Major Findings: Since 2000, the proportion of children receiving the standard recommended vaccine series in the first 18 months of life has increased; disparities in coverage among population subgroups have decreased.
Data Source: Federal analysis of Centers for Disease Control and Prevention data on 185,516 children in the 2000–2008 National Immunization Surveys.
Disclosures: The research was funded by the CDC and the Department of Health and Human Services. The authors reported having no disclosures.
A federal goal of vaccinating 80% of children to protect against 10 preventable diseases by 2010 may be on the verge of being met in all sectors of society, an analysis of national data found.
The proportion of children in various subgroups who received the 4:3:1:3:3:1 vaccine series in the first 18 months of life improved from rates of 47%–59% in 2000 (depending on the sociodemographic group) to 72%–81% in 2008. Discrepancies in vaccination rates decreased in 9 of 12 subgroups that were analyzed using data on 185,516 children in the 2000–2008 National Immunization Surveys. For example, significantly fewer rural residents (52%) received the complete vaccination series in 2000, compared with suburban residents (56%), but by 2008 76% of both rural and suburban children were vaccinated. Although the rate of vaccination among children serviced by public providers improved from 48% in 2000 to 73% in 2008, the 2008 rate remained significantly lower than the vaccination rate among children serviced by private providers (77%).
Each of the 12 subgroups studied showed significant disparities in vaccine coverage in 2000, but this decreased to 4 subgroups by 2008. In all of the subgroups, the discrepancies in vaccination rates that remained in 2008 were relatively small and none exceeded 6%, Zen Zhao, Ph.D., and Elizabeth T. Luman, Ph.D., reported.
By 2008, one subgroup had reached the Healthy People 2010 goal of at least 80% of children vaccinated with at least four doses of diphtheria-tetanus-pertussis, three doses of poliovirus, one of measles-mumps-rubella, three of hepatitis B, three of Haemophilus influenzae type B, and one of varicella vaccine. In that subgroup—children with no siblings—81% were vaccinated.
The study was published online (10.1016/j.amepre/2009.10.035
The investigators, both researchers at the Centers for Disease Control and Prevention in Atlanta, analyzed data from phone surveys of parents with children aged 19–35 months followed by mail contact with vaccination providers to confirm the immunizations.
Hispanic children consistently had significantly higher vaccination rates (just under 80% in 2008), compared with white children (75% in 2008). The 81% vaccination rate in 2008 for children with no siblings was significantly higher than the rate for children with one or more siblings (75%). Significant differences also were seen between children who lived in poverty (74%), compared with those not in poverty (78%); children of mothers with less than 12 years of education (75%), compared with those whose mothers had more education (78%); and children enrolled in the Vaccines for Children program (78%), compared with children not in the program (73%).
Vaccination rates were no different for black and white children (75% each in 2008) in a multivariable analysis that adjusted for the effects of the other factors studied. Rates for urban and suburban children were statistically similar (77% and 76%, respectively), as were rates for children whose parents were married (77%) or not married (76%), children whose mother was younger than 30 years (75%) or older (78%), and children with one vaccine provider (77%), compared with those who got vaccinated by two or more providers in 2008 (76%).
The increased vaccination rates may be due to a combination of factors in the past decade including improved public knowledge of the importance of immunizations and efforts by pediatricians and public health officials to educate parents about vaccines, suggested Dr. George W. Rutherford, a pediatrician who is head of the preventive medicine and public health group at the University of California, San Francisco (UCSF).
Another factor may be the use of Health Effectiveness Data and Information Set (HEDIS) indicators to audit managed care plans, he said in an interview.
Dr. Jay Tureen, a pediatric infectious disease specialist and hospitalist at UCSF, said in an interview that programs including Vaccines for Children and State Children's Health Insurance Program surely helped increase immunizations. Also, patient reminder systems became more widely used after a 2000 Cochrane review of 41 studies showed that patient reminders (using calls, postcards, or letters) increased vaccination rates by 5%–20% in 33 of the 41 studies (JAMA 2000;284:1820–7).
Dr. Rutherford, and Dr. Tureen, ere not affiliated with the study and said they had no financial conflicts of interest relevant to this topic.