	53.5 (\u00b18.2)	45.9 (\u00b18.1)	44.1 (\u00b17.8)\u00a7\u00a7\u00a7	26.8 (\u00b16.9)\u00a7\u00a7\u00a7	15.4 (\u00b15.5)\u00a7\u00a7\u00a7
PA-Philadelphia	90.2 (\u00b14.6)	91.8 (\u00b14.5)	89.6 (\u00b14.1)	92.1 (\u00b13.8)	78.4 (\u00b17.3)	71.2 (\u00b18.0)	54.5 (\u00b19.1)	55.8 (\u00b19.7)	35.7 (\u00b18.9)	15.8 (\u00b16.2)
PA-Rest of State	94.3 (\u00b13.1)	92.2 (\u00b13.8)	89.9 (\u00b13.9)	90.2 (\u00b14.0)	57.0 (\u00b19.0)	51.1 (\u00b19.1)	44.7 (\u00b19.1)	42.7 (\u00b18.7)\u00a7\u00a7\u00a7	25.7 (\u00b17.7)\u00a7\u00a7\u00a7	15.4 (\u00b16.2)
Virginia	92.0 (\u00b14.9)	68.0 (\u00b19.1)	83.6 (\u00b16.5)	64.2 (\u00b18.5)	51.9 (\u00b112.7)	41.4 (\u00b112.3)	27.6 (\u00b110.6)	26.4 (\u00b110.6)\u00a7\u00a7\u00a7	22.4 (\u00b110.4)	NA
West Virginia	83.2 (\u00b14.8)	59.4 (\u00b18.1)	76.7 (\u00b15.6)	77.3 (\u00b15.5)\u00a7\u00a7\u00a7	49.7 (\u00b19.4)	43.6 (\u00b19.2)	38.4 (\u00b19.0)	29.4 (\u00b18.5)	19.2 (\u00b17.3)	15.1 (\u00b16.6)
HHS Region IV	92.2 (\u00b11.6)\u00b6\u00b6\u00b6	76.5 (\u00b12.8)\u00a7\u00a7\u00a7	82.5 (\u00b12.3)	70.9 (\u00b12.6)\u00a7\u00a7\u00a7	53.0 (\u00b14.1)\u00a7\u00a7\u00a7	42.9 (\u00b14.1)	33.9 (\u00b13.9)	28.4 (\u00b13.8)\u00a7\u00a7\u00a7	18.6 (\u00b13.2)\u00a7\u00a7\u00a7	11.1 (\u00b12.6)\u00a7\u00a7\u00a7
Alabama	93.4 (\u00b13.2)	79.1 (\u00b16.1)\u00a7\u00a7\u00a7	87.3 (\u00b14.5)	69.5 (\u00b16.0)	54.7 (\u00b19.2)	46.6 (\u00b19.2)	39.6 (\u00b19.0)	18.4 (\u00b16.9)	10.9 (\u00b15.2)	NA
Florida	93.5 (\u00b13.8)	76.0 (\u00b17.0)	84.8 (\u00b15.4)	72.3 (\u00b16.4)	49.7 (\u00b110.2)	40.7 (\u00b110.0)	34.3 (\u00b19.8)	27.8 (\u00b18.6)	16.0 (\u00b16.6)	13.2 (\u00b16.2)
Georgia	96.4 (\u00b13.1)	93.7 (\u00b15.2)	82.0 (\u00b16.6)	76.9 (\u00b17.0)	53.7 (\u00b110.8)	42.3 (\u00b110.4)	33.2 (\u00b19.5)	40.5 (\u00b111.5)\u00a7\u00a7\u00a7	31.0 (\u00b110.7)\u00a7\u00a7\u00a7	15.3 (\u00b18.2)
Kentucky	92.7 (\u00b13.7)	66.5 (\u00b17.7)	84.4 (\u00b15.1)	71.2 (\u00b16.3)	47.6 (\u00b19.8)	38.6 (\u00b19.5)	26.8 (\u00b18.5)	19.0 (\u00b17.4)	10.8 (\u00b15.2)	NA
Mississippi	92.3 (\u00b13.9)	55.7 (\u00b18.2)	60.2 (\u00b16.7)	50.1 (\u00b16.9)	53.1 (\u00b19.5)	35.6 (\u00b19.3)\u00a7\u00a7\u00a7	25.2 (\u00b18.6)\u00a7\u00a7\u00a7	13.6 (\u00b16.6)	NA	NA
North Carolina	87.1 (\u00b14.7)\u00b6\u00b6\u00b6	74.0 (\u00b16.6)	89.4 (\u00b14.0)	72.4 (\u00b15.7)	59.3 (\u00b19.5)	47.4 (\u00b19.7)	32.8 (\u00b19.1)	33.2 (\u00b18.8)\u00a7\u00a7\u00a7	24.4 (\u00b18.0)\u00a7\u00a7\u00a7	12.4 (\u00b16.3)
South Carolina	91.0 (\u00b13.8)	58.6 (\u00b18.1)	71.9 (\u00b16.6)	68.7 (\u00b16.6)\u00a7\u00a7\u00a7	60.4 (\u00b19.7)\u00a7\u00a7\u00a7	53.0 (\u00b110.1)\u00a7\u00a7\u00a7	40.7 (\u00b110.4)\u00a7\u00a7\u00a7	22.2 (\u00b19.0)	13.1 (\u00b16.7)	NA
Tennessee	88.4 (\u00b14.6)	79.7 (\u00b16.5)	80.0 (\u00b15.4)	67.8 (\u00b16.1)	48.9 (\u00b19.5)	39.8 (\u00b19.4)	35.9 (\u00b19.1)	28.9 (\u00b18.2)	18.0 (\u00b17.1)	NA
HHS Region V	93.6 (\u00b11.3)\u00a7\u00a7\u00a7	83.0 (\u00b12.4)\u00a7\u00a7\u00a7	86.3 (\u00b11.9)\u00a7\u00a7\u00a7	79.9 (\u00b12.1)\u00a7\u00a7\u00a7	57.4 (\u00b13.8)\u00a7\u00a7\u00a7	46.1 (\u00b13.8)\u00a7\u00a7\u00a7	35.0 (\u00b13.6)	28.3 (\u00b13.4)\u2020\u2020\u2020	18.2 (\u00b12.9)\u2020\u2020\u2020	12.2 (\u00b12.5)\u2020\u2020\u2020
Illinois	93.5 (\u00b12.5)\u00a7\u00a7\u00a7	79.9 (\u00b15.1)\u00a7\u00a7\u00a7	86.2 (\u00b14.2)\u00a7\u00a7\u00a7	79.0 (\u00b14.5)\u00a7\u00a7\u00a7	53.2 (\u00b17.6)\u00a7\u00a7\u00a7	42.6 (\u00b17.5)\u00a7\u00a7\u00a7	33.8 (\u00b17.2)\u00a7\u00a7\u00a7	34.8 (\u00b17.5)	21.2 (\u00b16.6)	16.5 (\u00b16.4)
IL-City of Chicago	88.8 (\u00b15.4)	79.4 (\u00b18.3)	89.7 (\u00b15.2)\u00a7\u00a7\u00a7	83.3 (\u00b16.3)	61.8 (\u00b112.7)	49.2 (\u00b112.8)	38.6 (\u00b112.1)	50.0 (\u00b111.7)	29.1 (\u00b110.4)	19.8 (\u00b18.5)
IL-Rest of State	94.6 (\u00b12.8)\u00a7\u00a7\u00a7	80.0 (\u00b16.1)\u00a7\u00a7\u00a7	85.4 (\u00b15.0)\u00a7\u00a7\u00a7	78.0 (\u00b15.4)\u00a7\u00a7\u00a7	51.2 (\u00b19.0)\u00a7\u00a7\u00a7	41.1 (\u00b18.9)\u00a7\u00a7\u00a7	32.6 (\u00b18.5)\u00a7\u00a7\u00a7	31.4 (\u00b18.9)	19.4 (\u00b17.8)	15.8 (\u00b17.6)
Indiana	93.7 (\u00b13.1)	91.8 (\u00b14.2)	90.6 (\u00b13.3)	93.5 (\u00b12.7)	54.1 (\u00b18.3)	44.2 (\u00b18.2)	34.6 (\u00b17.7)	18.2 (\u00b16.3)	13.5 (\u00b15.6)	8.1 (\u00b14.3)
Michigan	94.0 (\u00b13.4)	92.2 (\u00b13.8)	81.0 (\u00b15.2)	90.7 (\u00b13.9)	66.0 (\u00b19.1)\u00a7\u00a7\u00a7	49.4 (\u00b19.9)	34.5 (\u00b19.4)	30.0 (\u00b18.1)\u00a7\u00a7\u00a7	16.8 (\u00b16.7)	7.7 (\u00b14.5)
Minnesota	94.0 (\u00b13.2)	86.3 (\u00b16.0)	91.4 (\u00b13.8)	66.3 (\u00b16.2)	59.3 (\u00b19.3)	45.8 (\u00b19.4)	37.6 (\u00b19.0)	22.0 (\u00b16.7)	13.1 (\u00b15.6)	8.6 (\u00b14.5)
Ohio	92.9 (\u00b13.4)	66.2 (\u00b17.4)	84.4 (\u00b14.9)\u00a7\u00a7\u00a7	69.2 (\u00b16.1)	54.8 (\u00b19.3)	47.6 (\u00b19.4)	35.0 (\u00b18.8)	26.5 (\u00b18.2)\u00a7\u00a7\u00a7	19.7 (\u00b17.1)\u00a7\u00a7\u00a7	14.7 (\u00b16.4)
Wisconsin	93.9 (\u00b13.2)	93.4 (\u00b13.7)	89.6 (\u00b14.2)	81.4 (\u00b14.9)	59.4 (\u00b19.1)	47.8 (\u00b19.4)	36.8 (\u00b19.0)	31.7 (\u00b18.5)\u00a7\u00a7\u00a7	20.9 (\u00b17.7)\u00a7\u00a7\u00a7	13.7 (\u00b16.7)
HHS Region VI	89.0 (\u00b12.5)	77.8 (\u00b13.5)	84.9 (\u00b12.6)	81.5 (\u00b12.5)	56.2 (\u00b15.2)	46.9 (\u00b15.3)	38.1 (\u00b15.2)\u00a7\u00a7\u00a7	33.1 (\u00b14.6)\u00a7\u00a7\u00a7	24.2 (\u00b14.2)\u00a7\u00a7\u00a7	14.5 (\u00b13.3)\u00a7\u00a7\u00a7
Arkansas	89.5 (\u00b13.8)	59.6 (\u00b17.6)	77.7 (\u00b15.3)\u00a7\u00a7\u00a7	40.4 (\u00b16.5)	44.3 (\u00b19.3)	35.4 (\u00b18.9)	24.4 (\u00b18.0)	17.7 (\u00b17.5)	NA	NA
Louisiana	97.4 (\u00b12.4)\u00a7\u00a7\u00a7	89.1 (\u00b14.4)	87.9 (\u00b14.5)	87.7 (\u00b14.4)	59.8 (\u00b19.2)	54.1 (\u00b19.6)	42.1 (\u00b19.8)	27.0 (\u00b18.1)	20.5 (\u00b17.6)	13.5 (\u00b16.6)
New Mexico	92.3 (\u00b13.1)	72.5 (\u00b16.3)\u00a7\u00a7\u00a7	85.6 (\u00b14.5)	70.9 (\u00b15.6)\u00a7\u00a7\u00a7	67.1 (\u00b18.6)\u00a7\u00a7\u00a7	56.1 (\u00b19.2)\u00a7\u00a7\u00a7	44.3 (\u00b19.2)\u00a7\u00a7\u00a7	31.4 (\u00b17.6)\u00a7\u00a7\u00a7	27.0 (\u00b17.2)\u00a7\u00a7\u00a7	19.2 (\u00b16.6)
Oklahoma	89.5 (\u00b13.4)	67.3 (\u00b16.2)	78.1 (\u00b14.9)	66.2 (\u00b15.4)	54.8 (\u00b18.7)	46.5 (\u00b18.7)	35.4 (\u00b18.3)	45.2 (\u00b17.5)\u00a7\u00a7\u00a7	31.1 (\u00b16.9)\u00a7\u00a7\u00a7	17.3 (\u00b15.7)
Texas	87.3 (\u00b13.6)	79.4 (\u00b14.9)	86.1 (\u00b13.6)	87.6 (\u00b13.5)	56.2 (\u00b17.4)	46.3 (\u00b17.4)	38.9 (\u00b17.4)	34.1 (\u00b16.5)\u00a7\u00a7\u00a7	25.2 (\u00b15.9)\u00a7\u00a7\u00a7	15.0 (\u00b14.6)\u00a7\u00a7\u00a7
TX-Bexar County	87.0 (\u00b14.4)	78.9 (\u00b16.2)	86.6 (\u00b14.5)	87.2 (\u00b14.2)	54.8 (\u00b19.1)	45.7 (\u00b19.2)	32.5 (\u00b18.8)	32.4 (\u00b18.7)\u00a7\u00a7\u00a7	19.1 (\u00b16.9)	9.6 (\u00b14.7)
TX-City of Houston	86.8 (\u00b15.3)	82.1 (\u00b17.2)	86.5 (\u00b15.6)	91.4 (\u00b14.6)	62.0 (\u00b110.8)	51.9 (\u00b111.3)	33.9 (\u00b110.6)	40.3 (\u00b19.8)	27.8 (\u00b18.5)	17.5 (\u00b17.0)
TX-Rest of State	87.3 (\u00b14.1)	79.2 (\u00b15.6)	86.0 (\u00b14.1)	87.4 (\u00b14.0)	55.9 (\u00b18.6)	45.9 (\u00b18.6)	39.8 (\u00b18.5)	33.7 (\u00b17.4)\u00a7\u00a7\u00a7	25.4 (\u00b16.8)\u00a7\u00a7\u00a7	15.2 (\u00b15.3)\u00a7\u00a7\u00a7

\n
\n

TABLE 3. (Continued) Estimated vaccination coverage with selected vaccines and doses* among adolescents aged 13\u201317 years\u2020 by HHS region and state/selected local area \u2014 National Immunization Survey\u2013Teen (NIS-Teen), United States, 2013
Regional/State/Local area	\u22652 MMR\u00a7	\u22652 VAR\u00b6	\u22651 Tdap**	\u22651 MenACWY\u2020\u2020	Females (n = 8,264)	Males (n = 9,554)
\u22651 HPV\u00a7\u00a7	\u22652 HPV\u00b6\u00b6	\u22653 HPV***	\u22651 HPV\u00a7\u00a7	\u22652 HPV\u00b6\u00b6	\u22653 HPV***
% (95% CI)\u2020\u2020\u2020	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)
HHS Region VII	89.0 (\u00b12.5)	67.4 (\u00b14.5)	82.4 (\u00b12.9)	62.5 (\u00b13.7)	49.7 (\u00b15.6)	41.7 (\u00b15.4)	31.7 (\u00b14.9)	26.0 (\u00b14.4)\u00a7\u00a7\u00a7	16.6 (\u00b13.5)\u00a7\u00a7\u00a7	9.4 (\u00b12.7)\u00a7\u00a7\u00a7
Iowa	90.2 (\u00b14.0)	62.1 (\u00b17.4)	79.6 (\u00b15.0)	63.6 (\u00b15.9)	57.0 (\u00b18.7)	52.2 (\u00b18.8)	41.9 (\u00b18.8)	30.3 (\u00b18.0)	24.0 (\u00b17.3)\u00a7\u00a7\u00a7	13.7 (\u00b15.4)
Kansas	86.9 (\u00b14.6)	80.7 (\u00b16.1)	84.6 (\u00b14.9)\u00b6\u00b6\u00b6	55.9 (\u00b16.8)	39.9 (\u00b19.9)	29.9 (\u00b19.2)	21.0 (\u00b18.2)	25.1 (\u00b18.6)\u00a7\u00a7\u00a7	19.3 (\u00b17.8)	NA
Missouri	88.3 (\u00b14.8)	58.6 (\u00b18.6)	81.5 (\u00b15.4)	60.7 (\u00b17.1)	46.1 (\u00b110.6)	38.1 (\u00b110.1)	28.8 (\u00b19.0)	20.5 (\u00b17.7)	NA	NA
Nebraska	92.3 (\u00b13.2)	84.6 (\u00b15.5)	86.1 (\u00b14.7)	77.5 (\u00b15.2)	65.1 (\u00b19.2)	55.3 (\u00b19.3)	41.5 (\u00b19.1)	38.2 (\u00b18.7)\u00a7\u00a7\u00a7	26.4 (\u00b17.8)\u00a7\u00a7\u00a7	19.7 (\u00b17.2)\u00a7\u00a7\u00a7
HHS Region VIII	91.0 (\u00b12.1)	71.8 (\u00b13.8)	86.1 (\u00b12.5)	67.0 (\u00b13.3)	52.6 (\u00b15.0)	43.4 (\u00b15.0)	33.1 (\u00b14.7)	24.3 (\u00b14.4)	16.6 (\u00b13.8)	8.6 (\u00b12.5)
Colorado	92.4 (\u00b13.3)	78.5 (\u00b15.7)	87.1 (\u00b14.4)\u00b6\u00b6\u00b6	73.6 (\u00b15.6)	58.2 (\u00b18.6)	50.0 (\u00b18.8)	39.1 (\u00b18.7)	33.5 (\u00b18.6)	21.7 (\u00b17.5)	9.9 (\u00b14.8)
Montana	90.5 (\u00b14.0)	58.6 (\u00b18.6)	84.3 (\u00b15.1)	51.6 (\u00b16.6)	45.8 (\u00b19.6)	37.9 (\u00b19.0)	28.3 (\u00b18.1)\u00b6\u00b6\u00b6	23.8 (\u00b18.1)	17.2 (\u00b17.0)	9.4 (\u00b14.6)
North Dakota	96.1 (\u00b11.9)\u00a7\u00a7\u00a7	86.0 (\u00b15.3)\u00a7\u00a7\u00a7	95.0 (\u00b12.9)	93.7 (\u00b13.2)	57.5 (\u00b19.4)	51.0 (\u00b19.4)	41.1 (\u00b19.1)	36.1 (\u00b19.1)\u00a7\u00a7\u00a7	26.6 (\u00b18.4)\u00a7\u00a7\u00a7	18.4 (\u00b17.5)
South Dakota	94.1 (\u00b13.2)	50.6 (\u00b18.4)	70.0 (\u00b16.4)	51.7 (\u00b16.7)\u00a7\u00a7\u00a7	56.0 (\u00b19.7)	52.0 (\u00b19.7)	42.3 (\u00b19.6)	22.1 (\u00b17.1)	17.0 (\u00b16.4)	8.4 (\u00b14.2)
Utah	87.5 (\u00b14.6)	62.2 (\u00b18.4)	86.2 (\u00b14.9)	61.0 (\u00b16.7)	44.3 (\u00b19.6)	30.9 (\u00b18.9)	20.5 (\u00b17.8)	11.0 (\u00b15.8)	NA	NA
Wyoming	90.6 (\u00b14.0)	90.1 (\u00b14.5)	92.3 (\u00b13.0)\u00a7\u00a7\u00a7	63.1 (\u00b16.2)	54.3 (\u00b19.4)	49.5 (\u00b19.4)	42.1 (\u00b19.3)	16.6 (\u00b16.0)	12.3 (\u00b15.3)	8.4 (\u00b14.5)
HHS Region IX	90.7 (\u00b13.4)	77.4 (\u00b15.2)	89.7 (\u00b13.5)	80.6 (\u00b14.5)	66.0 (\u00b17.5)	54.8 (\u00b18.0)	43.3 (\u00b18.1)	48.7 (\u00b17.8)\u00a7\u00a7\u00a7	32.5 (\u00b17.7)\u00a7\u00a7\u00a7	16.4 (\u00b16.3)
Arizona	85.4 (\u00b14.6)	67.8 (\u00b17.1)	84.4 (\u00b15.0)	86.7 (\u00b14.6)	64.1 (\u00b18.7)	47.9 (\u00b19.5)	37.4 (\u00b19.2)	44.4 (\u00b18.7)\u00a7\u00a7\u00a7	33.5 (\u00b18.4)\u00a7\u00a7\u00a7	19.5 (\u00b16.9)
California	91.5 (\u00b14.2)	79.0 (\u00b16.5)	91.1 (\u00b14.4)	80.9 (\u00b15.7)	67.6 (\u00b19.4)	57.3 (\u00b110.0)	45.8 (\u00b110.2)	50.9 (\u00b19.7)\u00a7\u00a7\u00a7	33.2 (\u00b19.7)\u00a7\u00a7\u00a7	16.6 (\u00b18.0)
Hawaii	90.4 (\u00b14.5)	83.3 (\u00b15.7)	80.2 (\u00b15.4)	75.0 (\u00b16.0)	52.7 (\u00b110.1)	46.6 (\u00b110.0)	34.4 (\u00b19.5)	39.7 (\u00b18.9)	29.0 (\u00b18.1)	15.1 (\u00b16.0)
Nevada	92.8 (\u00b13.5)	74.6 (\u00b16.6)	88.3 (\u00b14.1)	64.0 (\u00b16.1)	53.8 (\u00b19.4)	38.9 (\u00b19.2)	27.4 (\u00b18.3)	31.9 (\u00b18.5)\u00a7\u00a7\u00a7	20.4 (\u00b17.2)	7.3 (\u00b13.9)
HHS Region X	90.0 (\u00b12.4)	75.3 (\u00b14.6)	84.1 (\u00b13.0)	72.7 (\u00b13.5)\u00a7\u00a7\u00a7	61.0 (\u00b15.8)	51.2 (\u00b15.9)	40.7 (\u00b15.9)	32.0 (\u00b15.0)\u00a7\u00a7\u00a7	19.3 (\u00b14.0)\u00a7\u00a7\u00a7	11.6 (\u00b13.2)\u00a7\u00a7\u00a7
Alaska	92.0 (\u00b13.7)	80.7 (\u00b16.1)	74.3 (\u00b15.8)	55.2 (\u00b16.5)	52.2 (\u00b19.4)	36.1 (\u00b19.0)	27.1 (\u00b18.2)	27.6 (\u00b17.9)\u00a7\u00a7\u00a7	17.8 (\u00b16.9)\u00a7\u00a7\u00a7	8.5 (\u00b14.7)
Idaho	85.2 (\u00b15.5)	63.8 (\u00b19.4)	74.6 (\u00b16.6)\u00a7\u00a7\u00a7	71.6 (\u00b17.0)	55.0 (\u00b110.6)	45.8 (\u00b110.5)	31.3 (\u00b19.6)	34.5 (\u00b110.2)\u00a7\u00a7\u00a7	21.6 (\u00b18.8)	NA
Oregon	92.3 (\u00b13.2)	84.3 (\u00b14.7)\u00a7\u00a7\u00a7	87.0 (\u00b14.3)	65.3 (\u00b15.8)	66.3 (\u00b18.4)	54.9 (\u00b18.8)	39.5 (\u00b18.8)	35.8 (\u00b18.1)\u00a7\u00a7\u00a7	20.8 (\u00b16.9)\u00a7\u00a7\u00a7	12.2 (\u00b15.0)
Washington	89.9 (\u00b14.0)	71.6 (\u00b18.1)	86.2 (\u00b15.0)	79.0 (\u00b15.6)	60.7 (\u00b19.7)	52.3 (\u00b19.9)	45.3 (\u00b19.8)	29.8 (\u00b18.0)\u00a7\u00a7\u00a7	18.0 (\u00b16.3)\u00a7\u00a7\u00a7	12.5 (\u00b15.2)
*Range*	*(83.2\u201397.4)*	*(50.6\u201395.8)*	*(60.2\u201395.5)*	*(40.4\u201393.7)*	*(39.9\u201376.6)*	*(29.9\u201368.5)*	*(20.5\u201356.5)*	*(11.0\u201369.3)*	*(10.8\u201358.0)*	*(7.3\u201343.2)*
Territory
Guam	84.8 (\u00b14.6)	43.7 (\u00b18.5)	73.8 (\u00b15.4)	72.4 (\u00b15.7)	69.1 (\u00b18.2)	45.2 (\u00b18.9)	33.6 (\u00b18.3)	21.8 (\u00b17.0)	8.6 (\u00b14.2)	NA
U.S. Virgin Islands	92.0 (\u00b13.0)	77.9 (\u00b15.3)	76.4 (\u00b15.2)	38.4 (\u00b16.0)	33.2 (\u00b18.5)	17.7 (\u00b16.7)	9.5 (\u00b14.9)	17.2 (\u00b16.6)	NA	NA
Abbreviations: CI = confidence interval; HHS = U.S. Department of Health and Human Services; MMR = measles, mumps, and rubella; VAR = varicella; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis; MenACWY = meningococcal conjugate; HPV = human papillomavirus; NA = not available (estimate not reported because unweighted sample size for the denominator was <30 or 95% CI half width/estimate >0.6). * Vaccination estimates for additional measures, including \u22653 doses hepatitis B, and \u22651 dose varicella vaccines are available at http://www.cdc.gov/vaccines/stats-surv/nis/default.htm#nisteen. \u2020 Adolescents (N = 18,264) in the 2013 NIS-Teen were born January 11, 1995, through February 13, 2001. \u00a7 \u22652 doses of MMR vaccine. \u00b6 \u22652 doses of VAR vaccine among adolescents without a reported history of varicella. \u22651 dose Tdap vaccine on or after age 10 years. \u2020\u2020 \u22651 dose of MenACWY or meningococcal-unknown type vaccine. \u00a7\u00a7 \u22651 dose of HPV vaccine, either quadrivalent or bivalent may be used for females, and only quadrivalent may be used for males. For \u22651, \u22652, and \u22653 dose measures, separate percentages are reported among females only (n = 8,710) and among males only (n = 9,554). \u00b6\u00b6 \u22652 doses of HPV vaccine, either quadrivalent or bivalent may be used for females, and only quadrivalent may be used for males. * \u22653 doses of HPV vaccine, either quadrivalent or bivalent may be used for females, and only quadrivalent may be used for males. \u2020\u2020\u2020 Estimates with 95% CI half-widths >10 might not be reliable. \u00a7\u00a7\u00a7 Statistically significant (p<0.05) percentage point increase from 2012. \u00b6\u00b6\u00b6 Statistically significant (p<0.05) percentage point decrease from 2012.

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