Gaps in Pediatric Vaccination Linked With Uninsured Status

The Advisory Committee on Immunization Practices (ACIP), a committee within the US Centers for Disease Control and Prevention (CDC), recommends pediatric vaccinations against 14 potentially serious illnesses before age 24 months.

Investigators from the CDC summarized data from the National Immunization Survey-Child (NIS-Child) on vaccine coverage among children born in 2015 and 2016. Their findings, published in the CDC’s Morbidity and Mortality Weekly Report, indicate high and stable vaccination coverage overall but note sociodemographic disparities in coverage, particularly related to health insurance status.

The NIS-Child is a random-digit-dialed telephone survey of parents or guardians of children between the ages of 19-35 months. Respondents provided contact information for all providers who administered vaccines to their children and, with parental consent, a survey requesting the child’s vaccination history is mailed to each provider.

A total of 25,059 children with adequate provider data were incorporated into the NIS-Child results. Coverage by age 24 months was at least 90% nationally for ≥3 doses of poliovirus vaccine; ≥1 dose of measles, mumps, and rubella vaccine (MMR); ≥3 doses of hepatitis B vaccine (HepB); and ≥1 dose of varicella vaccine, although MMR coverage was <90% in 20 states. Children were least likely to be up to date by age 24 months with ≥2 doses of influenza vaccine (56.6%).

Nationally, only 1.3% of children born in 2015 and 2016 received no vaccinations; however, the proportion of children who received no vaccinations was higher among uninsured children at 7.8%, compared with 0.8% among those with private insurance. This held true for the majority of vaccines that were evaluated.

Coverage disparities among uninsured children, ranged from 7.8% for the HepB birth vaccine to 33.8% for ≥2 doses of influenza vaccine. Coverage was also low for those living below the poverty line and in rural areas.

“Lower vaccination coverage among children who are uninsured, insured by Medicaid or other nonprivate insurance, living below the poverty level, and living in rural areas suggests challenges with access to affordable vaccinations or optimal vaccination services,” the authors wrote in their report.

Although uninsured children are eligible for vaccines at no cost via the Vaccines for Children program, investigators hypothesized that “efforts to promote the program might not be reaching this population and therefore might need to be modified.” In addition, logistical challenges beyond direct cost, such as transportation, may impact those below the poverty line or in rural areas.

The report further pointed out that even small pockets of low vaccine coverage can lead to outbreaks, citing 22 measles outbreaks that occurred in the United States in 2019. Most outbreak-related cases were among those who were unvaccinated. The authors recommended that increased opportunity for vaccination “can be facilitated through expanded access to health insurance, greater promotion of available vaccines through the Vaccines for Children program, and solutions to logistical challenges such as transportation, child care, and time off from work.”

Check out Contagion®’s list of essential vaccines by age group for a full list of CDC-recommended vaccines.