How many young children are up to date on immunizations to prevent infectious diseases?

Four of five young children ages 19 to 35 months were up to date on five of the recommended immunizations in 2005. There was no change in this rate from 2004 to 2005. The rate ranged from 67 percent to 94 percent among the states.

Why is this important?

• Childhood vaccination is a very cost-effective disease prevention strategy, saving an estimated $43 billion in societal costs (medical care and productivity) over the lifetime of each annual birth cohort vaccinated (Zhou et al. 2005).
• High vaccination levels protect children against periodic outbreaks of infectious disease. For example, a measles outbreak in 1989–1991 resulted in 120 deaths, 11,000 people hospitalized, and $100 million in medical costs (DHHS 2000).
• Vaccination also protects against mild illnesses that lead to absence from school and lost workdays for parents.

Findings

Among young children ages 19 to 35 months in the United States, 81 percent received all recommended doses of five vaccines in 2005 (CDC 2006).

• This rate increased 18 percentage points from 1995 to 1998 (from 55 percent to 73 percent), only 2 percentage points from 1998 to 2002, and 6 percentage points from 2002 to 2004 (from 75 percent to 81 percent). The rate remained unchanged from 2004 to 2005.
• Among the states in 2005, this rate ranged from 67 percent in Nevada to 94 percent in Massachusetts (NIP 2006). As many states experienced an increase as a decrease in this rate from 2004 to 2005; changes ranged from a 7 percentage point increase in Nebraska to a 15 percentage point decrease in Arkansas.

Implications

One of every five young children is not completely up to date on recommended immunizations. Twenty-one states did not achieve the national Healthy People 2010 goal of 80 percent coverage for this combined immunization measure in 2005, a worsening from 2004 when 14 states failed to reach this goal. More progress is needed to reach and sustain national immunization goals in every area of the country and for all population groups.

Improvement Ideas and Resources

• Adopt public policies to ensure adequate vaccine supply and financing (IOM 2003).
• Improve tracking systems and participation in state and local immunization registries (Wood et al. 1999).
• Undertake community interventions that include education and outreach (Briss et al. 2000).
• Increase adoption of effective practices by health care providers, such as reminders for parents when immunizations are due, assessing the immunization status of all pediatric patients at a provider site, and prompts about needed vaccines during visits by children (ACIP 1996; Briss et al. 2000).

Measure:

The denominator includes children ages 19–35 months. The numerator includes those in the denominator who received all doses of five key vaccines recommended by the Center for Disease Control and Prevention's Advisory Committee on Immunization Practices:

• 4 doses of diphtheria, tetanus toxoids, and pertussis (whooping cough) or acellular pertussis vaccine, or diphtheria and tetanus toxoids only;
• 3 doses of poliovirus vaccine;
• 1 dose of any measles-containing vaccine (i.e., measles-mumps-rubella vaccine);
• 3 doses of Haemophilus influenzae type b vaccine;
• 3 doses of hepatitis B vaccine.

Limitations:

These estimates might differ from actual rates to the degree that statistical adjustments do not accurately account for vaccination coverage among nonresponding households, households without telephones, and children whose providers did not respond to the survey. The national estimates are considered precise, but "annual estimates and trends for states…should be interpreted with caution because of wider confidence intervals" (CDC 2006).

Source:

The National Immunization Survey combines a nationally representative telephone survey of parents with a mail survey of vaccination providers to validate the child's immunization record (CDC 2006; NIP 2006).

References:

* Indicates source of data used in the chart(s)>.

ACIP (Advisory Committee on Immunization Practices). 1996. Recommendations of the Advisory Committee on Immunization Practices: Programmatic Strategies to Increase Vaccination Rates—Assessment and Feedback of Provider-Based Vaccination Coverage Information. Morbidity and Mortality Weekly Report 45(10): 219–20. Briss, P. A., L. E. Rodewald, A. R. Hinman et al. 2000. Reviews of Evidence Regarding Interventions to Improve Vaccination Coverage in Children, Adolescents, and Adults. The Task Force on Community Preventive Services. American Journal of Preventive Medicine 18 (1 Suppl): 97–140. CDC (Centers for Disease Control and Prevention). 2006. National, State, and Urban Area Vaccination Coverage Among Children Aged 19–35 Months—United States, 2005. Morbidity and Mortality Weekly Report 55(36): 988–93. DHHS (Department of Health and Human Services). 2000. Healthy People 2010: Understanding and Improving Health. Washington, DC: Government Printing Office. IOM (Institute of Medicine). 2003. Financing Vaccines in the 21st century: Assuring Access and Availability. Washington, D.C.: National Academy Press. * NIP (National Immunization Program). 2006. Immunization Coverage in the U.S. Atlanta, Ga.: Centers for Disease Control and Prevention. Wood, D., K. N. Saarlas, M. Inkelas et al. 1999. Immunization Registries in the United States: Implications for the Practice of Public Health in a Changing Health Care System. Annual Review of Public Health 20: 231–55.Zhou F., J. Santoli, M. L. Messonnier et al. 2005. Economic evaluation of the 7-vaccine routine childhood immunization schedule in the United States, 2001. Archives of Pediatric and Adolescent Medicine 159(12): 1136–44.