Immunization
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Headline

Following years of gradually increasing coverage, progress towards full immunization of all young preschoolers has stalled since 2004, standing at 82 percent in 2006. (See Figure 1)

Importance

Diseases that once spread quickly and killed thousands are now largely controlled by vaccines. Vaccines are given early in life because many vaccine-preventable diseases are more common and more deadly among infants and small children. Additionally, childhood immunization is an important step in maintaining high vaccination levels, which prevent outbreaks of such diseases.¹ It is unlikely that an individual who is immune to a disease will transmit it to someone else. In this way, vaccination protects not only the child receiving the vaccine, but also those in the child's community. For this reason, most schools require that children be fully immunized when enrolling.² Protecting children against severe illnesses also results in positive outcomes other than improved physical health, including the ability to attend school more regularly and the absence of increased family stress.³

The Centers for Disease Control and Prevention (CDC) recommends vaccinating children against most vaccine-preventable diseases by the time they are two years old.⁴ The CDC's immunization schedule for children recommends four doses of the diphtheria, tetanus, and pertussis (DTP) vaccine, three or more doses of polio vaccine, one or more doses of the measles-mumps-rubella (MMR) vaccine, three or more doses of the Haemophilus influenzae type b (Hib) vaccine, the hepatitis B vaccine, and the varicella (chickenpox) vaccine. The DTP, polio, MMR, and Hib vaccines are collectively referred to as the combination series or 4:3:1:3 vaccine. Since 2002, the CDC has also tracked a new combination series that includes all of these vaccines (called the 4:3:1:3:3:1 series). As of 2005, 29 to 34 states (depending on which of these individual vaccines were examined) achieved a vaccination coverage rate of 95 percent or more among children entering kindergarten--meeting a Healthy People 2010 objective.⁵

Trends

The proportion of children ages 19 to 35 months receiving the combined series (4:3:1:3) vaccines increased from 69 percent to 83 percent between 1994 and 2004. Since this time, however, progress towards full immunization of all children ages 19 to 35 months has stalled, standing at 82 percent in 2006. (See Figure 1)

Vaccination rates for the hepatitis B vaccine, first recommended in the 1990s, increased rapidly between 1994 and 2006, from 37 percent to 93 percent. Rates for varicella (chickenpox) vaccines, also first recommended in the 1990s, have climbed steadily from 26 percent in 1997 (the first year for which data are available) to 89 percent in 2006. (See Table 1)

During the last few years, the proportion of children who received all of the vaccinations in the combined series plus hepatitis B and varicella (4:3:1:3:3:1) has increased. In 2006, 77 percent of young children ages 19 to 35 months received this combination, an increase from 66 percent in 2002. (See Table 1)

Differences by Race and Ethnicity

There were no significant differences in childhood vaccination rates by race/ethnicity. In 2006, the percentages of children who received the combined series of vaccines (4:3:1:3), included 79 percent of non-Hispanic blacks, 82 percent of Hispanics, 80 percent of Asians, and 84 percent of non-Hispanic whites. Meanwhile, the proportion of these groups receiving the combined series plus hepatitis B and varicella rates (4:3:1:3:3:1) ranged between 74 and 78 percent. (See Table 1)

Note: Estimates for specific race groups were revised in 1997 to reflect the new OMB race definitions, and include only those who are identified with a single race. Hispanics may be of any race.

Differences by Poverty Status

Children in families with incomes below the poverty level are less likely than are those with families with incomes at or above the poverty level to receive the combined series vaccination (4:3:1:3) (78 percent and 84 percent, respectively, in 2006). (See Figure 2)

Differences by Type of Immunization

In 2006, national immunization rates of children ages 19-35 months for MMR, polio, hepatitis B and Hib vaccines each met or exceeded 90 percent, the Healthy People 2010 target levels. However, only 85 percent had received the DTP vaccine and 89 percent had received the chickenpox vaccine. (See Figure 3)

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Related Indicators

Health Care Coverage

State and Local Estimates

2006 data for states are available for the combined series and individual vaccinations from the National Immunization Survey at:
http://www.cdc.gov/vaccines/stats-surv/imz-coverage.htm#nis

State-level estimates for 2006 are available by race and Hispanic origin from the State Health Facts web site of the Kaiser Family Foundation at:
http://www.statehealthfacts.kff.org/comparebar.jsp?ind=55&cat=2

International Estimates

2005 International estimates for national and local levels can be found in UNICEF's Immunization Survey.
http://www.unicef.org/publications/files/Immunization_Summary_2007.pdf

National Goals

Through its Healthy People 2010, the Federal government has set a national goal to increase the percentage of children who have received vaccines. The 2010 goal is for 90 percent of children aged 19-35 months to be immunized against DTP, polio, MMR, Hib, hepatitis B, and varicella.

More information is available at: http://www.health.gov/healthypeople/Document/HTML/Volume1/14Immunization.htm#_Toc494510242

What Works: Programs and Interventions that May Influence this Indicator

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Research References

¹"Parents Guide to Immunization: Why Immunize?" A publication by the National Immunization Program of the Center for Disease Control and Prevention. Available at: http://www.cdc.gov/vaccines/pubs/parents-guide/default.htm

²Communicating with Parents about Immunization: Common Questions about School Immunization Laws. (2002). A resource kit from the National Network for Immunization Information. Available at: http://www.immunizationinfo.org/assets/files/PDFs/KIT_FULL.pdf

³ Halle, T., Zaff, J., Calkins, J., and Margie, N.G. (2000). "Part II: Reviewing the Literature on Contributing Factors to School Readiness." Final Report to the Knight foundation: Background for Community-Level Work on School Readiness: A Review of Definitions, Assessments, and Investment Strategies. Washington, DC: Child Trends. Available at: http://www.childtrends.org/Files/LIT__REVIEW__DRAFT__7.pdf

⁴ "Child and Adolescent Immunization Schedule: Are Your Child's Vaccinations Up to Date?" (2007). A publication by the National Immunization Program of the Center for Disease Control and Prevention Available at: http://www.cdc.gov/nip/recs/child-schedule.htm

⁵Stanwyck, C., Davila, J., Lyons, B., Knighton, C. "Vaccination Coverage Among Children Entering School --- United States, 2005--06 School Year". MMWR Weekly. CDC: October 20, 2006. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5541a3.htm

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Definitions

Combined Series (4:3:1:3) Vaccine- includes 4 or more doses of diphtheria and tetanus toxoids and the pertussis vaccine (DTP), 3 or more doses of an oral polio vaccine, 1 or more doses of a measles-containing vaccine, and 3 or more doses of Haemophilus influenzae type b vaccine (Hib).

Combined Series (4:3:1:3:3:1) Vaccine- includes 4 or more doses of diphtheria, tetanus, and pertussis vaccine (DTP), 3 or more doses of polio vaccine, 1 or more doses of a measles-containing vaccine, 3 or more doses of Haemophilus influenzae type b vaccine (Hib), three or more doses of hepatitis B vaccine (HepB), and one or more doses of varicella.

Vaccines and their related diseases:
Tetanus- lockjaw
Pertussis- whooping cough
Haemophilus influenzae type b- Hib Disease
Varicella- chickenpox

For further information about children's immunizations, including definitions and recommendations, please visit the CDC's "Parents Guide to Childhood Immunizations" at http://www.cdc.gov/vaccines/pubs/parents-guide/default.htm.

The 2007 Recommended Childhood and Adolescent Immunization Schedule, published by the CDC, is available online at http://www.cdc.gov/nip/recs/child-schedule.htm.

Data Source

Data for 2006: Centers for Disease Control and Prevention, National Immunization Program (2007). NIS data, tables, Jan-Dec 06. Available online at: http://www.cdc.gov/vaccines/stats-surv/nis/data/tables_2006.htm .

Data for 2005: Centers for Disease Control and Prevention, National Immunization Program (2006). NIS data, tables, Jan-Dec 05. Available online at: http://www.cdc.gov/vaccines/stats-surv/imz-coverage.htm#nis .

Data for 2004: Centers for Disease Control and Prevention, National Immunization Program (2005). NIS data, tables, Jan-Dec 04. Available online at: http://www.cdc.gov/vaccines/stats-surv/imz-coverage.htm#nis .

Data for 2003: National Immunization Program (2004). Immunization Coverage in the U.S.: Results from National Immunization Survey. Centers for Disease Control and Prevention. Available online at: http://www.cdc.gov/vaccines/stats-surv/imz-coverage.htm#nis .

All data for 2002 and data by race for 2000-2001: National Immunization Program (2003). Immunization Coverage in the U.S.: Results from National Immunization Survey. Centers for Disease Control and Prevention. Available online at: http://www.cdc.gov/vaccines/stats-surv/imz-coverage.htm#nis.

All other Data for 1995-2001: National Center for Health Statistics. (2003) Health United States, 2003 With Chartbook on Trends in the Health of Americans. National Center for Health Statistics. 2003. Table 71. http://www.cdc.gov/nchs/data/hus/hus03.pdf

Data for 1994: Health, United States, 2001, Centers for Disease Control, National Center for Health Statistics. Table 73 http://www.cdc.gov/nchs/data/hus/hus01.pdf

Raw Data Source

National Immunization Survey
http://www.cdc.gov/nis/

Approximate Date of Next Update

2008

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