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Vaccination coverage against most diseases by age 24 months high, except flu :

October 22, 2020

More than 90% of children born in 2016 and 2017 received recommended vaccines that prevent measles, mumps and rubella, polio, hepatitis B and varicella by age 24 months.

In contrast, coverage rates for two doses of flu vaccine were lower than all vaccines studied, according to a report from the Centers for Disease Control and Prevention (CDC).

The findings, based on the CDC’s 2019 National Immunization Survey-Child (NIS-Child), were reported today in Morbidity and Mortality Weekly Report.

Survey data were used to estimate vaccination coverage at the national, regional, state, territorial and selected local levels.

Overall, the report concluded that national coverage with many recommended vaccines has remained high and stable, with recent increases for several vaccines for children born during 2016-’17 compared with those born during 2014-’15. Large coverage disparities by health insurance and poverty status persist, nonetheless.


The percentage of children born in 2016 and 2017 who were up to date on vaccines by age 24 months was highest for three doses of poliovirus vaccine (92.1%), three doses of hepatitis B (91.4%), one dose of measles-mumps-rubella (MMR) (90.7%) and one dose of varicella (90%).

Compared with children born in 2014 and 2015, coverage increased for two doses of influenza vaccine (4.3 percentage points), the hepatitis B birth dose (4.2 percentage points), completion of the rotavirus vaccination series (3.2 percentage points), the combined seven-vaccine series (2.1 percentage points) and one dose of hepatitis A (1.8 percentage points).

Coverage remained lowest for two doses of influenza vaccine (58.1%), the seven-vaccine series (70.5%), the rotavirus vaccination series (75.3%) and the hepatitis B birth dose (76.3%). About 1% of children received no vaccinations by age 24 months.

Not all children have benefited from the high and increasing national-level coverage.

Coverage is lower among uninsured children and those insured by Medicaid compared to privately insured children. The prevalence of being completely unvaccinated was highest among uninsured children (4.1%), followed by those enrolled in Medicaid (1.3%) and those with private insurance (0.8%). Coverage also was lower among children living in poverty; authors suggested this could be tied to challenges accessing the Vaccines for Children program, for which many of these children likely qualify.

Differences in coverage between uninsured children and those with private insurance ranged from 9.5 percentage points (three doses of hepatitis B) to 33.9 percentage points (two doses of influenza vaccine). Disparities between children insured by Medicaid and those with private insurance tended to be smaller, ranging from 2.7 percentage points (at least one dose of varicella) to 20.3 percentage points (at least two doses of influenza vaccine). Disparities in coverage also were observed by race/ethnicity, poverty level and metropolitan statistical area status, the report said.

Call to action

Although coverage rates are high for most vaccines for the years studied, the report spotlights how the pandemic could erode those rates.

“Extra effort to ensure that children continue receiving life-saving vaccines, especially uninsured children and those insured by Medicaid, is critical,” authors said. “…Providers should use every opportunity to safely administer recommended vaccines to children during the COVID-19 pandemic, with particular attention to influenza vaccination during fall and winter.”

The majority of children who have died in recent flu seasons were unvaccinated. In 2019, 189 pediatric deaths were reported to CDC — the highest recorded number during a regular flu season, according to the report.

The NIS-Child is an annual phone survey of parents and guardians of children ages 19-35 months.

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