CDC Finds Childhood Vaccination Varies by Demography and Disease

Most children in the US receive the vaccinations recommended in the first 24 months of life against 14 diseases, but rates vary between racial/ethnic categories, by economic class and health insurance coverage, and by the particular disease, according to the most recent findings of the Centers for Disease Control and Prevention's (CDC) National Immunization Survey-Child (NIS-Child).

The survey was conducted for children born 2017-2018, and provides data to compare with the immunization of children born in 2015-2016. The survey does not, however, describe the immunization rates that appear to have decreased, along with reduction in elective healthcare, during the COVID-19 pandemic.

"Its important to note these estimates reflect vaccination opportunities that mostly occurred before March 2020, and do not reflect the interruptions and delays in routine childhood vaccinations cause by the COVID-19 pandemic," Holly Hill, MD, PhD, Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, told Contagion.

"As schools and daycares begin to reopen and offer in-person learning and care—and as we move into fall and winter when COVID-19, influenza and other respiratory diseases may circulate—its essential that health care providers remind families to come in for well child visits and get their kids caught up on vaccine doses that they missed," Hill said.

The CDC conducts the NIS-Child annually as a random-digit-dialed cell phone survey of parents or guardians of children aged 19-35 months. Sociodemographic information is collected, and, when consent is given, the immunization provider is contacted for records. The current cohort of 29,114 children born in 2017-18 with adequate records for inclusion was established from data collected during 2018-2020.

Hill and colleagues report that coverage nationally was highest for ≥3 doses of poliovirus vaccine (92.7%); ≥3 doses of of hepatitis B vaccine (HepB) (91.9%); ≥1 dose of measles, mumps, and rubella vaccine (MMR) (91.6%); and ≥1 dose of varicella vaccine (VAR) (90.9%). They found the lowest coverage for ≥2 doses of influenza vaccine (60.6%). Compared to children born 2015-2016, those born 2017-2018 had 2.1-4.5% higher rates of vaccination against rotavirus, ≥1 dose of hepatitis A vaccine (HepA), the HepB birth dose, and ≥2 doses of influenza vaccine.

Only 1.0% of children born 2017-2018 had received no vaccinations by age 24 months, but there were disparities across the cohort, particularly between children with private insurance and those without insurance. Of children with private insurance, 0.8% did not receive any vaccination, compared with 3.3% of those without insurance. The largest disparities between these groups were for ≥2 doses of influenza vaccine, the combined 7-vaccine series, and rotavirus vaccination.

The investigators reported that coverage was lower for both Black and Hispanic children than White children for most vaccines; and lower among children living below the poverty level than at or above that level for all vaccines except the HepB birth dose.

"Disparities by metropolitan statistical area (MSA) were less frequent and not consistent," Hill commented."Additional analyses are conducted routinely to assess the accuracy of our findings. As demonstrated in previous years, we don't anticipate a change in bias with the most recent data—the analyses will be completed shortly."

Hill emphasized the importance of healthcare providers advising families who may have difficulty affording vaccination of the Vaccines for Children program; and using the CDC's Vaccinate with Confidence strategy and resources to reassure vaccine hesitant families.

"We urge providers to use any visit as an opportunity for the child to get recommended vaccinations that are due or might have been missed because of COVID-related disruptions," Hill said.