Although severe COVID-19 illness and hospitalization are more common among adults,
these outcomes can occur in adolescents (
1
). Nearly one third of adolescents aged 12–17 years hospitalized with COVID-19 during
March 2020–April 2021 required intensive care, and 5% of those hospitalized required
endotracheal intubation and mechanical ventilation (
2
). On December 11, 2020, the Food and Drug Administration (FDA) issued Emergency Use
Authorization (EUA) of the Pfizer-BioNTech COVID-19 vaccine for adolescents aged 16–17
years; on May 10, 2021, the EUA was expanded to include adolescents aged 12–15 years;
and on August 23, 2021, FDA granted approval of the vaccine for persons aged ≥16 years.
To assess progress in adolescent COVID-19 vaccination in the United States, CDC assessed
coverage with ≥1 dose* and completion of the 2-dose vaccination series
†
among adolescents aged 12–17 years using vaccine administration data for 49 U.S. states
(all except Idaho) and the District of Columbia (DC) during December 14, 2020–July
31, 2021. As of July 31, 2021, COVID-19 vaccination coverage among U.S. adolescents
aged 12–17 years was 42.4% for ≥1 dose and 31.9% for series completion. Vaccination
coverage with ≥1 dose varied by state (range = 20.2% [Mississippi] to 70.1% [Vermont])
and for series completion (range = 10.7% [Mississippi] to 60.3% [Vermont]). By age
group, 36.0%, 40.9%, and 50.6% of adolescents aged 12–13, 14–15, and 16–17 years,
respectively, received ≥1 dose; 25.4%, 30.5%, and 40.3%, respectively, completed the
vaccine series. Improving vaccination coverage and implementing COVID-19 prevention
strategies are crucial to reduce COVID-19–associated morbidity and mortality among
adolescents and to facilitate safer reopening of schools for in-person learning.
Data on COVID-19 vaccine administration in the United States are reported to CDC by
jurisdictions, pharmacies, and federal entities through immunization information systems
(IISs),
§
the Vaccine Administration Management System (VAMS),
¶
or direct data submission.** Adolescents aged 12–17 years with valid residence in
one of 49 states or DC who received ≥1 dose of a COVID-19 vaccine during December
14, 2020–July 31, 2021, and whose data were reported to CDC by August 11, 2021, were
included in this analysis.
††
COVID-19 vaccine doses administered to persons residing in Idaho were excluded because
the state has data-sharing restrictions on information reported to CDC.
Receipt of ≥1 COVID-19 vaccine dose and series completion among adolescents aged 12–17
years was calculated overall and stratified by age (12–13, 14–15, and 16–17 years),
sex, and jurisdiction (49 states and DC). As of August 17, 2021, only the Pfizer-BioNTech
vaccine had been authorized for use among adolescents aged 12–17 years in the United
States. Moderna and Janssen (Johnson & Johnson) COVID-19 vaccines were not authorized
under emergency use for this age group during the analysis period; however, for reasons
that are not known, many adolescents were reported to have received these vaccines,
and doses administered to adolescents were included in this analysis. Vaccination
coverage by race and ethnicity was not calculated because of high rates of missing
data. Population size by age group and sex was obtained from the U.S. Census Bureau’s
2019 Population Estimates Program (
3
). Second dose completion was calculated among adolescents who received ≥1 dose of
a 2-dose COVID-19 vaccination series and for whom sufficient time to receive a second
dose during the analysis period had elapsed.
§§
Among adolescents who received the first dose of a 2-dose COVID-19 vaccination series,
the proportions of adolescents who had already received the second dose, of those
who had not received the second dose but were still within the recommended time interval
to receive the second dose, and of those who had not received and were overdue for
the second dose were calculated. Tests for statistical significance were not conducted
because these data are reflective of the U.S. population (excluding Idaho) and were
not based on population samples. All analyses were conducted using SAS software (version
9.4; SAS Institute). This activity was reviewed by CDC and was conducted consistent
with applicable federal law and CDC policy.
¶¶
As of July 31, 2021, 42.4% of adolescents aged 12–17 years had received ≥1 dose of
a COVID-19 vaccine (Table 1), and 31.9% had completed the vaccination series (Table
2). Adolescent COVID-19 vaccination coverage with ≥1 dose varied by state (range = 20.2%
[Mississippi] to 70.1% [Vermont]), as it did for series completion (range = 10.7%
[Mississippi] to 60.3% [Vermont]), with higher vaccination coverage in the Northeast
and on the West Coast and lower vaccination coverage in the South (Figure). Coverage
was higher among adolescents aged 16–17 years (50.6% for ≥1 dose; 40.3% for series
completion) than among those aged 12–13 years (36.0% for ≥1 dose; 25.4% for series
completion) and 14–15 years (40.9% for ≥1 dose; 30.5% for series completion). Vaccination
coverage was similar among males and females across all age groups.
TABLE 1
Receipt of ≥1 COVID-19 vaccine dose by adolescents aged 12–17 years,* by age group
and sex
†
— United States,
§
December 14, 2020–July 31, 2021
Jurisdiction
Age group and sex, no. (%)
12–17 yrs
12–13 yrs
14–15 yrs
16–17 yrs
Total
Female
Male
Total
Female
Male
Total
Female
Male
Total
Female
Male
United States
10,677,934 (42.4)
5,425,265 (44.1)
5,216,450 (40.5)
3,094,245 (36.0)
1,543,152 (36.8)
1,541,710 (35.0)
3,454,771 (40.9)
1,750,329 (42.2)
1,693,216 (39.5)
4,128,918 (50.6)
2,131,784 (53.9)
1,981,524 (47.1)
Alabama
77,773 (20.6)
40,050 (22.4)
37,692 (19.0)
127,065 (17.5)
11,189 (18.7)
11,094 (16.5)
25,257 (19.6)
12,996 (20.3)
12,256 (18.9)
30,221 (24.8)
15,865 (28.7)
14,342 (21.6)
Alaska
23,706 (46.4)
11,621 (50.6)
11,788 (41.9)
14,859 (46.0)
3,279 (38.2)
3,480 (55.5)
7,627 (37.0)
3,755 (42.5)
3,789 (32.1)
9,241 (59.2)
4,587 (82.9)
4,519 (44.8)
Arizona
224,638 (38.9)
114,136 (40.9)
109,744 (36.8)
201,971 (32.3)
32,501 (32.7)
32,543 (31.7)
72,338 (37.3)
36,750 (38.9)
35,297 (35.5)
87,023 (48.1)
44,885 (52.7)
41,904 (43.7)
Arkansas
73,861 (30.3)
37,256 (31.6)
35,813 (28.6)
80,882 (25.0)
9,905 (24.7)
10,097 (24.8)
24,873 (31.2)
12,407 (30.4)
12,209 (31.5)
28,754 (34.7)
14,944 (40.3)
13,507 (29.5)
California
1,642,427 (53.2)
836,970 (55.5)
801,906 (50.8)
1,054,889 (44.3)
233,673 (45.3)
232,862 (43.2)
541,389 (52.3)
275,356 (54.7)
264,914 (49.9)
633,560 (63.6)
327,941 (67.2)
304,130 (59.8)
Colorado
222,780 (50.3)
113,015 (53.3)
109,520 (47.6)
147,908 (45.0)
33,118 (48.3)
33,343 (42.0)
73,879 (48.7)
37,316 (51.5)
36,481 (46.1)
82,383 (57.6)
42,581 (59.8)
39,696 (55.3)
Connecticut
166,941 (62.3)
84,333 (64.6)
82,242 (59.9)
87,364 (55.1)
23,935 (55.1)
24,047 (54.7)
53,242 (58.7)
27,015 (62.4)
26,116 (55.1)
65,592 (72.9)
33,383 (76.0)
32,079 (69.7)
Delaware
32,169 (45.2)
16,559 (49.0)
15,560 (41.6)
21,190 (44.0)
4,614 (50.5)
4,698 (39.0)
10,526 (37.8)
5,428 (34.9)
5,080 (41.2)
12,319 (55.7)
6,517 (71.3)
5,782 (44.6)
District of Columbia
17,256 (52.3)
8,872 (53.3)
8,325 (50.9)
11,514 (49.8)
2,965 (56.6)
2,741 (43.7)
5,356 (46.0)
2,700 (38.3)
2,637 (57.5)
6,168 (62.6)
3,207 (73.4)
2,947 (53.7)
Florida
558,957 (37.6)
286,050 (39.4)
272,548 (35.9)
514,351 (31.0)
80,517 (32.9)
78,894 (29.3)
183,765 (37.2)
93,750 (37.6)
89,911 (36.8)
215,683 (45.3)
111,783 (48.4)
103,743 (42.3)
Georgia
271,600 (30.7)
138,608 (32.6)
132,222 (28.8)
307,972 (25.5)
39,194 (26.1)
39,086 (24.8)
87,107 (29.1)
44,308 (30.9)
42,597 (27.3)
105,965 (38.3)
55,106 (41.8)
50,539 (34.9)
Hawaii
60,457 (63.7)
30,251 (67.7)
30,035 (59.8)
33,044 (52.3)
8,501 (54.1)
8,725 (50.4)
19,774 (64.0)
9,869 (74.0)
9,857 (56.0)
23,409 (75.7)
11,881 (76.0)
11,453 (74.8)
Illinois
527,953 (53.2)
268,107 (54.1)
257,707 (52.0)
331,413 (45.4)
75,084 (44.8)
74,889 (45.7)
175,184 (52.1)
88,684 (52.1)
85,790 (51.7)
202,272 (62.4)
104,339 (65.9)
97,028 (58.5)
Indiana
164,717 (29.8)
84,039 (31.5)
79,638 (28.0)
194,055 (24.6)
23,834 (25.1)
23,786 (24.0)
52,778 (29.8)
26,775 (31.6)
25,704 (27.9)
64,144 (35.4)
33,430 (38.2)
30,148 (32.2)
Iowa
88,317 (36.7)
45,436 (38.6)
42,643 (34.8)
83,053 (31.8)
13,341 (32.8)
13,058 (30.8)
28,451 (36.9)
14,440 (36.2)
13,970 (37.5)
33,421 (41.6)
17,655 (47.3)
15,615 (36.4)
Kansas
88,601 (36.4)
45,509 (38.0)
42,995 (34.9)
84,150 (31.6)
13,211 (30.7)
13,352 (32.5)
27,907 (34.8)
14,328 (40.8)
13,557 (30.1)
34,100 (43.3)
17,970 (43.1)
16,086 (43.3)
Kentucky
115,204 (32.7)
59,363 (34.5)
55,723 (31.0)
122,071 (27.8)
17,009 (27.7)
16,927 (27.9)
37,571 (33.0)
19,163 (35.5)
18,375 (30.6)
43,680 (37.6)
23,191 (40.7)
20,421 (34.4)
Louisiana
81,272 (21.9)
41,478 (23.4)
39,560 (20.3)
131,531 (17.7)
11,736 (19.3)
11,536 (16.3)
26,369 (21.6)
13,273 (22.2)
13,019 (20.9)
31,616 (26.7)
16,469 (29.1)
15,005 (24.4)
Maine
48,729 (55.1)
24,474 (59.0)
23,874 (50.9)
27,699 (53.3)
7,247 (64.3)
7,370 (44.9)
16,031 (52.4)
8,004 (54.5)
7,858 (49.4)
17,937 (59.6)
9,223 (59.6)
8,646 (59.2)
Maryland
263,433 (56.3)
132,880 (57.8)
130,206 (54.7)
163,386 (49.1)
39,948 (51.2)
40,174 (47.1)
84,806 (53.6)
42,484 (52.7)
42,206 (54.4)
98,420 (67.4)
50,448 (70.9)
47,826 (63.8)
Massachusetts
319,741 (65.7)
161,726 (68.5)
157,494 (62.9)
158,110 (59.9)
47,185 (62.7)
47,336 (57.1)
105,067 (65.2)
53,176 (64.4)
51,711 (65.7)
120,042 (71.7)
61,365 (78.3)
58,447 (65.7)
Michigan
273,071 (36.0)
139,194 (38.1)
133,776 (34.1)
254,314 (30.6)
39,045 (31.8)
38,746 (29.5)
86,078 (34.7)
43,910 (36.8)
42,132 (32.7)
109,164 (42.7)
56,239 (45.5)
52,898 (40.0)
Minnesota
198,287 (44.3)
101,571 (45.8)
95,698 (42.4)
149,301 (40.8)
30,696 (39.3)
30,025 (42.1)
60,068 (38.7)
30,610 (40.9)
29,257 (36.4)
77,289 (54.1)
40,265 (58.4)
36,416 (49.3)
Mississippi
49,940 (20.2)
25,444 (21.0)
24,454 (19.3)
86,695 (16.7)
7,162 (17.7)
7,272 (15.7)
16,559 (21.4)
8,298 (20.3)
8,245 (22.7)
18,931 (22.6)
9,984 (25.0)
8,937 (20.4)
Missouri
152,486 (32.4)
77,515 (33.0)
74,807 (31.7)
158,781 (28.9)
22,844 (29.3)
23,025 (28.5)
49,384 (31.0)
25,006 (31.7)
24,325 (30.2)
57,185 (37.5)
29,665 (38.0)
27,457 (37.0)
Montana
23,962 (30.3)
12,105 (31.5)
11,683 (28.8)
25,348 (28.9)
3,579 (28.1)
3,669 (29.1)
7,428 (28.9)
3,730 (28.5)
3,638 (28.9)
9,209 (32.9)
4,796 (38.0)
4,376 (28.5)
Nebraska
62,131 (39.2)
31,723 (39.8)
30,292 (38.5)
56,881 (33.1)
9,447 (31.5)
9,343 (34.7)
19,599 (37.1)
9,928 (40.0)
9,649 (34.5)
23,719 (48.7)
12,348 (49.6)
11,300 (47.5)
Nevada
89,835 (37.2)
46,021 (37.7)
43,775 (36.6)
85,434 (29.8)
12,717 (30.8)
12,723 (28.8)
29,148 (36.3)
14,933 (34.9)
14,202 (37.8)
35,241 (46.5)
18,371 (48.4)
16,850 (44.6)
New Hampshire
48,188 (49.5)
24,264 (49.9)
23,250 (47.7)
34,943 (38.1)
6,575 (38.3)
6,609 (37.2)
15,129 (51.1)
7,567 (47.1)
7,332 (54.2)
19,747 (60.1)
10,122 (65.7)
9,309 (53.3)
New Jersey
357,267 (52.5)
180,504 (54.7)
175,521 (50.0)
232,003 (43.8)
50,304 (42.3)
51,137 (45.2)
113,832 (50.9)
57,509 (54.3)
55,960 (47.5)
141,702 (62.9)
72,691 (69.2)
68,424 (56.9)
New Mexico
92,891 (55.1)
46,824 (55.5)
44,864 (53.1)
57,115 (49.5)
13,992 (49.8)
13,800 (47.6)
29,505 (50.9)
14,745 (49.8)
14,367 (50.7)
35,137 (65.5)
18,087 (68.0)
16,697 (61.6)
New York
651,562 (46.6)
328,743 (48.5)
319,985 (44.5)
471,237 (39.3)
91,375 (39.4)
93,069 (38.9)
205,664 (44.3)
103,529 (46.5)
101,489 (42.0)
260,904 (56.6)
133,839 (60.1)
125,427 (52.6)
North Carolina
288,722 (35.4)
147,723 (35.7)
139,514 (34.8)
280,592 (29.4)
41,310 (28.5)
40,939 (30.1)
95,543 (35.3)
48,666 (35.0)
46,473 (35.3)
110,577 (42.0)
57,747 (44.3)
52,102 (39.1)
North Dakota
13,910 (26.3)
7,084 (25.4)
6,613 (26.5)
18,993 (20.2)
1,888 (20.4)
1,894 (19.5)
4,533 (27.4)
2,290 (24.1)
2,175 (30.8)
5,535 (32.0)
2,906 (31.8)
2,544 (31.3)
Ohio
284,374 (31.9)
145,410 (33.8)
138,167 (29.9)
300,214 (27.1)
40,975 (28.2)
40,302 (26.0)
89,895 (29.9)
45,960 (31.6)
43,719 (28.2)
113,035 (38.8)
58,475 (42.1)
54,146 (35.5)
Oklahoma
92,409 (29.1)
47,313 (31.4)
44,973 (27.1)
113,915 (23.4)
13,242 (25.7)
13,346 (21.4)
29,283 (29.1)
15,020 (30.0)
14,228 (28.2)
36,505 (35.5)
19,051 (38.7)
17,399 (32.5)
Oregon
147,476 (49.3)
74,896 (49.7)
72,231 (48.8)
100,819 (43.5)
21,971 (44.0)
21,828 (42.9)
48,739 (48.1)
24,714 (47.6)
23,927 (48.3)
54,859 (56.8)
28,211 (57.6)
26,476 (55.5)
Pennsylvania
437,303 (47.7)
219,211 (48.7)
209,686 (44.8)
308,332 (41.3)
62,448 (41.8)
62,623 (39.4)
140,842 (45.2)
70,283 (46.6)
67,547 (42.1)
168,972 (56.7)
86,480 (57.7)
79,516 (53.7)
Rhode Island
42,660 (55.4)
21,683 (60.8)
20,919 (50.6)
25,863 (48.2)
6,167 (45.7)
6,290 (50.9)
13,645 (51.2)
7,024 (61.9)
6,595 (43.1)
16,544 (67.4)
8,492 (78.4)
8,034 (58.6)
South Carolina
100,830 (25.8)
51,820 (26.7)
48,946 (24.9)
135,830 (19.9)
13,591 (20.5)
13,384 (19.2)
33,001 (24.6)
17,005 (25.3)
15,977 (23.9)
40,842 (33.7)
21,224 (34.9)
19,585 (32.5)
South Dakota
24,848 (34.4)
12,468 (34.6)
11,989 (33.1)
24,483 (30.1)
3,612 (32.6)
3,661 (27.3)
8,051 (30.9)
4,073 (29.1)
3,850 (31.9)
9,439 (43.5)
4,783 (43.5)
4,478 (41.8)
Tennessee
126,159 (24.3)
65,267 (26.1)
60,591 (22.6)
185,246 (19.6)
18,164 (20.1)
18,156 (19.2)
40,295 (24.0)
20,848 (24.2)
19,407 (23.8)
49,495 (29.9)
26,255 (35.8)
23,028 (24.9)
Texas
1,028,789 (40.6)
521,461 (42.2)
506,643 (39.0)
854,580 (34.6)
147,957 (35.6)
147,505 (33.6)
330,444 (38.5)
167,302 (39.9)
162,971 (37.1)
402,745 (49.1)
206,202 (51.6)
196,167 (46.6)
Utah
129,559 (41.9)
65,495 (43.8)
63,818 (40.0)
106,783 (34.6)
18,393 (34.5)
18,549 (34.7)
39,977 (38.8)
20,029 (41.4)
19,925 (36.5)
52,615 (53.1)
27,073 (56.6)
25,344 (49.3)
Vermont
28,904 (70.1)
14,332 (74.4)
14,474 (65.9)
11,732 (75.0)
4,306 (83.5)
4,464 (67.9)
9,454 (70.3)
4,790 (91.7)
4,627 (56.3)
10,649 (66.3)
5,236 (58.9)
5,383 (75.1)
Virginia
342,958 (53.7)
173,904 (56.1)
168,793 (51.3)
222,929 (45.3)
50,509 (46.5)
50,461 (44.1)
113,259 (53.0)
57,040 (54.8)
56,153 (51.2)
128,655 (63.6)
66,355 (68.2)
62,179 (59.2)
Washington
296,782 (53.1)
149,501 (53.6)
145,592 (52.0)
192,800 (48.7)
46,631 (49.0)
46,691 (47.8)
95,740 (50.0)
47,895 (48.3)
47,255 (51.2)
107,187 (61.3)
54,975 (64.9)
51,646 (57.3)
West Virginia
38,159 (30.2)
19,127 (31.5)
18,459 (28.2)
44,298 (23.8)
5,126 (24.7)
5,263 (22.3)
12,061 (30.2)
6,090 (32.4)
5,782 (27.3)
15,564 (37.1)
7,911 (37.2)
7,414 (35.8)
Wisconsin
174,211 (39.9)
88,947 (41.5)
84,996 (38.2)
142,836 (35.8)
25,720 (38.3)
25,427 (33.6)
55,260 (36.8)
28,010 (37.0)
27,178 (36.4)
67,750 (47.1)
35,217 (49.2)
32,391 (44.9)
Wyoming
9,729 (20.4)
4,982 (21.7)
4,706 (19.0)
18,337 (15.8)
1,420 (16.5)
1,471 (15.2)
3,058 (20.9)
1,548 (19.9)
1,497 (21.8)
3,772 (25.7)
2,014 (30.8)
1,738 (21.4)
* Receipt of ≥1 COVID-19 vaccine dose is defined either as receiving at least one
of the 2 doses of the Pfizer-BioNTech or Moderna vaccines or a single dose of the
Janssen (Johnson & Johnson) vaccine. As of August 17, 2021, only the Pfizer-BioNTech
vaccine had been authorized for use among adolescents aged 12–17 years. Moderna and
Janssen COVID-19 vaccines were not authorized under emergency use for this age group
during the analysis period; however, these vaccinations were included in this analysis.
† Fewer than 0.5% of the records were missing information on sex.
§
COVID-19 vaccine doses administered to adolescents residing in Idaho were excluded
because the state has data-sharing restrictions on information reported to CDC.
TABLE 2
COVID-19 vaccination coverage among adolescents aged 12–17 years who completed the
vaccine series,* by age group and sex
†
— United States,
§
December 14, 2020–July 31, 2021
Jurisdiction
Age group and sex, no. (%)
12–17 yrs
12–13 yrs
14–15 yrs
16–17 yrs
Total
Female
Male
Total
Female
Male
Total
Female
Male
Total
Female
Male
United States
8,045,685 (31.9)
4,117,404 (33.5)
3,905,344 (30.3)
2,183,597 (25.4)
1,093,057 (26.0)
1,085,039 (24.7)
2,570,498 (30.5)
1,311,724 (31.6)
1,251,765 (29.2)
3,291,590 (40.3)
1,712,623 (43.3)
1,568,540 (37.3)
Alabama
40,925 (10.8)
21,303 (11.9)
19,606 (9.9)
10,360 (8.2)
5,234 (8.7)
5,118 (7.6)
12,421 (9.6)
6,452 (10.1)
5,969 (9.2)
18,144 (14.9)
9,617 (17.4)
8,519 (12.8)
Alaska
18,394 (36.0)
9,066 (39.5)
9,148 (32.5)
4,947 (33.3)
2,384 (27.7)
2,522 (40.2)
5,678 (27.5)
2,778 (31.4)
2,847 (24.1)
7,769 (49.7)
3,904 (70.6)
3,779 (37.4)
Arizona
167,297 (29.0)
85,471 (30.6)
81,203 (27.3)
44,661 (22.1)
22,273 (22.4)
22,209 (21.7)
52,639 (27.1)
26,854 (28.4)
25,546 (25.7)
69,997 (38.7)
36,344 (42.6)
33,448 (34.9)
Arkansas
41,891 (17.2)
21,742 (18.4)
19,956 (15.9)
10,494 (13.0)
5,259 (13.1)
5,194 (12.7)
13,552 (17.0)
6,945 (17.0)
6,551 (16.9)
17,845 (21.5)
9,538 (25.7)
8,211 (17.9)
California
1,271,593 (41.2)
652,802 (43.3)
616,318 (39.0)
344,509 (32.7)
172,803 (33.5)
171,083 (31.7)
416,508 (40.3)
213,322 (42.4)
202,396 (38.1)
510,576 (51.2)
266,677 (54.6)
242,839 (47.7)
Colorado
185,447 (41.9)
94,420 (44.5)
90,901 (39.5)
52,056 (35.2)
25,885 (37.8)
26,150 (32.9)
61,301 (40.4)
31,074 (42.9)
30,191 (38.2)
72,090 (50.4)
37,461 (52.6)
34,560 (48.1)
Connecticut
136,730 (51.0)
69,481 (53.2)
66,983 (48.8)
36,973 (42.3)
18,513 (42.6)
18,368 (41.8)
43,625 (48.1)
22,287 (51.5)
21,253 (44.8)
56,132 (62.4)
28,681 (65.3)
27,362 (59.5)
Delaware
25,675 (36.1)
13,313 (39.4)
12,334 (33.0)
7,027 (33.2)
3,496 (38.2)
3,524 (29.3)
8,378 (30.1)
4,378 (28.2)
3,990 (32.3)
10,270 (46.4)
5,439 (59.5)
4,820 (37.2)
District of Columbia
11,239 (34.1)
5,818 (34.9)
5,393 (33.0)
3,574 (31.0)
1,847 (35.2)
1,716 (27.4)
3,607 (31.0)
1,849 (26.2)
1,748 (38.1)
4,058 (41.2)
2,122 (48.6)
1,929 (35.1)
Florida
377,443 (25.4)
194,735 (26.8)
182,570 (24.0)
98,344 (19.1)
49,892 (20.4)
48,418 (18.0)
120,847 (24.5)
62,121 (24.9)
58,694 (24.0)
158,252 (33.2)
82,722 (35.8)
75,458 (30.7)
Georgia
166,329 (18.8)
85,830 (20.2)
80,219 (17.5)
41,215 (13.4)
20,691 (13.8)
20,437 (13.0)
48,426 (16.2)
24,922 (17.4)
23,455 (15.0)
76,688 (27.7)
40,217 (30.5)
36,327 (25.1)
Hawaii
35,203 (37.1)
17,549 (39.3)
17,546 (34.9)
9,931 (30.1)
4,831 (30.7)
5,072 (29.3)
11,450 (37.0)
5,705 (42.8)
5,715 (32.5)
13,822 (44.7)
7,013 (44.9)
6,759 (44.2)
Illinois
348,478 (35.1)
179,085 (36.1)
168,328 (33.9)
95,818 (28.9)
48,301 (28.8)
47,255 (28.8)
113,863 (33.9)
58,356 (34.3)
55,143 (33.2)
138,797 (42.8)
72,428 (45.8)
65,930 (39.7)
Indiana
131,406 (23.8)
67,329 (25.2)
63,257 (22.2)
35,025 (18.0)
17,450 (18.4)
17,450 (17.6)
41,394 (23.4)
21,124 (24.9)
20,030 (21.7)
54,987 (30.4)
28,755 (32.8)
25,777 (27.6)
Iowa
70,809 (29.4)
36,654 (31.1)
34,002 (27.7)
19,670 (23.7)
9,953 (24.5)
9,692 (22.8)
22,623 (29.3)
11,540 (28.9)
11,059 (29.7)
28,516 (35.5)
15,161 (40.6)
13,251 (30.9)
Kansas
61,300 (25.2)
31,698 (26.4)
29,559 (24.0)
16,594 (19.7)
8,240 (19.2)
8,339 (20.3)
18,868 (23.5)
9,778 (27.8)
9,082 (20.2)
25,838 (32.8)
13,680 (32.8)
12,138 (32.7)
Kentucky
81,664 (23.2)
42,709 (24.8)
38,895 (21.6)
22,107 (18.1)
11,199 (18.2)
10,903 (18.0)
26,034 (22.8)
13,521 (25.1)
12,500 (20.8)
33,523 (28.8)
17,989 (31.6)
15,492 (26.1)
Louisiana
46,411 (12.5)
24,126 (13.6)
22,181 (11.4)
11,607 (8.8)
5,905 (9.7)
5,695 (8.0)
13,932 (11.4)
7,128 (11.9)
6,772 (10.9)
20,872 (17.6)
11,093 (19.6)
9,714 (15.8)
Maine
42,857 (48.5)
21,496 (51.9)
21,044 (44.8)
12,259 (44.3)
5,993 (53.1)
6,149 (37.4)
14,157 (46.2)
7,069 (48.1)
6,953 (43.7)
16,441 (54.7)
8,434 (54.5)
7,942 (54.4)
Maryland
218,233 (46.7)
110,698 (48.2)
107,376 (45.1)
62,420 (38.2)
31,169 (39.9)
31,214 (36.6)
70,372 (44.5)
35,469 (44.0)
34,851 (44.9)
85,441 (58.5)
44,060 (61.9)
41,311 (55.1)
Massachusetts
263,919 (54.2)
134,332 (56.9)
129,099 (51.5)
74,471 (47.1)
37,267 (49.5)
37,081 (44.7)
86,063 (53.4)
43,839 (53.1)
42,066 (53.5)
103,385 (61.8)
53,226 (67.9)
49,952 (56.2)
Michigan
229,551 (30.3)
117,541 (32.1)
111,939 (28.5)
61,506 (24.2)
30,932 (25.2)
30,548 (23.3)
72,163 (29.1)
36,968 (31.0)
35,175 (27.3)
95,882 (37.5)
49,641 (40.2)
46,216 (34.9)
Minnesota
174,700 (39.0)
89,821 (40.5)
84,347 (37.4)
50,776 (34.0)
25,668 (32.9)
25,006 (35.1)
56,104 (36.1)
28,844 (38.5)
27,156 (33.8)
67,820 (47.4)
35,309 (51.2)
32,185 (43.5)
Mississippi
26,576 (10.7)
13,709 (11.3)
12,846 (10.2)
6,393 (7.4)
3,182 (7.9)
3,204 (6.9)
8,134 (10.5)
4,094 (10.0)
4,033 (11.1)
12,049 (14.4)
6,433 (16.1)
5,609 (12.8)
Missouri
104,029 (22.1)
53,410 (22.7)
50,568 (21.4)
28,825 (18.2)
14,385 (18.5)
14,432 (17.8)
32,843 (20.6)
16,854 (21.4)
15,979 (19.8)
42,361 (27.8)
22,171 (28.4)
20,157 (27.1)
Montana
18,046 (22.8)
9,197 (23.9)
8,794 (21.7)
5,167 (20.4)
2,551 (20.0)
2,598 (20.6)
5,430 (21.2)
2,784 (21.3)
2,626 (20.9)
7,449 (26.6)
3,862 (30.6)
3,570 (23.2)
Nebraska
48,472 (30.6)
25,035 (31.4)
23,394 (29.8)
13,509 (23.7)
6,854 (22.9)
6,647 (24.7)
15,152 (28.7)
7,759 (31.3)
7,384 (26.4)
19,811 (40.7)
10,422 (41.9)
9,363 (39.4)
Nevada
55,558 (23.0)
28,686 (23.5)
26,854 (22.5)
14,043 (16.4)
7,011 (17.0)
7,030 (15.9)
17,412 (21.7)
8,995 (21.0)
8,411 (22.4)
24,103 (31.8)
12,680 (33.4)
11,413 (30.2)
New Hampshire
39,480 (40.5)
19,952 (41.0)
18,996 (38.9)
10,267 (29.4)
5,083 (29.6)
5,094 (28.7)
12,290 (41.5)
6,173 (38.4)
5,945 (43.9)
16,923 (51.5)
8,696 (56.4)
7,957 (45.5)
New Jersey
289,682 (42.5)
146,961 (44.6)
141,715 (40.3)
77,253 (33.3)
38,290 (32.2)
38,734 (34.3)
92,001 (41.1)
46,666 (44.1)
45,052 (38.2)
120,428 (53.4)
62,005 (59.0)
57,929 (48.2)
New Mexico
72,669 (43.1)
37,085 (44.0)
35,178 (41.7)
20,417 (35.7)
10,265 (36.5)
10,012 (34.5)
22,917 (39.6)
11,613 (39.2)
11,184 (39.5)
29,335 (54.6)
15,207 (57.2)
13,982 (51.6)
New York
537,956 (38.5)
272,326 (40.2)
263,665 (36.6)
143,966 (30.6)
71,259 (30.7)
72,385 (30.2)
169,430 (36.5)
85,566 (38.4)
83,440 (34.5)
224,560 (48.7)
115,501 (51.9)
107,840 (45.2)
North Carolina
210,162 (25.8)
108,311 (26.2)
100,839 (25.2)
55,824 (19.9)
28,001 (19.3)
27,612 (20.3)
68,736 (25.4)
35,229 (25.3)
33,228 (25.2)
85,602 (32.5)
45,081 (34.6)
39,999 (30.0)
North Dakota
10,254 (19.4)
5,257 (18.9)
4,842 (19.4)
2,516 (13.2)
1,259 (13.6)
1,219 (12.5)
3,234 (19.5)
1,628 (17.2)
1,556 (22.1)
4,504 (26.1)
2,370 (26.0)
2,067 (25.4)
Ohio
239,023 (26.8)
122,890 (28.6)
115,636 (25.0)
63,374 (21.1)
32,046 (22.0)
31,238 (20.2)
74,684 (24.8)
38,484 (26.4)
36,083 (23.3)
100,965 (34.7)
52,360 (37.7)
48,315 (31.7)
Oklahoma
61,250 (19.3)
31,546 (20.9)
29,633 (17.8)
15,691 (13.8)
7,764 (15.0)
7,913 (12.7)
18,709 (18.6)
9,633 (19.2)
9,056 (18.0)
26,850 (26.1)
14,149 (28.8)
12,664 (23.7)
Oregon
126,346 (42.3)
64,593 (42.8)
61,618 (41.6)
36,145 (35.9)
18,188 (36.4)
17,937 (35.3)
41,459 (40.9)
21,114 (40.7)
20,319 (41.0)
48,742 (50.4)
25,291 (51.7)
23,362 (49.0)
Pennsylvania
303,836 (33.1)
153,011 (34.0)
145,168 (31.0)
84,516 (27.4)
41,529 (27.8)
41,414 (26.0)
98,297 (31.6)
49,226 (32.6)
47,005 (29.3)
121,023 (40.6)
62,256 (41.5)
56,749 (38.3)
Rhode Island
35,520 (46.1)
18,100 (50.7)
17,380 (42.0)
9,733 (37.6)
4,786 (35.4)
4,938 (40.0)
11,386 (42.7)
5,862 (51.6)
5,508 (36.0)
14,401 (58.7)
7,452 (68.8)
6,934 (50.6)
South Carolina
72,130 (18.4)
37,476 (19.3)
34,621 (17.6)
17,802 (13.1)
8,967 (13.5)
8,831 (12.7)
22,947 (17.1)
11,939 (17.7)
10,996 (16.4)
31,381 (25.9)
16,570 (27.3)
14,794 (24.5)
South Dakota
16,383 (22.7)
8,318 (23.1)
7,813 (21.6)
4,264 (17.4)
2,113 (19.1)
2,108 (15.7)
5,037 (19.3)
2,585 (18.5)
2,374 (19.7)
7,082 (32.6)
3,620 (32.9)
3,331 (31.1)
Tennessee
87,019 (16.8)
45,491 (18.2)
41,307 (15.4)
22,260 (12.0)
11,200 (12.4)
11,035 (11.6)
26,342 (15.7)
13,724 (15.9)
12,597 (15.4)
38,417 (23.2)
20,567 (28.0)
17,675 (19.1)
Texas
718,918 (28.4)
369,600 (29.9)
348,945 (26.9)
193,523 (22.6)
97,354 (23.4)
96,096 (21.9)
225,520 (26.2)
115,724 (27.6)
109,695 (24.9)
299,875 (36.5)
156,522 (39.1)
143,154 (34.0)
Utah
96,759 (31.3)
49,212 (32.9)
47,466 (29.8)
25,119 (23.5)
12,578 (23.6)
12,530 (23.4)
29,095 (28.3)
14,641 (30.3)
14,449 (26.4)
42,545 (42.9)
21,993 (46.0)
20,487 (39.9)
Vermont
24,881 (60.3)
12,395 (64.3)
12,437 (56.6)
7,388 (63.0)
3,657 (70.9)
3,720 (56.6)
8,118 (60.4)
4,095 (78.4)
4,006 (48.8)
9,375 (58.4)
4,643 (52.2)
4,711 (65.7)
Virginia
283,385 (44.3)
144,360 (46.6)
138,878 (42.2)
79,268 (35.6)
39,685 (36.5)
39,546 (34.6)
93,389 (43.7)
47,282 (45.5)
46,077 (42.0)
110,728 (54.7)
57,393 (59.0)
53,255 (50.7)
Washington
245,243 (43.9)
124,122 (44.5)
119,901 (42.8)
73,427 (38.1)
36,514 (38.4)
36,573 (37.4)
79,630 (41.6)
40,075 (40.4)
39,149 (42.5)
92,186 (52.7)
47,533 (56.1)
44,179 (49.0)
West Virginia
27,203 (21.6)
13,567 (22.3)
13,174 (20.1)
6,953 (15.7)
3,372 (16.3)
3,453 (14.6)
8,505 (21.3)
4,299 (22.9)
4,066 (19.2)
11,745 (28.0)
5,896 (27.7)
5,655 (27.3)
Wisconsin
140,545 (32.2)
72,235 (33.7)
68,167 (30.6)
37,736 (26.4)
19,067 (28.4)
18,641 (24.6)
43,634 (29.0)
22,269 (29.4)
21,335 (28.6)
59,175 (41.2)
30,899 (43.1)
28,191 (39.1)
Wyoming
6,866 (14.4)
3,540 (15.4)
3,305 (13.4)
1,874 (10.2)
912 (10.6)
956 (9.8)
2,162 (14.8)
1,088 (14.0)
1,070 (15.6)
2,830 (19.3)
1,540 (23.6)
1,279 (15.7)
* Vaccine series completion was defined as receiving either both doses of the Pfizer-BioNTech
or Moderna vaccines, including mismatched products between the first and second dose
(i.e., Pfizer-BioNTech for the first dose and Moderna for the second dose or vice
versa) or a single dose for the Janssen (Johnson & Johnson) vaccine. As of August
17, 2021, only the Pfizer-BioNTech vaccine had been authorized for use among adolescents
aged 12–17 years. Moderna and Janssen COVID-19 vaccines were not authorized under
emergency use for this age group during the analysis period; however, these vaccinations
were included in this analysis.
† Fewer than 0.5% of the records were missing information on sex.
§
COVID-19 vaccine doses administered to adolescents residing in Idaho were excluded
because the state has data-sharing restrictions on information reported to CDC.
FIGURE
Percentage of adolescents aged 12–17 years who completed the COVID-19 vaccination
series*
,†— United States,
§
December 14, 2020–July 31, 2021
Abbreviation: DC = District of Columbia.
* As of August 17, 2021, only the Pfizer-BioNTech vaccine had been authorized for
use among adolescents aged 12–17 years. Moderna and Janssen (Johnson & Johnson) COVID-19
vaccines were not authorized under emergency use for this age group during the analysis
period; however, many adolescents had documentation of receipt of these vaccines.
Thus, these vaccine doses were included in this analysis if they were administered
to adolescents aged 12–17 years.
† Series completion was defined as receipt of either both doses of the Pfizer-BioNTech
or Moderna vaccines, including those who might have received mismatched products between
the first and second dose (i.e., Pfizer-BioNTech for the first dose and Moderna for
the second dose or vice versa) or a single dose of the Janssen vaccine.
§ COVID-19 vaccine doses administered to adolescents residing in Idaho were excluded
because the state has data-sharing restrictions on information reported to CDC.
The figure is a map of the United States showing the percentage of adolescents aged
12–17 years who completed the COVID-19 vaccination series during December 14, 2020–July
31, 2021.
Overall, 86.8% of adolescents aged 12–17 years who received the first dose of a 2-dose
COVID-19 vaccination series*** received the second dose within the recommended interval.
A total of 2.4% had not received the second dose but were within the allowable interval,
and 10.8% were overdue for the second dose (i.e., >42 days since receipt of the first
dose) (Supplementary Table, https://stacks.cdc.gov/view/cdc/109000).
Discussion
Among all U.S. adolescents aged 12–17 years who received the first dose of a 2-dose
COVID-19 vaccine series, the vast majority received the second dose, indicating high
adherence to completing the COVID-19 vaccine series. However, as of July 31, 2021,
only 42.4% of adolescents had received ≥1 dose of a COVID-19 vaccine, and fewer than
one third (31.9%) had completed the vaccination series. Further, vaccination coverage
varied widely by state, with those in the Northeast and on the West Coast reporting
the highest COVID-19 vaccination coverage among adolescents. Vaccination coverage
also varied widely by age group, with reported coverage higher among those aged 16–17
years compared with those aged 12–15 years. This is likely because the older age group
has been vaccine-eligible for a longer period (i.e., since December 2020).
After the start of the COVID-19 pandemic, many schools shifted to virtual or hybrid
learning. Because in-person learning fosters social and emotional development,
†††
safely returning to schools for in-person learning remains a goal. However, given
the rapid emergence and spread of the highly transmissible B.1.617.2 (Delta) variant
of SARS-CoV-2, the virus that causes COVID-19, and the increase in cases and hospitalizations
among children and adolescents (
1
), ensuring high adolescent vaccination coverage is crucial to a safer return to the
classroom. Unvaccinated or undervaccinated adolescents can become ill with COVID-19
and spread the SARS-CoV-2 virus in schools, and by extension, in local communities,
placing other populations at risk. School systems can consider implementing layered
prevention strategies consistent with CDC’s guidance for COVID-19 prevention in schools,
including universal indoor masking regardless of vaccination status, improving ventilation,
screening testing, physical distancing where feasible, and contact tracing in combination
with quarantine and isolation. As the 2021–22 school year begins, concerted public
health efforts are needed to increase COVID-19 vaccination coverage among adolescents
in addition to implementing COVID-19 prevention strategies based on community transmission.
Public health practitioners can use various measures to increase adolescent COVID-19
vaccination coverage. Building on lessons from the public-private partnership between
CDC and retail pharmacies in the Federal Retail Pharmacy Partnership
§§§
regarding vaccination clinics offered for selected population groups at different
times throughout the response (
4
), local public health agencies and pharmacies could partner with school districts
and school systems to provide COVID-19 vaccinations to students at schools. Vaccine
administration on site at schools is an effective, evidence-based intervention that
improves childhood and adolescent vaccination rates for routinely recommended vaccines
(
5
). State and local governments, school administrators, community leaders, health care
professionals, and public health practitioners can facilitate safer return to schools
and improve equity among sociodemographic groups by prioritizing COVID-19 vaccination
among adolescents and incorporating on-site school vaccinations for eligible students
(
6
,
7
). In addition, on-site vaccination clinics might also be planned in coordination
with other school-based vaccination programs, such as those for seasonal influenza
and routine adolescent vaccination.
Concerted outreach can help inform adolescents and their parents about the importance
of COVID-19 vaccination. Effective outreach with tailored communication could help
improve vaccine confidence, acceptance, and coverage among adolescents and their parents.
In a recent report, only 56% of parents of unvaccinated adolescents aged 12–17 years
expressed intent for their adolescent to receive a COVID-19 vaccine (
8
). Given that parental vaccination status is a marker for adolescent vaccination status,
¶¶¶
vaccine hesitancy or antivaccination sentiments among parents might directly lead
to missed opportunities to vaccinate adolescents (
9
). Among adolescents and their parents who were surveyed about their intent to receive
a COVID-19 vaccine, many reported that having more information about the safety and
efficacy of COVID-19 vaccines would increase their likelihood of receiving a vaccine
(
8
). Public health practitioners can use multimodal outreach efforts involving a variety
of traditional and social media platforms to engage adolescents and their parents
to improve vaccination acceptance and coverage. Further, state and local governments
can consider strategies that encourage receipt by adolescents of all vaccines recommended
by the Advisory Committee on Immunization Practices, especially given the declines
in routine childhood and adolescent vaccinations during the pandemic (
10
).
The findings in this report are subject to at least five limitations. First, vaccination
coverage rates were aggregated and analyzed only at the state level. Calculating coverage
at more specific levels (e.g., by county or urban-rural classification) could potentially
identify geographic areas with low vaccination coverage rates. Second, because Idaho
was excluded from the analysis, the findings are not representative of the entire
United States. Third, adolescents who received COVID-19 vaccines from different entities
that used different methods for submitting data (e.g., if the first dose was administered
at a pharmacy and the second dose was given at a mass vaccination site) might not
have their first and second doses linked, which could have led to underestimation
of the percentage of adolescents who completed the vaccination series. Fourth, if
an adolescent had inadvertently received a different recipient ID when receiving their
second dose, first and second doses could not be linked. Finally, vaccination coverage
could not be calculated on the basis of race and ethnicity because of incomplete reporting.
An estimated 2 million COVID-19 cases and approximately 300 associated deaths have
been reported among children aged 5–17 years since the start of the COVID-19 pandemic
(
1
). As persons in younger age groups become eligible for COVID-19 vaccination, public
health practitioners, health care professionals, school administrators, and state
and local governments can use evidence-based practices to decrease barriers to vaccination
and increase confidence in COVID-19 vaccines, which can help facilitate the safer
return to in-person learning at schools and ultimately reduce COVID-19–associated
morbidity and mortality.
Summary
What is already known about this topic?
Although more common among adults, severe COVID-19 illness and hospitalization occur
among adolescents.
What is added by this report?
As of July 31, 2021, coverage with ≥1 dose of COVID-19 vaccine among adolescents aged
12–17 years was 42%, and 32% had completed the series. Series completion rates varied
widely by state, ranging from 11% to 60%, and was 25% for adolescents aged 12–13 years,
30% for those aged 14–15 years, and 40% for those aged 16–17 years.
What are the implications for public health practice?
Improving adolescent COVID-19 vaccination coverage is crucial to reduce COVID-19–associated
morbidity and mortality among adolescents and can help facilitate safer reopening
of schools for in-person learning.