The percentage of children under 19 months who received all recommended vaccines on-time steadily improved from 22.5% in 2011 to 34.9% in 2020, according to a new national study. The research will be presented at the Pediatric Academic Societies (PAS) 2023 Meeting, held April 27-May 1 in Washington, D.C.
Researchers examined 161,187 child vaccination records over a 10-year period for the combined seven-vaccine series of diphtheria, pertussis, tetanus, poliovirus, measles, mumps, rubella, hepatitis B, Haemophilus influenzae type b, varicella, and pneumococcal infections. The records came from the National Immunization Survey-Child (NIS-Child), administered by the Centers for Disease Control and Prevention. The researchers measured whether children got vaccines on-time and in the order recommended on the U.S. immunization schedule.
The study noted a significant decline in children who were undervaccinated from 2011-2020. Causes for undervaccination may include parental vaccine refusal or barriers to accessing vaccination services.
Despite improvement in overall rates, findings show the number of children who consistently received zero vaccinations held steady at 1.2% during the study period.
“The study results show that adherence to national guidelines for childhood vaccination has been steadily improving,” said Sophia R. Newcomer, Ph.D., MPH, associate professor at University of Montana Center for Population Health Research and presenting author. “The national data not only underscores the need to continue to boost on-time vaccination but offers important context for the state of childhood vaccines in the United States.”
Researchers estimate pediatric vaccinations during the pandemic and COVID-19 vaccination patterns will likely differ, urging additional data collection and analysis to guide future public health efforts.
# # #
EDITOR:
Dr. Newcomer will present “National Trends in Patterns of Undervaccination in Early Childhood” on Monday, May 2 at 1 p.m. ET.
Reporters interested in an interview with Dr. Newcomer should contact Amber Fraley at amber.fraley@pasmeeting.org.
The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.
About the Pediatric Academic Societies Meeting
The Pediatric Academic Societies (PAS) Meeting is the premier North American scholarly child health meeting. The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit www.pas-meeting.org. Follow us on Twitter @PASMeeting and like us on Facebook PASMeeting.
Abstract: National Trends in Patterns of Undervaccination in Early Childhood
Presenting Author: Sophia R. Newcomer, PhD, MPH
Organization
University of Montana School of Public and Community Health Sciences at Missoula
Topic
Immunizations/Delivery
Background
Assessing national trends in undervaccination can help guide public health activities. Some undervaccination patterns may indicate parental vaccine refusal, whereas others may indicate vaccination barriers, and different patterns likely require different solutions.
Objective
Using National Immunization Survey-Child (NIS-Child) data from survey years 2011 through 2020, to assess trends in specific patterns of undervaccination.
Design/Methods
Using provider-verified vaccination records from NIS-Child, we assessed receipt of vaccines routinely recommended before 19 months of age. Based on prior work, we defined 11 hierarchical, mutually exclusive patterns of vaccination. Patterns included selective vaccination (not starting ≥1 series in the combined 7-vaccine series before age 19 months) and shot-limiting (limiting the number of vaccines per visit, either consistently or episodically). Up-to-date (UTD) with delays was defined as receiving all vaccines before age 19 months, with some vaccines ≥30 days later than due. We also collapsed the patterns into 3 categories indicating probable parental vaccine refusal (no vaccines; selective vaccination; shot-limiting), other barriers (started all series but missing doses), or UTD with or without delays. Tests for secular trends were conducted on patterns and broader vaccination categories.
Results
The study population comprised 161,187 children over 10 survey years. Trends in vaccination patterns are presented in Figure 1 and Table 1. The percent with no vaccines did not significantly increase or decrease from survey year 2011 (1.2%, 95% confidence interval [CI] 1.0%, 1.5%) through 2020 (1.2%, 95% CI 1.0%, 1.5%), p-trend 0.29. The patterns “selective vaccination plus shot-limiting,” “selective vaccination,” and “episodic shot-limiting” significantly declined. The collapsed categories are presented in Figure 2; probable parental vaccine refusal significantly declined, other barriers significantly declined, and UTD by 19 months (with or without prior delay) significantly increased over 10 survey years. In 2020, a higher proportion of children were categorized with other barriers (20.6%, 95% CI 19.5%, 21.7%) than with parental refusal (16.1%, 95% CI 15.1%, 17.1%).
Conclusion(s)
Over a recent 10-year period, national vaccination coverage for the combined 7-vaccine series has improved, with patterns suggestive of parental refusal or other barriers declining. These data largely represent pre-pandemic vaccination; pandemic vaccination patterns will likely differ and can be interpreted with these trends as context.
Tables and Images
