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National, State, and Urban Area Vaccination Coverage Levels Among Children Aged 19-35 Months -- United States, January-December 1995

The National Immunization Survey (NIS) is an ongoing survey that provides national estimates of vaccination coverage among children aged 19-35 months based on data for the most recent 12 months for each of the 50 states and for 28 selected urban areas, including the District of Columbia (1-3). CDC implemented NIS in April 1994 to monitor current vaccination coverage levels as one element of the five-part Childhood Immunization Initiative (CII) (Table_1), a national strategy to attain high vaccination coverage among children during the first 2 years of life (1,4). This report presents NIS findings for 1995, which indicate that 1995 CII interim national coverage goals were achieved or exceeded for all routinely recommended childhood vaccines. *

NIS collects data in two phases. In the first phase, during each quarter, a random sample of telephone numbers is contacted in each survey area and a screening questionnaire is administered to respondents aged greater than or equal to 18 years to identify households with one or more children aged 19-35 months **. Vaccination information is collected from all participating households with age-eligible children. All respondents are asked to refer to written vaccination records; however, reports from recall also are used. During 1995, approximately 1.6 million telephone numbers were called, and 31,997 interviews were completed (an average of 410 interviews per survey site). The overall response rate for eligible households was 69% (range: 53%-86% among the 78 survey sites). Survey responses were weighted to account for household nonresponse, natality data, and the lower vaccination coverage among children in households without telephones (1,2,5; CDC, unpublished data, 1994).

In the second phase, health-care providers are contacted about eligible children in surveyed households for whom consent was obtained to verify and/or complete vaccination information. Demographic characteristics and reported vaccination histories were similar for children in households with and without provider information. For all children in the survey during 1995, vaccination information was obtained from written records for 16,067 (50%) children and from providers' records for 16,699 children (52% of all children eligible for provider follow-up). Overall, for 64% of the children in the survey, accurate vaccination information was obtained either from written records indicating receipt of the required doses for four vaccines *** or from a provider record. As previously described, provider data were used to adjust responses for the entire group of children surveyed (1,2,6).

In August 1996, as part of the ongoing quality monitoring activities for this survey, all NIS vaccine data and analytic procedures were examined for accuracy and soundness. When corrections to data or changes to analytic procedures were necessary, the adjustments were made to the data for January-December 1995 and retrospectively to the previously published data for July 1994-June 1995; however, these adjustments did not substantially alter national coverage estimates for either period.

Compared with the previous reporting period (July 1994-June 1995), there were statistically significant increases during the current reporting period (January-December 1995) in national vaccination coverage with three or more doses of poliovirus vaccine (from 86% to 88%) and three or more doses of hepatitis B vaccine (from 51% to 68%) (Table_1) ****. Series-complete coverage estimates were unchanged for the 4:3:1 series (i.e., four doses of diphtheria and tetanus toxoids and pertussis vaccine {DTP}, three doses of poliovirus vaccine, and one dose of measles-mumps-rubella vaccine {MMR}) (76%) and for the 4:3:1:3 series (i.e., four doses of DTP, three doses of poliovirus vaccine, one dose of MMR, and three doses of Haemophilus influenzae type b {Hib}) (74%).

For every vaccine or series of vaccines, estimated vaccination coverage for the most recent quarter (October-December 1995) was equal to or higher than that for the entire year of 1995. In addition, during the fourth quarter of 1995, the 1996 interim goals were achieved or exceeded for all routinely recommended vaccines, including hepatitis B vaccine (Table_1).

The differences in coverage with hepatitis B vaccine between older and younger children also narrowed during the 1995 reporting period. During July 1994-June 1995, coverage among children aged 19-24 months was 31 percentage points higher than coverage among children aged 31-35 months (65% versus 34%, respectively); however, for 1995, the difference decreased to 18 percentage points (75% versus 57%, respectively) and, for the fourth quarter of 1995, decreased to 5 percentage points.

During 1995, estimated state-specific coverage levels for the 4:3:1 series ranged from 66% to 89% (median: 77%) and, for the 4:3:1:3 series, ranged from 64% to 87% (median: 75%) (Table_2). Estimated coverage levels among selected large urban areas ranged from 62% to 87% (median: 75%) for the 4:3:1 series and, for the 4:3:1:3 series, ranged from 57% to 87% (median: 73%) (Table_3). Compared with July 1994-June 1995 (CDC, unpublished data, 1996), state-specific increases in coverage with the 4:3:1:3 series were largest in Colorado (from 71% to 77%), Illinois (from 73% to 79%), and Louisiana (from 70% to 76%); among urban areas, increases were largest in Newark, New Jersey (from 56% to 67% ); Bexar County, Texas (from 64% to 74%); Orleans Parish, Louisiana (from 65% to 75%); and Houston, Texas (from 61% to 70%).

The 1995 CII interim goal for coverage with three or more doses of DTP was achieved by all states and 27 of the 28 urban areas, and for three or more doses of Hib vaccine, was achieved by 48 states and 27 urban areas. From the previous reporting period (July 1994-June 1995) to the current reporting period (1995), the number of states and urban areas that achieved the 1995 interim goals for three or more doses of poliovirus vaccine increased from 31 states and 16 urban areas to 44 and 21, respectively, and for three or more doses of hepatitis B vaccine, the numbers increased from 20 states and 16 urban areas to 44 and 28, respectively; for one or more doses of measles-containing vaccine, the number of states that met the 1995 interim coverage goal for MMR increased from 25 to 28 but, for urban areas, decreased from 16 to 15.

Reported by: National Center for Health Statistics; Assessment Br, Data Management Div, National Immunization Program, CDC.

Editorial Note

Editorial Note: The findings from the NIS indicate that the 1995 CII interim national coverage goals (4) have been achieved or exceeded for all recommended childhood vaccines. Furthermore, during the last quarter of 1995, the 1996 interim coverage goals were achieved for all these vaccines. The improvement in coverage levels for hepatitis B reflects continuing increases in coverage resulting from widespread and gradual acceptance of and adherence to the hepatitis B vaccination recommendations issued in November 1991 (7).

During 1995, vaccination levels among U.S. preschool-aged children were higher than ever recorded, and the number of reported cases of diphtheria, tetanus, mumps, measles, rubella, poliomyelitis, and H. influenzae were at or near record low levels (8). This substantial decline in incidence of vaccine-preventable diseases among preschool-aged children is attributable, in part, to increased vaccination coverage among this group. However, series-complete coverage with the 4:3:1 series during 1995 indicates that approximately 1 million children still require one or more of the recommended doses of vaccine to be fully protected.

Although national coverage goals have been achieved for the individual vaccines, coverage varied substantially among the states and urban areas, and many states and urban areas did not achieve the 1995 interim goals for the individual vaccines. Both the 1995 and 1996 goals of the CII were established as interim goals (for individual vaccines) toward achieving the national health objective for the year 2000 for the complete series of routinely recommended childhood vaccinations (at least 90% series-complete coverage) (objective 20.11). Series-complete goals have been more difficult to achieve than goals for individual vaccines.

The recent recommendation to include varicella vaccine in the recommended series and the persistently lower completion rate for four doses of DTP also underscore the need for intensified use of proven strategies for increasing vaccination coverage. Examples of these strategies include 1) linkage with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (9) and 2) assessment of vaccination coverage levels in public and private provider settings with feedback of results to individual providers (10).

The recent licensure of combination vaccines and the anticipated licensure of new single-antigen vaccines will further challenge the existing vaccine-delivery system. In addition, because a new birth cohort of children enters the population each year, efforts to achieve high coverage levels must begin anew each year. To benefit from these scientific advances and maintain high coverage in each successive birth cohort of children, additional components of the vaccine-delivery system need to be developed. Examples of these key components include 1) linkages between each child and a primary-care provider who is accountable for all aspects of the child's care, 2) automated vaccination registries that include both public and private providers, 3) means for ensuring financial access to vaccines, and 4) mechanisms for educating parents and potential parents about the importance of vaccines and for educating providers about the latest changes in vaccine recommendations (4).

References

  1. CDC. State and national vaccination coverage levels among children aged 19-35 months -- United States, April-December 1994. MMWR 1995;44:613,619-23.

  2. CDC. National, state, and urban area vaccination coverage levels among children aged 19-35 months -- United States, April 1994-March 1995. MMWR 1996;45:145-50.

  3. CDC. National, state, and urban area vaccination coverage levels among children aged 19-35 months -- United States, July 1994-June 1995. MMWR 1996;45:508-13.

  4. CDC. Reported vaccine-preventable diseases -- United States, 1993, and the Childhood Immunization Initiative. MMWR 1994;43:57-60.

  5. Massey JT, Botman SL. Weighting adjustments for random-digit-dialed surveys. In: Groves RM, Biemer PP, Lyberg LE, Massey JT, Nicholls WL, Waksberg J. Telephone survey methodology. New York: John Wiley & Sons, 1988:143-60.

  6. CDC. Sample design and procedures to produce estimates of vaccination coverage in the National Immunization Survey. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, CDC, National Immunization Program, April 18, 1996.

  7. CDC. Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination: recommendations of the Immunization Practices Advisory Committee. MMWR 1991;40(no. RR-13).

  8. Orenstein WA, Hadler S, Wharton M. Trends in vaccine-preventable diseases. Seminars in Pediatric Infectious Diseases 1997;8:23-33.

  9. Birkhead GS, LeBaron CW, Parsons P, et al. The immunization of children enrolled in the Special Supplemental Food Program for Women, Infants, and Children (WIC): the impact of different strategies. JAMA 1995;274:312-6.

  10. Dini E, Chaney M, Moolenaar R, LeBaron C. Information as intervention: how Georgia used vaccination coverage data to double public sector vaccination coverage in seven years. Journal of Public Health Management Practice 1996;2:45-9.

    • Diphtheria and tetanus toxoids and pertussis vaccine/diphtheria and tetanus toxoids (DTP/DT), poliovirus vaccine, measles-mumps-rubella vaccine (MMR), Haemophilus influenzae type b vaccine (Hib), and hepatitis B vaccine. As during the two preceding reporting periods, MMR reflects any measles-containing vaccine (MCV). ** For this reporting period (January-December 1995), NIS included children born during February 1992-May 1994 (median age: 27 months). *** DTP/DT, poliovirus vaccine, MCV, and Hib. For approximately 90% of children with such written records, provider records confirmed their up-to-date status. **** The overlap of two quarters between the present reporting period and the previous reporting period requires a special procedure for calculating the standard error of the difference. Accounting for the overlap results in a smaller standard error than would be calculated if the reporting periods were independent.

+------------------------------------------------------------------- ------+ | Erratum: Vol. 46, No. 8 | | ======================= | | SOURCE: MMWR 46(10);227 DATE: Mar 14, 1997 | |             | | In (Table_2E) of the report "National, State, and Urban Area | | Vaccination Coverage Levels Among Children Aged 19-35 Months -- United | | States, January-December 1995," the text of the ** and double dagger | | footnotes is incorrect. The corrected table appears on page 228. | +------------------------------------------------------------------- ------+



Table_1
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TABLE 1. Childhood Immunization Initiative goals and vaccination coverage levels among children aged 19-35 months, by selected vaccines -- United
States, National Immunization Survey, 1995
======================================================================================================================================================
                                                                                              National Immunization Survey

                          Childhood Immunization Initiative           July 1994-June 1995 *       January-December 1995      October-December 1995
                          ---------------------------------           ---------------------       ---------------------      ---------------------
Vaccine/Dose                  1995 Goal         1996 Goal                 %    (95% CI +)            %     (95% CI)             %      (95% CI)
-----------------------------------------------------------------------------------------------------------------------------------------------------
DTP/DT &
 >=3 Doses                       87%               90%                   94%   (+/-0.5%)            95%   (+/-0.6%)            95%    (+/-0.7%)
 >=4 Doses                       --                 --                   78%   (+/-1.0%)            79%   (+/-1.0%)            80%    (+/-1.2%)
Poliovirus
 >=3 Doses                       85%               90%                   86%   (+/-0.8%)            88%   (+/-0.8%)            90%    (+/-1.0%)
Hib @
 >=3 Doses                       85%               90%                   91%   (+/-0.7%)            92%   (+/-0.6%)            92%    (+/-0.8%)
MCV **
 >=1 Dose                        90%               90%                   89%   (+/-0.7%)            90%   (+/-0.7%)            91%    (+/-0.9%)
Hepatitis B
 >=3 Doses                       50%               70%                   51%   (+/-1.1%)            68%   (+/-1.0%)            78%    (+/-1.3%)
  19-24 Months                   --                 --                   65%   (+/-1.3%)            75%   (+/-1.1%)            80%    (+/-2.1%)
  25-30 Months                   --                 --                   52%   (+/-1.3%)            70%   (+/-1.2%)            77%    (+/-2.1%)
  31-35 Months                   --                 --                   34%   (+/-1.3%)            57%   (+/-1.3%)            75%    (+/-2.4%)
Combined series
 4 DTP/3 Polio/1                 --                 --                   76%   (+/-1.0%)            76%   (+/-1.0%)            78%    (+/-1.3%)
MMR ++
 4 DTP/3 Polio/1
MMR/
  3 Hib &&                       --                 --                   74%   (+/-1.0%)            74%   (+/-1.0%)            76%    (+/-1.3%)
------------------------------------------------------------------------------------------------------------------------------------------------------
*  Corrected estimates from previously published estimates.
+  Confidence interval.
&  Diptheria and tetanus toxoids and pertussis vaccine/Diptheria and tetanus toxoids.
@  Haemophilus influenzae type b vaccine.
** Any measles-containing vaccine; vaccination coverage goals are specifically for measles-mumps-rubella vaccine.
++ Four doses of DTP/DT, three doses of poliovirus vaccine, and one dose of MCV.
@@ Four doses of DTP/DT, three doses of poliovirus vaccine, one dose of MCV, and three doses of Hib.
======================================================================================================================================================

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Table_2
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TABLE 2. Estimated vaccination coverage with the 4:3:1 series * and
the 4:3:1:3 series +, by coverage level and state -- United States, National
Immunization Survey, 1995
=============================================================================
                                   4:3:1 Series coverage
                                ----------------------------
Coverage level/State              %               (95% CI &)
-----------------------------------------------------------------------------
>=85%
  Connecticut @                   85               (+/-4.7)
  Maine @                         89               (+/-3.8)
  New Hampshire @                 87               (+/-3.8)
  Vermont @                       86               (+/-4.1)

75%-84%
  Alabama @                       77               (+/-4.6)
  Colorado @                      78               (+/-5.3)
  Delaware **                     75               (+/-5.8)
  Florida **                      76               (+/-4.6)
  Georgia @                       78               (+/-4.8)
  Hawaii @                        81               (+/-5.5)
  Illinois @                      81               (+/-4.0)
  Indiana **                      76               (+/-4.6)
  Iowa **                         83               (+/-4.2)
  Kentucky **                     80               (+/-5.5)
  Louisiana **                    77               (+/-4.6)
  Maryland @                      81               (+/-4.3)
  Massachusetts @                 81               (+/-4.3)
  Minnesota ++                    77               (+/-5.3)
  Mississippi ++                  83               (+/-5.0)
  Missouri @                      76               (+/-5.6)
  Nebraska @                      78               (+/-5.0)
  New Jersey @                    75               (+/-5.3)
  New Mexico **                   77               (+/-5.5)
  New York @                      79               (+/-4.2)
  North Carolina @                81               (+/-5.0)
  North Dakota @                  82               (+/-4.8)
  Oklahoma **                     76               (+/-5.6)
  Pennsylvania @                  78               (+/-4.5)
  Rhode Island @                  83               (+/-4.7)
  South Carolina @                80               (+/-4.7)
  South Dakota &&                 80               (+/-4.5)
  Texas @                         76               (+/-3.5)
  Washington @                    78               (+/-4.2)
  Wisconsin @                     77               (+/-3.8)

65%-74%
  Alaska **                       74               (+/-6.3)
  Arizona **                      73               (+/-4.8)
  Arkansas @                      74               (+/-5.5)
  California **                   71               (+/-4.6)
  Idaho **                        66               (+/-5.9)
  Kansas &&                       72               (+/-5.8)
  Michigan **                     70               (+/-4.8)
  Montana **                      74               (+/-5.4)
  Nevada **                       68               (+/-6.3)
  Ohio **                         74               (+/-4.2)
  Oregon **                       74               (+/-5.7)
  Tennessee **                    74               (+/-4.0)
  Utah **                         68               (+/-5.3)
  Virginia **                     74               (+/-5.8)
  West Virginia ++                73               (+/-5.6)
  Wyoming ++                      74               (+/-5.6)

Total                             76               (+/-1.0)
-----------------------------------------------------------------------------
                                   4:3:1:3 Series coverage
                                 ---------------------------
Coverage level/State               %              (95% CI &)
-----------------------------------------------------------------------------
>=85%
  Maine                           87               (+/-3.9)
  New Hampshire                   86               (+/-3.8)

75%-84%
  Alabama                         75               (+/-4.7)
  Colorado                        77               (+/-5.4)
  Connecticut                     83               (+/-4.9)
  Florida                         75               (+/-4.6)
  Georgia                         77               (+/-4.9)
  Hawaii                          78               (+/-5.8)
  Illinois                        79               (+/-4.1)
  Indiana                         75               (+/-4.6)
  Iowa                            82               (+/-4.4)
  Kentucky                        79               (+/-5.6)
  Louisiana                       76               (+/-4.7)
  Maryland                        78               (+/-4.5)
  Massachusetts                   80               (+/-4.3)
  Minnesota                       76               (+/-5.4)
  Mississippi                     81               (+/-5.2)
  Missouri                        75               (+/-5.7)
  Nebraska                        75               (+/-5.2)
  New Mexico                      76               (+/-5.6)
  New York                        77               (+/-4.3)
  North Carolina                  80               (+/-5.0)
  North Dakota                    81               (+/-4.8)
  Pennsylvania                    76               (+/-4.7)
  Rhode Island                    82               (+/-4.8)
  South Carolina                  80               (+/-4.7)
  South Dakota                    79               (+/-4.5)
  Vermont                         84               (+/-4.3)
  Washington                      77               (+/-4.2)

65%-74%
  Alaska                          72               (+/-6.4)
  Arizona                         70               (+/-4.9)
  Arkansas                        73               (+/-5.6)
  California                      69               (+/-4.6)
  Delaware                        72               (+/-5.9)
  Kansas                          70               (+/-5.8)
  Michigan                        67               (+/-4.9)
  Montana                         71               (+/-5.6)
  Nevada                          65               (+/-6.3)
  New Jersey                      72               (+/-5.5)
  Ohio                            73               (+/-4.3)
  Oklahoma                        73               (+/-5.7)
  Oregon                          72               (+/-5.8)
  Tennessee                       73               (+/-4.0)
  Texas                           73               (+/-3.6)
  Utah                            66               (+/-5.3)
  Virginia                        71               (+/-5.9)
  West Virginia                   71               (+/-5.6)
  Wisconsin                       74               (+/-3.9)
  Wyoming                         71               (+/-5.7)

<65%
  Idaho                           64               (+/-5.9)

Total                             74               (+/-1.0)
-----------------------------------------------------------------------------
*  Four or more doses of diphtheria and tetanus toxoids and pertussis
   vaccine/Diphtheria and tetanus toxoids (DTP/DT), three or more doses of
   poliovirus vaccine, and one or more doses of measles-containing vaccine
   (MCV).
+  Four or more doses of DTP/DT, three or more doses of poliovirus vaccine,
   one or more doses of MCV, and three or more doses of Haemophilus
   influenzae type b vaccine (Hib).
&  Confidence interval.
@  Achieved the 1995 Childhood Immunization Initiative (CII) goals for three
   or more doses of DTP, three or more doses of poliovirus vaccine, one or
   more doses of MCV, three or more doses of Hib, and three or more doses of
   hepatitis B vaccine.
** Achieved the 1995 CII goals for three or more doses of DTP, three or more
   doses of poliovirus vaccine, one or more doses of MCV, and three or more
   doses of Hib but not for three or more doses of hepatitis B vaccine.
++ Did not achieve the 1995 CII goal for at least one of the following:
   three or more doses of DTP, three or more doses of poliovirus vaccine,
   one or more doses of MCV, or three or more doses of Hib but achieved the
   1995 goal for three or more doses of hepatitis B vaccine.
&& Did not achieve the 1995 CII goal for at least one of the following:
   three or more doses of DTP, three or more doses of poliovirus vaccine,
   one or more doses of MCV, or three or more doses of Hib and did not
   achieve the 1995 goal for three or more doses of hepatitis B vaccine.
=============================================================================

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Table_3
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TABLE 3. Estimated vaccination coverage with the 4:3:1 series * and
the 4:3:1:3 series +, by coverage level and selected urban area
-- United States, National Immunization Survey, 1995
=======================================================================
                              4:3:1 Series coverage
                              ---------------------
Coverage level/Area                %   (95% CI &)
-----------------------------------------------------------------------
85%
Boston, Mass. @                   87   (+/-4.9%)
Jefferson County, Ala. @          86   (+/-4.7%)

75%-84%
Baltimore, Md. @                  77   (+/-6.8%)
Bexar County, Tex. @              78   (+/-6.0%)
Dade County, Fla. @               78   (+/-6.1%)
El Paso County, Tex. **           78   (+/-5.1%)
Franklin County, Ohio **          76   (+/-5.8%)
Fulton/DeKalb counties, Ga. @     83   (+/-5.5%)
King County, Wash. @              83   (+/-4.6%)
Marion County, Ind. @             78   (+/-5.7%)
New York City, N.Y. @             81   (+/-6.2%)
Orleans Parish, La. **            77   (+/-6.0%)
San Diego County, Calif. @        75   (+/-6.3%)
Santa Clara County, Calif. @      77   (+/-5.5%)

65%-74%
Chicago, Ill. **                  71   (+/-6.8%)
Cuyahoga County, Ohio **          74   (+/-6.6%)
Dallas County, Tex. **            72   (+/-6.0%)
Davidson County, Tenn. **         74   (+/-5.6%)
District of Columbia **           74   (+/-6.5%)
Duval County, Fla. **             72   (+/-6.7%)
Houston, Tex. **                  73   (+/-6.6%)
Los Angeles County, Calif. @      73   (+/-7.1%)
Maricopa County, Ariz. **         72   (+/-7.0%)
Milwaukee County, Wis. @          71   (+/-5.9%)
Newark, N.J. **                   68   (+/-7.3%)
Philadelphia County, Pa. **       70   (+/-7.2%)
Shelby County, Tenn. **           69   (+/-6.2%)

<65%
Detroit, Mich. **                 62   (+/-7.6%)
-----------------------------------------------------------------------
                             4:3:1:3 Series coverage
                             -----------------------
Coverage level/Area                %    (95% CI)
-----------------------------------------------------------------------
85%
Boston, Mass.                     87   (+/-4.9%)
Jefferson County, Ala.            85   (+/-4.9%)

75%-84%
Baltimore, Md.                    75   (+/-6.9%)
Dade County, Fla.                 77   (+/-6.1%)
El Paso County, Tex.              77   (+/-5.1%)
Fulton/DeKalb counties, Ga.       79   (+/-5.8%)
King County, Wash.                82   (+/-4.7%)
Marion County, Ind.               75   (+/-6.0%)
New York City, N.Y.               78   (+/-6.5%)
Orleans Parish, La.               75   (+/-6.1%)

65%-74%
Bexar County, Tex.                74   (+/-6.3%)
Chicago, Ill.                     69   (+/-6.8%)
Cuyahoga County, Ohio             71   (+/-6.8%)
Dallas County, Tex.               70   (+/-6.1%)
Davidson County, Tenn.            73   (+/-5.7%)
District of Columbia              67   (+/-6.9%)
Duval County, Fla.                71   (+/-6.8%)
Franklin County, Ohio             74   (+/-5.9%)
Houston, Tex.                     70   (+/-6.7%)
Los Angeles County, Calif.        70   (+/-7.2%)
Maricopa County, Ariz.            69   (+/-7.2%)
Milwaukee County, Wis.            68   (+/-6.1%)
Newark, N.J.                      67   (+/-7.3%)
Philadelphia County, Pa.          67   (+/-7.4%)
San Diego County, Calif.          73   (+/-6.4%)
Santa Clara County, Calif.        74   (+/-5.7%)
Shelby County, Tenn.              68   (+/-6.2%)

<65%
Detroit, Mich.                    57   (+/-7.6%)
-----------------------------------------------------------------------
*  Four or more doses of diphtheria and tetanus toxoids and pertussis
   vaccine/Diphtheria and tetanus toxoids (DTP/DT), three or more
   doses of poliovirus vaccine, and one or more doses of
   measles-containing vaccine (MCV).
+  Four or more doses of DTP/DT, three or more doses of poliovirus
   vaccine, one or more doses of MCV, and three or more doses of
   Haemophilus influenzae type b vaccine (Hib).
&  Confidence interval.
@  Achieved the 1995 Childhood Immunization Initiative (CII) goals for
   three or more doses of DTP, three or more doses of poliovirus
   vaccine, one or more doses of MCV, three or more doses of Hib,
   and three or more doses of hepatitis B vaccine.
** Did not achieve the 1995 CII goal for at least one of the
   following: three or more doses of DTP, three or more doses of
   poliovirus vaccine, one or more doses of MCV, or three or more
   doses of Hib but achieved the 1995 goal for three or more doses of
   hepatitis B vaccine.
=======================================================================

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Table_2E
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TABLE 2. Estimated vaccination coverage with the 4:3:1 series *                                                                                      
and the 4:3:1:3 series +, by coverage level and state -- United                                                                                      
States, National Immunization Survey, 1995   
===================================================================                                                                                  
                     4:3:1 Series Coverage   
                     ---------------------   
Coverage level/State     %   (95% CI &)      
------------------------------------------   
>=85%                                        
  Connecticut @         85    (+/-4.7)       
  Maine @               89    (+/-3.8)       
  New Hampshire @       87    (+/-3.8)       
  Vermont @             86    (+/-4.1)       
75%-84%                                      
  Alabama @             77    (+/-4.6)       
  Colorado @            78    (+/-5.3)       
  Delaware **           75    (+/-5.8)       
  Florida **            76    (+/-4.6)       
  Georgia @             78    (+/-4.8)       
  Hawaii @              81    (+/-5.5)       
  Illinois @            81    (+/-4.0)       
  Indiana **            76    (+/-4.6)       
  Iowa **               83    (+/-4.2)       
  Kentucky **           80    (+/-5.5)       
  Louisiana **          77    (+/-4.6)       
  Maryland @            81    (+/-4.3)       
  Massachusetts @       81    (+/-4.3)       
  Minnesota ++          77    (+/-5.3)       
  Mississippi ++        83    (+/-5.0)       
  Missouri @            76    (+/-5.6)       
  Nebraska @            78    (+/-5.0)       
  New Jersey @          75    (+/-5.3)       
  New Mexico **         77    (+/-5.5)       
  New York @            79    (+/-4.2)       
  North Carolina @      81    (+/-5.0)       
  North Dakota @        82    (+/-4.8)       
  Oklahoma **           76    (+/-5.6)       
  Pennsylvania @        78    (+/-4.5)       
  Rhode Island @        83    (+/-4.7)       
  South Carolina @      80    (+/-4.7)       
  South Dakota &&       80    (+/-4.5)       
  Texas @               76    (+/-3.5)       
  Washington @          78    (+/-4.2)       
  Wisconsin @           77    (+/-3.8)       
65%-74%                                      
  Alaska **             74    (+/-6.3)       
  Arizona **            73    (+/-4.8)       
  Arkansas @            74    (+/-5.5)       
  California **         71    (+/-4.6)       
  Idaho **              66    (+/-5.9)       
  Kansas &&             72    (+/-5.8)       
  Michigan **           70    (+/-4.8)       
  Montana **            74    (+/-5.4)       
  Nevada **             68    (+/-6.3)       
  Ohio **               74    (+/-4.2)       
  Oregon **             74    (+/-5.7)       
  Tennessee **          74    (+/-4.0)       
  Utah **               68    (+/-5.3)       
  Virginia **           74    (+/-5.8)       
  West Virginia ++      73    (+/-5.6)       
  Wyoming ++            74    (+/-5.6)       
                                             
Total                   76    (+/-1.0)       
                                             
                    4:3:1:3 Series Coverage  
                    -----------------------  
Coverage level/State     %    (95% CI)       
-------------------------------------------  
>=85%                                        
  Maine                 87    (+/-3.9)       
  New Hampshire         86    (+/-3.8)       
75%-84%                                      
  Alabama               75    (+/-4.7)       
  Colorado              77    (+/-5.4)       
  Connecticut           83    (+/-4.9)       
  Florida               75    (+/-4.6)       
  Georgia               77    (+/-4.9)       
  Hawaii                78    (+/-5.8)       
  Illinois              79    (+/-4.1)       
  Indiana               75    (+/-4.6)       
  Iowa                  82    (+/-4.4)       
  Kentucky              79    (+/-5.6)       
  Louisiana             76    (+/-4.7)       
  Maryland              78    (+/-4.5)       
  Massachusetts         80    (+/-4.3)       
  Minnesota             76    (+/-5.4)       
  Mississippi           81    (+/-5.2)       
  Missouri              75    (+/-5.7)       
  Nebraska              75    (+/-5.2)       
  New Mexico            76    (+/-5.6)       
  New York              77    (+/-4.3)       
  North Carolina        80    (+/-5.0)       
  North Dakota          81    (+/-4.8)       
  Pennsylvania          76    (+/-4.7)       
  Rhode Island          82    (+/-4.8)       
  South Carolina        80    (+/-4.7)       
  South Dakota          79    (+/-4.5)       
  Vermont               84    (+/-4.3)       
  Washington            77    (+/-4.2)       
65%-74%                                      
  Alaska                72    (+/-6.4)       
  Arizona               70    (+/-4.9)       
  Arkansas              73    (+/-5.6)       
  California            69    (+/-4.6)       
  Delaware              72    (+/-5.9)       
  Kansas                70    (+/-5.8)       
  Michigan              67    (+/-4.9)       
  Montana               71    (+/-5.6)       
  Nevada                65    (+/-6.3)       
  New Jersey            72    (+/-5.5)       
  Ohio                  73    (+/-4.3)       
  Oklahoma              73    (+/-5.7)       
  Oregon                72    (+/-5.8)       
  Tennessee             73    (+/-4.0)       
  Texas                 73    (+/-3.6)       
  Utah                  66    (+/-5.3)       
  Virginia              71    (+/-5.9)       
  West Virginia         71    (+/-5.6)       
  Wisconsin             74    (+/-3.9)       
  Wyoming               71    (+/-5.7)       
<65%                                         
  Idaho                 64    (+/-5.9)       
                                             
Total                   74    (+/-1.0)       
-------------------------------------------------------------------                                                                                  
*  Four or more doses of diphtheria and tetanus toxoids and                                                                                          
   pertussis vaccine/Diphtheria and tetanus toxoids (DTP/DT), three                                                                                  
   or more doses of poliovirus vaccine, and one or more doses of                                                                                     
   measles-containing vaccine (MCV).         
+  Four or more doses of DTP/DT, three or more doses of poliovirus                                                                                   
   vaccine, one or more doses of MCV, and three or more doses of                                                                                     
   Haemophilus influenzae type b vaccine (Hib).                                                                                                      
&  Confidence interval.                      
@  Achieved the 1995 Childhood Immunization Initiative (CII) goals                                                                                   
   for three or more doses of DTP, three or more doses of                                                                                            
   poliovirus vaccine, one or more doses of MCV, three or more                                                                                       
   doses of Hib, and three or more doses of hepatitis B vaccine.                                                                                     
** Did not achieve the 1995 CII goal for at least one of the                                                                                         
   following: three or more doses of DTP, three or more doses of                                                                                     
   poliovirus vaccine, one or more doses of MCV, or three or more                                                                                    
   doses of Hib but achieved the 1995 goal for three or more                                                                                         
   doses of hepatitis B vaccine.             
++ Achieved the 1995 CII goals for three or more doses of DTP,                                                                                       
   three or more doses of poliovirus vaccine, one or more doses of                                                                                   
   MCV, and three or more doses of Hib but not for three or more                                                                                     
   doses of hepatitis B vaccine.             
&& Did not achieve the 1995 CII goal for at least one of the                                                                                         
   following: three or more doses of DTP, three or more doses of                                                                                     
   poliovirus vaccine, one or more doses of MCV, or three or more                                                                                    
   doses of Hib and did not achieve the 1995 goal for three or more                                                                                  
   doses of hepatitis B vaccine.             
===================================================================                                                                                  

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