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Vaccine coverage high among U.S. toddlers in 2016, but gaps remain


 

FROM MMWR

 

Coverage with recommended vaccines for children aged 19-35 months generally remained high and stable in 2016, but problems persisted, said Holly A. Hill, MD, PhD, and her associates at the National Center for Immunization and Respiratory Diseases, Atlanta.

Coverage still was below 90% for vaccines that needed booster doses during the second year of life (four or more doses of DTaP and pneumococcal conjugate vaccine [PCV] and Haemophilus influenzae type b [Hib] full series) and for other recommended vaccines (hepatitis B [HepB] birth dose, rotavirus, and hepatitis A [HepA]), they reported in Morbidity and Mortality Weekly Report.

Small child receiving a vaccine copyright Sean Locke/iStockphoto.com
Data from the 2016 National Immunization Survey-Child (NIS-Child) of 14,988 U.S. children were used to determine estimates of national coverage with recommended vaccines among children aged 19-35 months. Coverage was estimated to be 92% of three or more doses of poliovirus vaccine; 91% of one or more doses of measles, mumps, and rubella vaccine; 91% of one or more doses of varicella vaccine; and 91% of three or more doses of the HepB vaccine.

Coverage was estimated to be 61% for two or more doses of HepA vaccine, 71% of the HepB birth dose, 74% of a completed series of rotavirus vaccine, and 71% of the combined seven-vaccine series (four or more doses of DTaP; three or more doses of poliovirus vaccine; one or more doses of measles-containing vaccine; three or four doses of Hib [depending upon product type of vaccine]; three or more doses of HepB; one or more doses of varicella vaccine; and four or more doses of PCV).

Fewer than 1% of children received no vaccinations.

Coverage of most vaccines in 2016 was lower in non-Hispanic black children, compared with non-Hispanic white children. It also was lower for children living below the federal poverty level, compared with children living at or above the poverty level. For Medicaid children, vaccination coverage was lower by 3%-13% than among children who had private insurance; for children with no insurance, vaccination coverage was lower by 12%-25% than among children with private insurance, the investigators reported.

Uninsured children “are eligible for the Vaccines for Children (VFC) program, which was designed to increase access to vaccination among children through age 18 years who might not otherwise be vaccinated because of inability to pay,” the researchers said. “Some families might not be aware of the VFC program, be unable to afford fees associated with visits to a vaccine provider, or might need assistance locating a physician who participates in the VFC program. Children living below poverty and up to a certain percentage above the poverty level are eligible for Medicaid … and are entitled to VFC vaccines.”

The investigators cited language barriers, lack of trust in providers, transportation problems, inconvenient office hours, and other provider- and system-level factors as health care–access barriers among publicly insured children.

“These data indicate that the immunization safety net is not reaching all children early in life,” Dr. Hill and her associates said. “Health care providers can increase vaccination coverage using evidence-based strategies such as provider reminders, standing orders to provide vaccination whenever appropriate, and immunization information systems” such as www.thecommunityguide.org/topic/vaccination.

Read more in MMWR (2017 Nov 3;66[43]:1171-7).
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