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Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. Vaccination Coverage of 2-Year-Old Children -- United States, 1991-1992Protecting children against vaccine-preventable diseases is a national priority in public health. Because approximately 80% of childhood vaccine doses are recommended for administration during the first 2 years of life, vaccination coverage among children must be continuously monitored. National estimates of vaccination coverage were calculated annually from 1959 through 1985 but not for 1986-1990. Beginning in 1991, national estimates of vaccination coverage of preschool children have been available through the National Health Interview Survey (NHIS), a national survey of the civilian noninstitutionalized population conducted by CDC's National Center for Health Statistics (1). This report presents 1992 national estimates of vaccination coverage for 2-year-old children and describes changes from 1991 to 1992. The NHIS collects vaccination information during household interviews. If vaccination records are available, data are abstracted from the record. If such records are not available, information is based on parental recall. For data measurement, 2-year-old children are defined as persons aged 19-35 months. The proportion of children vaccinated were separately analyzed by poverty classification and place of residence. In addition, to assist in targeting vaccination activities based on cultural differences, data were analyzed by race. Limitations in sample size precluded collection of data on ethnicity and analysis of data for races other than black and white. Coverage for measles-containing vaccine was similar in 1991 and 1992 (82.0% and 82.5%, respectively) (Table_1). In contrast, coverage in 1992 was substantially higher than that in 1991 for diphtheria and tetanus toxoids and pertussis vaccine (DTP) and poliovirus vaccine. From 1991 to 1992, coverage for three or more doses of DTP increased from 68.8% to 83.0% and for three or more doses of poliovirus vaccine, from 53.2% to 72.4%. Children living below the poverty level* were less well vaccinated than others. Differences between children living below the poverty level and those living at or above the poverty level ranged from a low of 4.1 percentage points for measles (80.2% vs 84.3%) to a high of 8.1 percentage points for polio (66.6% vs 74.7%). Vaccination levels in urban, suburban, and rural areas were similar in 1992. In general, vaccination levels were lower in black children than in white. In 1992, 71%-72% of children at or above the poverty level were in need of at least one vaccine (Table_2). Among white children, 72%-75% were in need of at least one of the recommended vaccines. Overall, an estimated 1 million 2-year-olds required a single dose of measles-containing vaccine, and 1.6 million 2-year-olds required one or more doses of poliovirus vaccine. Approximately 1 million children had not received at least three doses of DTP vaccine. Reported by: National Immunization Program; Div of Health Interview Statistics, National Center for Health Statistics, CDC. Editorial NoteEditorial Note: The findings in this report summarizing NHIS data document the overall continuing problem of undervaccination of children in the United States. However, vaccination coverage for some antigens has improved in some age groups -- particularly for vaccination against measles in the preschool population. Estimated measles vaccine coverage for 2-year-olds in 1985 was 61%, compared with 82% in 1991 and 1992; before 1991, the highest previously documented level was 67% in 1982 (CDC, unpublished data, 1993). The recent increase in coverage reflects the national response to increased vaccination levels following the measles resurgence during 1988-1991; as a result of these efforts, the incidence of measles decreased to a historic low in 1993 (2). This report also documents a substantial increase in poliovirus and DTP vaccination levels from 1991 to 1992. At least two factors may account for these increases. First, many state and local public health agencies, in collaboration with national and local private voluntary organizations, have intensified their efforts to vaccinate preschool children, especially since the 1989- 1991 measles resurgence. Second, changes in survey methodology between 1991 and 1992 have simplified data collection from parental recall. In 1991, respondents were required to specify the exact ages at which vaccinations were administered for the full number of doses to be credited; however, some parents had difficulty recalling the exact ages at which their child received vaccinations. As a consequence, in 1992, a parental response that the child had received all doses of a particular antigen was accepted; retrospective studies have shown this methodology has enhanced the accuracy of data (CDC, unpublished data, 1993). Because of difficulties in determining vaccination status from parental recall (3), in 1994, the NHIS will include a check of provider records for all children aged 19-35 months, thus allowing for adjustment of overall survey results. In addition, health-care providers will encourage parents to maintain home vaccination records (4). Despite ongoing and substantial efforts to improve the vaccine delivery system in the United States, vaccination levels for 2-year-olds remain below 90%. In addition, coverage varies by and are substantially lower in some population groups, especially those underserved by the health-care system. Differences in vaccination levels among racial/ethnic groups may be influenced by social and cultural phenomena and require special interventions. For example, during 1992 in Los Angeles, 42% of Hispanic preschool children were fully vaccinated by age 24 months, compared with 25% of black children, even though Hispanic parents reported lower mean annual family incomes ($3218 vs. $4596) and lower mean years of education (8.6 years vs. 12.5 years) (CDC, unpublished data, 1993). Limitations in the sample size of the 1992 NHIS preclude estimation of vaccination coverage of Hispanic populations; however, the increased incidence of measles among Hispanics before and during the measles resurgence suggests that overall vaccination coverage is also substantially lower in Hispanics than in white non-Hispanics (5-7 ). The prevention of vaccine-preventable diseases in the United States will require that uniformly high vaccination levels for preschool children be achieved and sustained in all communities. References
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| Erratum: Vol. 42, Nos. 51 & 52
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| SOURCE: MMWR 43(1);18 DATE: Jan. 14, 1994
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| In the article "Vaccination Coverage of 2-Year-Old Children
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| United States, 1991-1992," on page 986, the first two sentences
of |
| the second paragraph should read "In 1992, 71%-72% of children in
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| need of at least one of the recommended vaccines were at or above
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| the poverty level (Table_2). Among children in need of at
least one |
| of the recommended vaccines, 72%-75% were white." In addition, in
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| Table_1, the plus or minus symbol should appear in front of
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| 95% confidence interval variable.
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TABLE 1. Percentage * of 2-year-olds + receiving doses of diphtheria and tetanus toxoids
and pertussis vaccine (DTP), poliovirus vaccine, and measles-containing vaccine (MCV),
by selected characteristics -- United States, 1991 and 1992
======================================================================================================================
>=3 doses DTP >=3 doses poliovirus 1 dose MCV
------------------------------ ------------------------------ ------------------------------
Characteristic 1991 (95% CI &) 1992 (95% CI) 1991 (95% CI) 1992 (95% CI) 1991 (95% CI) 1992 (95% CI)
--------------------------------------------------------------------------------------------------------------------
Socioeconomic
status @
Below poverty
level 53.0 ( 8.8) 79.7 (5.7) 38.7 ( 7.9) 66.6 (6.2) 73.4 ( 6.8) 80.2 ( 5.6)
At or above
poverty level 75.7 ( 2.8) 84.6 (2.2) 59.5 ( 3.6) 74.7 (2.5) 86.6 ( 2.3) 84.3 ( 2.2)
Race
White 73.4 ( 3.6) 84.8 (2.3) 57.3 ( 4.0) 74.1 (2.6) 82.9 ( 2.7) 83.6 ( 2.4)
Black 50.6 ( 7.3) 74.7 (6.3) 35.6 ( 6.1) 62.7 (7.0) 77.4 ( 7.3) 77.9 ( 6.3)
Other ** 58.0 (12.5) 79.3 (9.0) 49.8 (14.8) 75.5 (9.9) 83.8 (12.5) 79.9 (10.0)
Residence
Urban 64.8 ( 4.4) 82.5 (3.5) 49.9 ( 4.7) 74.1 (4.0) 78.4 ( 4.0) 84.5 ( 2.7)
Suburban 72.3 ( 4.3) 84.4 (2.8) 55.8 ( 5.2) 72.6 (3.4) 85.0 ( 3.5) 83.3 ( 3.1)
Rural 67.6 ( 6.0) 80.7 (5.4) 52.5 ( 5.9) 69.0 (5.3) 81.1 ( 5.7) 77.2 ( 6.7)
Total 68.8 ( 3.0) 83.0 (2.2) 53.2 ( 3.4) 72.4 (2.3) 82.0 ( 2.5) 82.5 ( 2.3)
--------------------------------------------------------------------------------------------------------------------
* Data are based on household interviews of a sample of the civilian noninstitutionalized
population. Refusals and unknowns were excluded (DTP: 4% in 1991, 16% in 1992;
measles-containing vaccine: 3% in 1991, 14% in 1992; poliovirus vaccine: 3% in 1991, 17% in
1992). In 1991, 45.6% of respondents had a vaccination record; in 1992, 31.2% had a vaccination
record.
+ Children aged 19-35 months.
& Confidence interval.
@ Poverty statistics are based on definitions developed by the Social Security Administration
that include a set of income thresholds that vary by family size and composition.
** Data for American Indians/Alaskan Natives and Asians/Pacific Islanders were combined
because of limitations in sample size.
======================================================================================================================
Return to top. Table_2 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
TABLE 2. Percentage of all undervaccinated 2-year-olds * requiring at least one dose
of diphtheria and tetanus toxoids and pertussis vaccine (DTP), poliovirus vaccine,
and/or measles-containing vaccine (MCV), by selected characteristics -- United
States, 1992
===============================================================================================
Characteristic <3 doses DTP <3 doses poliovirus 0 doses MCV
--------------------------------------------------------------------------------
Socioeconomic status +
Below poverty level 28 29 28
At or above
poverty level 72 71 72
Total 100 100 100
Race
White 72 75 75
Black 22 20 19
Other & 6 4 6
Total 100 99 100
--------------------------------------------------------------------------------
* Children aged 19-35 months.
* Poverty statistics are based on definitions developed by the Social Security Administration
that include a set of income thresholds that vary by family size and composition.
& Data for American Indians/Alaskan Natives and Asians/Pacific Islanders were combined
because of limitations in sample size.
===============================================================================================
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