Trends in the Well-Being of America's Children and Youth, 1997. HC 3.3 Immunization

04/01/1997

Childhood vaccinations can prevent diseases that killed or permanently impaired many children in past decades. The Centers for Disease Control and Prevention recommend that 80 percent of all routine childhood vaccinations be administered within the first two years of life. Vaccination coverage is particularly important before children enter preschool to prevent the spread of disease.

There were substantial increases in the proportion of children vaccinated between 1991 and 1994 for each of the recommended vaccines presented in Table HC 3.3.A. These improvements are observed for all children, but particularly for low-income children, minority children, and children living in urban and rural areas (see Table HC 3.3.A). Between 1991 and 1994 there was also a substantial improvement in the proportion of children receiving the combined series of DTP, OPV and MMR (4:3:1)36 vaccination (see Figure HC 3.3.A).

Even with the increases of recent years, more than one million children remain unvaccinated for serious preventable diseases.37 In particular, there are differences in immunization rates by income, race, and place of residence.

Differences by Income. Children in households at or above poverty are more likely to have received each of the vaccinations specified in each year from 1991 to 1994 than are children in households below poverty. However, the gap between vaccination levels of poor and non-poor children decreased from 1991 to 1994. For instance, the percentage of poor children vaccinated for polio was 38.7 percent in 1991, compared to 59.5 percent of children at or above the poverty line, nearly a 21 percentage point gap. By 1994, that gap had closed to less than one percentage point, with respective percentages at 79.4 and 79.9.

Differences by Race. White infants ages 19 to 35 months have higher percentages of vaccination receipt than do black children or children of other races. The disparity in vaccination levels between white and black infants has narrowed from 1991 to 1994, as the vaccination levels of black children have greatly improved.

Differences by Place of Residence. For many, but not all diseases, suburban children are more likely than either rural or urban children to have been vaccinated.

Provider-Adjusted Estimates. Unlike data for previous years, which were based only on parent reports, 1994-1995 immunization estimates are based on information from parents and health care providers. These newer estimates are more accurate and reflect higher rates of immunization than those based on parent reports alone. Data for 1994-1995 cannot be compared to estimates for 1991-1994, however, since an undetermined portion of the observed increase is due to this change in methodology.

The most recent provider-adjusted estimates (July 1994June 1995) indicate that 75 percent of children ages 19 to 35 months received their 4:3:1 combined series vaccinations. Fifty-one percent of all children in that age group had received their Hepatitis B vaccination (see Table HC 3.3.B).
 

Figure HC 3.3.A  
Percentage of Children 19-35 Months Who Received the Combined Seriesa Immunizations:b 1991-1994 

HC3_3A.GIF

Note: aFour doses DTP, three doses poliovirus, one dose measles-mumps-rubella vaccine. bData are based on household interviews of a sample of the non-civilian, non- institutionalized population. Refusals and unknowns were excluded.

Source: Centers for Disease Control and Prevention. Data computed by the National Immunization Program, Center for Prevention Services from data compiled by the Division of Health Interview Statistics, National Center for Health Statistics.
 
 

Figure HC 3.3.B  
Vaccination Coverage Levels Among Children Aged 19-35 Months, by Selected VaccinesNational Immunization Survey, U.S., July 1994June 1995 

HC3_3B.GIF

Note: a3 DTP/DT is 3 or more doses of diphtheria and tetanus toxoids and pertussis vaccine/diphtheria and tetanus toxoids.
b4 DTP/DT is 4 or more doses of DTP/DT.
cPoliovirus is 3 or more doses of poliovirus vaccine.
dHib is 3 or more doses of Haemophilus influenzas type b vaccine.
eMMR is 1 or more doses of measles-mumps-rubella vaccine.
fHepatitis B is 3 or more doses of Hepatitis B vaccine.

Source: Morbidity and Mortality Weekly Reports. National, State and Urban Area Vaccination Coverage Levels Among Children Aged 19-35 Months - United States, July 1994 - June 1995, June 21, 1996, Vol. 45, No. 24, Table 1.
 
 

Table HC 3.3.A 
Percentage of Children Aged 19-35 Months Who Have Received Vaccinations for Routinely Recommended Vaccinesa, by Selected CharacteristicsU.S.: 1991-1994

 
   
Race
Poverty Statusb
Location of Residencec
         
Below
Poverty
At/Above
Poverty
     
 
Total
White
Black
Otherd
Urban
Suburban
Rural
>3 Doses DTP* 
1991
68.8
73.4
50.6
58
53
75.7
64.8
72.3
67.6
1992
83.1
84.8
74.7
79.3
79.7
84.6
82.5
84.4
80.7
1993
88.2
89.4
82.6
84.5
80.6
90.8
85.8
89.8
88.5
1994
89.5
90.6
84.4
87.9
88.8
90.3
87.7
90.4
90
>4 Doses DTP*`
1991
43.3
47.3
27.9
33.1
29.9
48.6
36.4
46.4
47.5
1992
59
59.5
55
62.4
54.4
61
59.7
60
55.4
1993
72.1
73
69.2
64.7
65.3
74.6
68.5
75.6
70.6
1994
70.1
70.8
64.4
77.3
67.7
71.2
67.2
72.1
69.9
>3 Doses Poliovirus
1991
53.2
57.3
35.6
49.8
38.7
59.5
49.9
55.8
52.5
1992
72.4
74.1
62.7
75.5
66.6
74.7
74.1
72.6
69
1993
78.9
79.8
73.4
80.8
73.3
81
75.3
79.7
82.5
1994
79.2
80.3
73.2
81.7
79.4
79.9
76.4
80.9
79.5
>3 Doses Hib**
1991
1.7
1.9
1.4
0
0
2.2
0.9
2.5
1.2
1992
28.2
29.1
25.5
23
23
29.8
27.5
31.8
20.8
1993
55
56.9
44.8
56.9
43.9
59.6
47.8
60.5
55.2
1994
75
76.6
67.2
72.3
72.1
76.6
70.6
76.7
77.6
Measles
1991
82
82.9
77.4
83.8
73.4
86.6
78.4
85
81.1
1992
82.5
83.6
77.9
79.9
80.2
84.3
84.5
83.3
77.2
1993
84.1
86
76.9
72.5
78.4
86.9
84.2
86.2
79.8
1994
90.3
91.7
86
81.1
88.3
91.8
87.9
91.7
91
>3 Doses Hepatitis B
1991
 
 
 
 
 
 
 
 
 
1992
 
 
 
 
 
 
 
 
 
1993
16.3
16.3
16
16.7
11.3
18.2
17.4
19
9.3
1994
34.4
33.7
36.2
39.7
31.6
35.2
33.8
37.8
27.1
Combined Series: 4:3:1
1991
37
41.4
20.8
27.5
23.8
42.2
31.7
38.6
41.9
1992
55.3
55.9
50.9
57.5
51.4
56.7
57.7
55.4
50.5
1993
67.1
68.4
61.8
58.4
58.7
70.5
62.1
71.4
66
1994
67.5
68.4
61.2
72.4
64.9
68.8
63.5
69.7
68.3
Combined Series: 3:3:1§
1991
50
54.5
31.4
44.2
34.3
56.6
46.6
52.8
49.4
1992
68.7
70
60.2
71.9
65
70.2
72.4
68.2
63.2
1993
74.5
75.7
69.2
68
66.8
77.7
71.5
76.3
75.3
1994
77.3
78.7
70.5
76.3
76.6
78.4
72.9
79.5
78.9
 
*Diphtheria, tetanus toxoids, and pertussis vaccine.  
**Hemophilus influenzas type b vaccine.  
Any vaccination containing measles vaccine.  
Four doses DTP, three doses poliovirus, one dose measles-mumps-rubella vaccine.  
§Three doses DTP, three doses poliovirus, one dose measles-mumps-rubella vaccine.  
aData are based on household interviews of a sample of the non-civilian, non institutionalized population. Refusals and unknowns were excluded. Exclusions included unknown vaccine type.  
bPoverty status is based on family income and family size using Bureau of the Census poverty thresholds.  
cRural areas were those not in a metropolitan statistical area (MSA); suburban areas were those in an MSA but outside the central city; and urban areas were the central city of the MSA.  
dLimitations in sample size precluded collection of data about ethnicity and analysis of data for races other than black and white.  

Source: Centers for Disease Control and Prevention. Data computed by the National Immunization Program, Center for Prevention Services from data compiled by the Division of Health Interview Statistics, National Center for Health Statistics.

 
 

Table HC 3.3.B 
Percentage of Children Aged 19-35 Months Who Have Received Vaccinations for Routinely Recommended Vaccine, by Selected VaccinesNational Immunization Survey, U.S.a 
July 1994June 1995

 
Vaccine  Dose 
July 1994 - June 1995
 
DPT/DT*
  >3 Doses
94
  >4 Doses
78
Poliovirus  
 
>3Doses
86
Hib¶  
  >3 Doses 
91
MMR§  
  >1 Dose
89
Hepatitis B  
  >3 Doses 
51
    19-24 Months
64
    25-30 Months
51
    31-35 Months
34
Combined Series  
  4 DTP/3 Polio/1 MMR
75
  4 DTP/3 Polio/1 MMR/3 Hib
73
 
*Diphtheria and tetanus toxoids and pertussis vaccine/Diphtheria and tetanus toxoids.  
¶Hemophilus influenzas type b vaccine.  
§Measles-mumps-rubella vaccine.  
Four doses DTP/DT, three doses poliovirus vaccine, and one dose MMR.  
Four doses DTP/DT, three doses poliovirus vaccine, one dose MMR, three doses Hib.  
aData are based on household interviews of a sample of the non-civilian, non-institutionalized population.  
Refusals and unknowns were excluded.  

Note: In 1994-1995, data from the household interviews is supplemented with information from medical providers and cannot be compared to 1991-1993 data.  

Source: Morbidity and Mortality Weekly Reports. "National, State and Urban Area Vaccination Coverage Levels Among Children Aged 19-35 Months," June 21, 1996, Vol. 45, No. 24, Table 1. (Data from the National Immunization Survey.)

 

36 Four doses diphtheria, tetanus toxoids and pertussis vaccine (DTP); three doses poliovirus vaccine (OPV); and one dose measles-mumps-rubella vaccine (MMR).

37 Centers for Disease Control and Prevention. "Vaccination Coverage Levels Among Children Aged 19-35 Months -- United States, April-December 1994." Morbidity and Mortality Weekly Report. Vol. 44, No. 33, August 25, 1995
 
 

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