National, state, and urban area vaccination coverage among children aged 19-35 months--United States, 2003

Each annual birth cohort in the United States comprises approximately 4 million infants. Maintaining the gains in vaccination coverage achieved during the 1990s among these children poses a continuing challenge for public health practitioners. The National Immunization Survey (NIS) provides estimates of vaccination coverage among children aged 19-35 months for each of the 50 states and 28 selected urban areas. This report summarizes NIS results for 2003, which indicated substantial increases nationwide in coverage with > or =1 dose of varicella vaccine (VAR) and > or =3 doses of pneumococcal conjugate vaccine (PCV) and the highest coverage ever for all vaccines; however, wide variability in coverage continues among states and urban areas. Continued vigilance is needed to maintain high levels of coverage, and sustained efforts will be required to reduce geographic disparities in coverage.     

National, state, and urban area vaccination coverage among children aged 19-35 months--United States, 2004

The National Immunization Survey (NIS) provides vaccination coverage estimates for children aged 19-35 months for each of the 50 states and 28 selected urban areas. This report summarizes results from the 2004 NIS, which indicated nationwide increases in coverage with at least 1 dose of varicella vaccine (VAR), pneumococcal conjugate vaccine (PCV), and the 4:3:1, 4:3:1:3:3, and 4:3:1:3:3:1 vaccine series. These levels represent an important accomplishment by exceeding for the first time the Healthy People 2010 goal of >/=80% coverage for the 4:3:1:3:3 vaccine series.     

National, state, and urban area vaccination coverage levels among children aged 19-35 months--United States, 1999

Childhood vaccinations have a major impact on the reduction and elimination of many causes of morbidity and mortality among children (1). Monitoring vaccination coverage levels is necessary to characterize undervaccinated populations and to evaluate the effectiveness of efforts to increase coverage. The National Immunization Survey (NIS) provides ongoing national estimates of vaccination coverage among children aged 19-35 months based on data for the most recent 12 months for each of the 50 states and 28 geographic areas (2). This report presents the findings of the 1999 NIS, which indicate that vaccination coverage among U.S. children aged 19-35 months were at or near record high levels.     

National and state vaccination coverage among children aged 19-35 months--United States, 2010

The National Immunization Survey (NIS) monitors vaccination coverage among children aged 19-35 months using a random-digit-dialed sample of telephone numbers of households to evaluate childhood immunization programs in the United States. This report describes the 2010 NIS coverage estimates for children born during January 2007-July 2009. Nationally, vaccination coverage increased in 2010 compared with 2009 for ≥ 1 dose of measles, mumps, and rubella vaccine (MMR), from 90.0% to 91.5%; ≥ 4 doses of pneumococcal conjugate vaccine (PCV), from 80.4% to 83.3%; the birth dose of hepatitis B vaccine (HepB), from 60.8% to 64.1%; ≥ 2 doses of hepatitis A vaccine (HepA), from 46.6% to 49.7%; rotavirus vaccine, from 43.9% to 59.2%; and the full series of Haemophilus influenzae type b (Hib) vaccine, from 54.8% to 66.8%. Coverage for poliovirus vaccine (93.3%), MMR (91.5%), ≥ 3 doses HepB (91.8%), and varicella vaccine (90.4%) continued to be at or above the national health objective targets of 90% for these vaccines.* The percentage of children who had not received any vaccinations remained low (<1%). For most vaccines, no disparities by racial/ethnic group were observed, with coverage for other racial/ethnic groups in 2010 similar to or higher than coverage among white children. However, disparities by poverty status still exist. Maintaining high vaccination coverage levels is important to reduce the burden of vaccine-preventable diseases and prevent a resurgence of these diseases in the United States, particularly in undervaccinated populations.     

National, state, and urban area vaccination coverage levels among children aged 19-35 months--United States, 1998.

PROBLEM/CONDITION: High vaccination levels in the population are necessary to decrease disease transmission and prevent disease; therefore, an important component of the U.S. vaccination program is the assessment of vaccination coverage. Current goals are for > or = 90% coverage with recommended vaccines during the first 2 years of life. REPORTING PERIOD: January-December 1998. DESCRIPTION OF SYSTEMS: The National Immunization Survey (NIS) is an ongoing, random-digit-dialed telephone survey that gathers vaccination coverage data for children aged 19-35 months in all 50 states and 28 urban areas. Vaccination coverage rates derived from NIS data are adjusted statistically for households with multiple telephone lines, household nonresponse, the proportion of households without telephones, and vaccination provider nonresponse. The results were also adjusted to match the known total population of children in each survey area. RESULTS: On the basis of NIS data, national coverage was > or = 90% for three doses of poliovirus vaccine (Polio), three doses of Haemophilus influenzae type b vaccine (Hib), and one dose of measles-containing vaccine (MCV). Coverage was the highest ever reported for four doses of any diphtheria and tetanus toxoids and pertussis vaccine (DTP) (i.e., diphtheria and tetanus toxoids and pertussis vaccine, diphtheria and tetanus toxoids [DT], or diphtheria and tetanus toxoids and acellular pertussis vaccine [DTaP]) (83.9%), three doses of hepatitis B vaccine (Hep B, 87.0%), and one dose of varicella vaccine (43.2%). The number of states achieving the > or = 90% goal was 47 for three doses of Hib, 40 for three doses of Polio, 40 for one dose of MCV, nine for three doses of Hep B, and seven for four doses of DTP. Proportionally fewer urban areas achieved the > or = 90% goal: 23 of 28 for three doses of Hib, 13 for three doses of Polio, 16 for one dose of MCV, five for three doses of Hep B, and one for four doses of DTP. No state or urban area has yet achieved the > or = 90% goal for varicella. INTERPRETATION: Findings from the 1998 NIS indicate that national vaccination coverage levels for routinely recommended childhood vaccines are at the highest levels ever reported. However, substantial variation in coverage remains at the state and urban area levels. PUBLIC HEALTH ACTIONS: The public health community and vaccination providers in areas with low coverage should intensify their efforts to implement recommended strategies for increasing vaccination coverage to ensure that children are equally well protected throughout the United States.     

National, state, and local area vaccination coverage among children aged 19-35 months--United States, 2006

The National Immunization Survey (NIS) provides vaccination coverage estimates among children aged 19-35 months for each of the 50 states and selected urban and county areas. This report describes the findings of the 2006 NIS, which indicated increases in national coverage with pneumococcal conjugate vaccine (PCV) and varicella vaccine (VAR) and a stable coverage level for the 4:3:1:3:3:1 vaccine series (i.e., > or =4 doses of diphtheria, tetanus toxoid, and any acellular pertussis vaccine [DTaP]; > or =3 doses of poliovirus vaccine; > or =1 dose of measles, mumps, and rubella vaccine [MMR]; > or =3 doses of Haemophilus influenzae type b [Hib] vaccine; > or =3 doses of hepatitis B vaccine [HepB]; and > or =1 dose of VAR). However, national coverage estimates remained below the Healthy People 2010 target of 90% coverage for PCV, DTaP, and VAR and below the 80% target for the 4:3:1:3:3:1 vaccine series. No significant racial/ethnic disparities in 4:3:1:3:3:1 series coverage were observed after controlling for family income. State and local immunization programs should continue to identify and target children who are not fully vaccinated, especially because of low socioeconomic status and other barriers.     

National, state, and local area vaccination coverage among children aged 19-35 months--United States, 2007

The National Immunization Survey (NIS) provides vaccination coverage estimates among children aged 19--35 months for each of the 50 states and selected urban areas. This report describes the results of the 2007 NIS, which provided coverage estimates among children born during January 2004-July 2006. Healthy People 2010 established vaccination coverage targets of 90% for each of the vaccines included in the combined 4:3:1:3:3:1 vaccine series and a target of 80% for the combined series. Findings from the 2007 NIS indicated that >/=90% coverage was achieved for most of the routinely recommended vaccines. The majority of parents were vaccinating their children, with less than 1% of children receiving no vaccines by age 19-35 months. The coverage level for the 4:3:1:3:3:1 series remained steady at 77.4%, compared with 76.9% in 2006. Among states and local areas, substantial variability continued, with estimated vaccination coverage ranging from 63.1% to 91.3%. Coverage remained high across all racial/ethnic groups and was not significantly different among racial/ethnic groups after adjusting for poverty status. However, for some vaccines, coverage remained lower among children living below the poverty level compared with children living at or above the poverty level. Maintaining high vaccination coverage and continued attention to reducing current poverty disparities is needed to limit the spread -preventable diseases and ensure that children are protected.     

National,state, and urban area vaccination levels among children aged 19-35 months--United States, 2002

Each annual birth cohort in the United States comprises approximately four million infants. Maintaining the gains in childhood vaccination coverage achieved during the 1990s among these children poses an ongoing challenge for public health. The National Immunization Survey (NIS) provides annual estimates of vaccination coverage among children aged 19-35 months for each of the 50 states and 28 selected urban areas. This report presents NIS findings for 2002, which indicate a marked nationwide increase in coverage with >/=1 dose of varicella vaccine (VAR), substantial uptake for >/=3 doses of pneumococcal conjugate vaccine (PCV), generally steady coverage levels for other vaccines nationwide, and continued wide variability in coverage among the states and selected urban areas.     

Hepatitis A vaccination coverage among children aged 24-35 months--United States, 2004-2005

After the licensure of hepatitis A vaccine in 1995 for children aged > or =24 months, the Advisory Committee on Immunization Practices (ACIP) incrementally expanded the proportion of children for whom it recommended the vaccine. In 1996, ACIP recommended vaccinating children in communities that had high rates of hepatitis A virus (HAV) infection, including American Indian/Alaska Native (AI/AN) communities and selected Hispanic and religious communities. In 1999, ACIP extended the recommendation to include routine vaccination for all children living in states, counties, and communities with incidence rates twice the 1987-1997 national average of 10 cases per 100,000 population (i.e., > or =20 cases per 100,000 population); ACIP also recommended considering vaccination for children living in states, counties, and communities with incidence rates exceeding the 1987-1997 national average (i.e., >10 to <20 cases per 100,000 population). National estimates of hepatitis A vaccination coverage were first made available through the 2003 National Immunization Survey (NIS), which indicated an overall national 1-dose coverage level of 16.0% (range: 6.4%-72.7%) among children aged 24-35 months. The estimates in this report update those findings by including 2 additional years of data (2004 and 2005). National 1-dose vaccination-coverage levels among children aged 24-35 months increased from 17.6% in 2004 to 21.3% in 2005. Coverage in states where vaccination was recommended (overall in 2005: 56.5%; range: 12.9%-71.0%) was below those for other recommended childhood vaccinations, such as varicella (87.5% in 2004). Despite low hepatitis A vaccination-coverage levels compared with other recommended childhood vaccinations, incidence of acute HAV infections have declined to the lowest level ever recorded. The 2005 licensure of the hepatitis A vaccine for use in younger children (aged > or =12 months) and the 2006 ACIP guideline for routine hepatitis A vaccination of all children aged > or =12 months should result in improved vaccination coverage and further reductions in disease incidence.     

Hepatitis a vaccination coverage among children aged 24-35 months--United States, 2003

Hepatitis A vaccine was first licensed in the United States in 1995. In 1996, the Advisory Committee on Immunization Practices (ACIP) recommended vaccination of children aged >/=24 months in populations with the highest incidence of hepatitis A (e.g., American Indian/Alaska Native [AI/AN], Asian/Pacific Islander, and selected Hispanic and religious communities). In 1999, these guidelines were expanded to recommend routine vaccination for children residing in 11 states where average annual hepatitis A incidence during 1987-1997 was at least 20 per 100,000 population (twice the national average) and to consider routine vaccination for children in six states where average annual incidence was 10-20 per 100,000 population. This report is the first national analysis of hepatitis A vaccination coverage among children. The results indicate that, in 2003, vaccination coverage levels with at least 1 dose of hepatitis A vaccine for children aged 24-35 months varied from 6.4% to 72.7% in areas where routine vaccination is recommended. In addition, hepatitis A vaccination coverage rates for children aged 24-35 months are lower than overall rates for other vaccines recommended for children. Sustaining and improving vaccination coverage among young children is needed to ensure continued declines in hepatitis A incidence in the United States.     

Influenza vaccination coverage among children aged 6-23 months--United States, 2005-06 influenza season

Children aged <2 years are at increased risk for influenza-related hospitalizations, and those aged <5 years have more influenza-related health-care visits than older children. In 2004, the Advisory Committee on Immunization Practices (ACIP) recommended annual influenza vaccination of children aged 6-23 months. Two doses, at least 4 weeks apart, were recommended to fully vaccinate children aged <9 years who were receiving influenza vaccination for the first time. To assess influenza vaccination coverage among children aged 6-23 months during the 2005-06 influenza season, data from the 2006 National Immunization Survey (NIS) were analyzed. This report describes the results of that analysis, which indicated that 31.9% of children in this age group received at least 1 dose of influenza vaccine and 20.6% were fully vaccinated according to ACIP recommendations; however, results varied substantially among states. The results underscore the need to continue to monitor influenza vaccination coverage among young children, develop systems to provide childhood influenza vaccination services more efficiently, and increase awareness among health-care providers and caregivers about the effectiveness of influenza vaccination among young children.     

Influenza vaccination coverage among children aged 6-23 months--United States, 2006-07 influenza season

Children aged <5 years have more influenza-related medical-care visits compared with older children, and those aged <2 years are at the greatest risk for influenza-related hospitalizations. In 2002, the Advisory Committee on Immunization Practices (ACIP) encouraged annual influenza vaccination of children aged 6-23 months and then, in 2004, recommended vaccination for this group. Two doses, spaced at least 4 weeks apart, are recommended to fully vaccinate children aged <9 years who are receiving influenza vaccination for the first time. This report, based on data from the 2007 National Immunization Survey (NIS), provides an assessment of influenza vaccination coverage among children aged 6-23 months during September-December of the 2006-07 influenza season. Nationally, 31.8% of children received 1 or more doses of influenza vaccine, and 21.3% were fully vaccinated, with substantial variability among states. The findings underscore the need to increase interest in and access to influenza vaccination for more children in the United States. Further study is needed to identify knowledge deficits or logistical barriers that might contribute to continued low influenza vaccination coverage among young children.     

National vaccination coverage among adolescents aged 13-17 years--United States, 2006

Before 2005, vaccines were administered during adolescence to "catch up" children with vaccinations not received at a younger age, with the exception of the tetanus and diphtheria (Td) booster. However, since 2005, three new vaccines specifically for older children have been licensed and recommended in the United States: meningococcal conjugate vaccine (MCV4) for those aged 11-12 years and 15 years; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine for those aged 11-12 years (or at ages 13-18 years if not received at ages 11-12 years); and human papillomavirus (HPV) vaccine for girls aged 11-12 years (or at ages 13-18 years if not received at 11-12 years). Since 1996, the Advisory Committee on Immunization Practices (ACIP) and professional organizations, including the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American Medical Association (AMA), have recommended a health-care visit at ages 11-12 years for receipt of recommended vaccinations. In addition, a Healthy People 2010 objective (14-27) is to achieve > or =90% vaccination coverage among adolescents aged 13-15 years for certain vaccines. In 2006, for the first time, the National Immunization Survey (NIS) collected provider-reported vaccination information for adolescents aged 13-17 years (NIS-Teen). This report describes the results of that survey, which indicated that the Healthy People 2010 target has not been met for any of the vaccines analyzed. HPV vaccination coverage is not included in this report because NIS-Teen was conducted before HPV vaccination recommendations were published in March 2007. Routine health-care visits for adolescents should be encouraged, with emphasis on a visit at ages 11-12 years, and providers should continue to assess the need for vaccinations at every opportunity. NIS-Teen will be conducted annually to monitor coverage with recommended vaccines during ages 11-17 years and to identify groups with lower coverage.     

National and state vaccination coverage among adolescents aged 13 through 17 years--United States, 2010

The Advisory Committee on Immunization Practices (ACIP) recommends that adolescents routinely receive meningococcal conjugate (MenACWY, 2 doses); tetanus, diphtheria, acellular pertussis (Tdap, 1 dose); and human papillomavirus (HPV, 3 doses) vaccines (influenza vaccine is recommended annually for all persons aged 6 months and older). CDC tracks vaccination coverage among adolescents aged 13 through 17 years through the National Immunization Survey--Teen (NIS-Teen). To provide updated vaccination coverage estimates, CDC analyzed 2010 NIS-Teen data and compared results with 2009 NIS-Teen estimates. This report summarizes the results of that analysis, which found that coverage increased for all three of the routinely administered adolescent vaccines: Tdap from 55.6% to 68.7%, MenACWY from 53.6% to 62.7%, (among females) ≥1 dose of HPV from 44.3% to 48.7%, and ≥3 doses of HPV from 26.7% to 32.0%. Vaccination coverage varied widely among states; three states (Massachusetts, Rhode Island, and Washington) had coverage of >65% for ≥1 dose of all three vaccines (Tdap, MenACWY, and HPV). Continued evaluation of vaccination-promoting initiatives, including state vaccination-financing policies, is needed to understand their impact on adolescent vaccination and to promote effective practices.     

Vaccination coverage levels among Alaska Native children aged 19-35 months--National Immunization Survey,United States, 2000-2001

In 2000, a total of 118,846 persons indicated that their race/ethnicity was Alaska Native (AN), either alone or in combination with one or more other racial/ethnic groups. AN groups comprise 19% of the population of Alaska and 0.4% of the total U.S. population. The AN grouping includes Eskimos, Aleuts, and Alaska Indians (members of the Alaska Athabaskan, Tlingit, Haida, or other AN tribes). Eskimo represented the largest AN tribal grouping, followed by Tlingit/Haida, Alaska Athabascan, and Aleut. Vaccination coverage levels among AN children have not been reported previously. This report presents data from the National Immunization Survey (NIS) for 2000-2001, which indicate that vaccination coverage levels among AN children aged 19-35 months exceeded the national health objective for 2010 (objective no. 14-22) for the majority of vaccines. This achievement indicates the effectiveness of using multiple strategies to increase vaccination coverage. Similar efforts might increase vaccination coverage in other rural regions with American Indian (AI)/AN populations.     

Influenza and pneumococcal vaccination coverage among persons aged > or = 65 years--United States, 2004-2005

Vaccination of persons at increased risk for complications from influenza and pneumococcal disease is a key public health strategy in the United States. During the 1990-1999 influenza seasons, approximately 36,000 deaths were attributed annually to influenza infection, with approximately 90% of deaths occurring among adults aged > or = 65 years. In 1998, an estimated 3,400 adults aged > or = 65 years died as a result of invasive pneumococcal disease. One of the Healthy People 2010 objectives is to achieve 90% coverage of noninstitutionalized adults aged > or = 65 years for both influenza and pneumococcal vaccinations (objective 14-29). To assess progress toward this goal, this report examines vaccination coverage for persons interviewed in the 2004 and 2005 Behavioral Risk Factor Surveillance System (BRFSS) surveys. The 2004-05 influenza season was characterized by an influenza vaccine shortage. As a result, the Advisory Committee on Immunization Practices (ACIP) issued recommendations that influenza vaccine be reserved for persons in priority groups, including persons aged > or = 65 years, and that others should defer vaccination until supply was sufficient. The results of this assessment indicated that, overall, influenza vaccination coverage was lower in the 2005 survey year than in 2004, whereas pneumococcal vaccination coverage was nearly unchanged from 2004 to 2005. In both years, influenza and pneumococcal vaccination coverage varied from state to state. Continued measures are needed to increase the proportion of older adults who receive influenza and pneumococcal vaccines; health-care providers should offer pneumococcal vaccine all year and should continue to offer influenza vaccine during December and throughout the influenza season, even after influenza activity has been documented in the community.     

Influenza vaccination coverage among children aged 6-23 months - six immunization information system sentinel sites, United States, 2005-06 influenza season

Beginning with the 2004-05 influenza season, the Advisory Committee on Immunization Practices (ACIP) recommended that all children aged 6-23 months receive influenza vaccinations annually. Other children recommended to receive influenza vaccinations include those aged 6 months-18 years who have certain high-risk medical conditions, those on chronic aspirin therapy, those who are household contacts of persons at high risk for influenza complications, and, since 2006, all children aged 24-59 months. Previously unvaccinated children aged <9 years need 2 doses administered at least 1 month apart to be considered fully vaccinated. This report assesses influenza vaccination coverage among children aged 6-23 months during the 2005-06 influenza season by using data from six immunization information system (IIS) sentinel sites. The findings demonstrate that vaccination coverage with 1 or more doses varied widely (range: 6.6% to 60.4%) among sites, with coverage increasing from the preceding influenza season in four of the six sites. However, <23% of children in five of the sites were fully vaccinated, underscoring the need for increased measures to improve the proportion of children who are fully vaccinated.     

Influenza vaccination coverage among persons with asthma--United States, 2005-06 influenza season

During 2006, approximately 6.8 million (9.3%) U.S. children and 16.1 million (7.3%) U.S. adults were reported to have asthma. Since 1964, the Advisory Committee on Immunization Practices (ACIP) has recommended influenza vaccination of all persons with asthma because of the higher risk for medical complications from influenza for those persons. Influenza vaccination coverage of persons with asthma varies by age group and remains below Healthy People 2010 targets of 60% coverage of persons aged 18--64 years with high-risk conditions (14-29 c) and 90% of all persons aged > or =65 years (14-29 a). Influenza vaccination rates of children and older adults with asthma have not been well studied. Using 2006 National Health Interview Survey (NHIS) data, this report provides the first examination of influenza vaccination rates and related factors across a national sample of persons with asthma aged > or =2 years. The results indicated that 36.2% received influenza vaccination during the 2005--06 influenza season. Vaccination rates remained below target levels among all subgroups examined, including those reporting the greatest number of health-care visits in the past 12 months. The results of this study indicate that influenza vaccination coverage of all persons with asthma can be improved by increasing access to health care and using opportunities for vaccination during health-care visits.