Publication Date:

Mar 01, 2017

Trends in Immunization

17_fig1Between 1994 and 2004, the proportion of children ages 19 to 35 months receiving the combined series (4:3:1:3) vaccines increased from 69 to 83 percent. Since that time, however, there has been no progress,[1] with the 2013 rate at 82 percent. The proportion of children who received all of the vaccinations in the combined series 4:3:1:3:3:1, increased markedly in the early years of this decade, from 66 percent in 2002 to 77 percent in 2006; since then, progress on this rate has also stagnated. (Figure 1)

In 2010, the first year that the CDC tracked whether children were receiving the appropriate number of doses for the brand of Hib vaccine that they received, only 62 percent received the full 4:3:1:3* series, while only 59 percent received the full 4:3:1:3*:3:1 series. However, by 2011 these proportions had increased greatly, and by 2014 were 78 and 75 percent, respectively. (Figure 1)

Differences by Race/ Hispanic Origin[2]

In 2014, black children were less likely to be fully vaccinated than white or Hispanic children: 70 versus 79 and 80 percent, respectively, for the 4:3:1:3* series; 68 versus 76 and 77 percent, respectively, for the 4:3:1:3*:3:1 series. The share of children who received the combined series of vaccines (4:3:1:3*), ranged, by race and Hispanic origin, from 70 to 80 percent. Meanwhile, the proportion of these groups receiving the 4:3:1:3*:3:1 series ranged between 68 and 77 percent. (Appendix 1)

Differences by Poverty Status

17_fig2Children in families with incomes below the poverty level are less likely than those with families with incomes at or above the poverty level to receive the combined-series vaccination (4:3:1:3*) (71 versus 82 percent, respectively, in 2014). Children in families with incomes below the poverty level are also less likely to receive the 4:3:1:3*:3:1 series: 70 versus 78 percent. (Figure 2)

Differences by Type of Immunization

17_fig3Vaccination rates for the hepatitis B vaccine, first recommended in the 1990s, increased rapidly between 1994 and 2008, from 37 to 94 percent. Although lower, the rate has been fairly steady since, and was at 92 percent coverage in 2014. In addition, 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 91 percent in 2008. The rate remained at 91 percent in 2014. Rates of receipt of other vaccines have also risen since the early 1990s. (Appendix 1) In 2014, national immunization rates of children, ages 19-35 months, for MMR, polio, chickenpox, and hepatitis B vaccines each met or exceeded 90 percent, the Healthy People 2020 targets. However, only 84 percent had received the recommended doses of the DTP vaccine, and only 82 percent had received the recommended doses of the Hib vaccine. (Figure 3)

Other Estimates

State and Local Estimates

2014 data for states are available for the combined series and individual vaccinations from the National Immunization Survey.

State-level estimates are also available at the Kids Count Data Center

International Estimates

International estimates for 2000 through 2014
for countries and territories can be found from UNICEF’s Immunization Survey.

Data and Appendix

Data Sources

Data for 2003-2014: Centers for Disease Control and Prevention, National Immunization Program, NIS data, tables, Jan-Dec . http://www.cdc.gov/vaccines/imz-managers/coverage/nis/child/index.html

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 (updated)http://www.cdc.gov/nchs/data/hus/hus01.pdf

Raw Data Source

National Immunization Survey

http://www.cdc.gov/nchs/nis.htm

Appendix

Background

Definition

Combined Series (4:3:1:3) Vaccine: includes 4 or more doses of diphtheria and tetanus toxoids and the pertussis vaccine (DTaP), 3 or more doses of  the poliovirus vaccine, 1 or more doses of a measles-mumps-rubella vaccine, and  3 or more doses of series of Haemophilus influenzae type b vaccine (Hib). Combined Series (4:3:1:3*), is the same as above, except that instead of 3 or more doses of Hib, it is  three or more or four or more doses of Hib vaccine, depending on the brand.

Combined Series (4:3:1:3:3:1) Vaccine: includes those doses listed above for combined series (4:3:1:3), plus three or more doses of hepatitis B vaccine (HepB), and one or more doses of varicella. Combined Series (4:3:1:3*:3:1) is defined as above, except that instead of 3 or more doses of Hib, it is  three or more, or four or more doses of Hib vaccine, depending on the brand.

Vaccines and the common names of the diseases they protect against:

  • 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“.

The current Recommended Childhood and Adolescent Immunization Schedules, published by the CDC, are available online.

Endnotes

[1] A marked “dip” in 2009 was likely due to a shortage of Hib vaccine and a
recommendation to defer the Hib vaccine booster dose administered at age 12–15
months. More information is available here: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5824a5.htm

[2]Hispanics may be any race. Estimates of whites, blacks, Asians, and American Indian or
Alaska Natives in this report do not include Hispanics.

Suggested Citation

Child Trends Databank. (2015). Immunization. Available at: https://www.childtrends.org/?indicators=immunization