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County-Level Trends in Vaccination Coverage Among Children Aged 19--35 Months --- United States, 1995--2008

Philip J. Smith, PhD

James A. Singleton, MS

National Center for Immunization and Respiratory Diseases


Corresponding author: Philip J. Smith, PhD, CDC, National Center for Immunization and Respiratory Diseases, MS E-32, 1600 Clifton Road, NE, Atlanta, GA 30333, Telephone: 404-639-8729; Fax: 404-639-3266; E-mail: pzs6@cdc.gov.

Abstract

Problem/Condition: Estimated trends in county-level vaccination coverage compared with national health objectives and associated with other variables (e.g., access to care, economic conditions, and demographic characteristics) have not been reported previously.

Reporting Period: 1995--2008.

Description of System: The National Immunization Survey (NIS) is an ongoing, random-digit--dialed telephone survey that gathers vaccination coverage data from households with children aged 19--35 months in 50 states and selected urban areas and territories.

Results: During 1995--2008, 185,336 children aged 19--35 months sampled by NIS had adequate provider data and lived in one of the 257 counties where the combined sample size for at least one of the seven biennial periods during 1995--2008 was ≥35. Statistically significant increases in estimated vaccination coverage occurred in 27 of 233 counties (12%) with ≥4 doses of diphtheria and tetanus toxoids and acellular pertussis (DTaP); for 38 of 233 counties (16%) with ≥3 doses of polio vaccine; eight of 233 counties (3%) with ≥1 dose of measles, mumps, and rubella (MMR); nine of 233 counties (4%) with ≥3 doses of Haemophilus influenzae type B (Hib) vaccine; 193 of 233 counties (83%) with ≥3 doses of hepatitis B vaccine; 228 of 232 counties (98%) with ≥1 dose of varicella vaccine; and 187 of 192 counties (97%) with ≥4 doses of 7-valent pneumococcal conjugate vaccine (PCV7). Six of 233 (2%) counties had significant decreases in vaccination coverage for Hib. During the 2007--2008 biennial period, the percentage of 193 counties with estimated vaccine coverage that achieved the Healthy People 2010 objective of 90% vaccination coverage was 8% for DTaP/DTP vaccines, 93% for polio vaccine, 86% for MMR vaccine, 71% Hib vaccine, 94% for hepatitis B vaccine, 50% for varicella vaccine, and <1% for PCV7. Among 104 counties, the estimated percentage of children aged 6--23 months who were administered ≥1 dose of the seasonal influenza vaccine during the 2007--2008 influenza vaccination season was 39.0% (range: 22.2%--68.8%). For most vaccines and vaccine series, higher levels of county-level vaccination coverage correlated with a higher number of pediatricians per capita, a higher number of people living in group quarters (e.g., college residence halls, residential treatment centers, skilled nursing facilities, group homes, military barracks, correctional facilities, workers' dormitories, and facilities for persons experiencing homelessness) per capita, higher per capita income, a higher number of Hispanics per capita, and having a service-dependent economy. Lower levels of county-level vaccination coverage correlated with higher number of persons in poverty per capita, a higher percentage of black children among children aged <5 years, higher levels of housing stress (i.e., ≥30% income for rent or mortgage and certain inadequate housing characteristics), a higher number of pediatric intensive care beds per capita, and designation as a nonmetropolitan county with an economy dependent on recreation activities.

Interpretation: During 1995--2008, significant increases in vaccination coverage for individual vaccines occurred in many counties for the newly recommended vaccines, varicella and PCV7.

Public Health Actions: In counties that did not meet the Healthy People 2010 vaccination coverage objectives, states should evaluate strategies to achieve these objectives. The Guide to Community Preventive Services provides a summary of interventions that increase community vaccination coverage, including provider reminder-recall systems that remind parents to return to clinics to administer missed doses to children and assessment and feedback on the performance of vaccination providers. In counties where significant decreases in Hib vaccination coverage occurred, additional research is warranted to determine whether the recent shortage in the Hib vaccine was the sole cause of these decreases. In counties with a high proportion of children living in poverty, interventions to increase vaccination coverage among these children are needed. Additional research is required to understand potential barriers to increased coverage with these vaccines, the role of vaccination providers and their resource constraints, and factors associated with access to health care among children.

Introduction

County-level vaccination coverage estimates are important, both because public health issues often originate in small geographic areas and because certain public health actions are most effective at the local level. For example, a study conducted during 1996--2001 in inner-city locations in Atlanta, Georgia, found a high rate of unvaccinated children among racial/ethnic minorities living in the surveyed neighborhoods (1). In Sullivan County, New York, an investigation by the New York State Department of Health identified a mumps outbreak of among 31 persons (nine not vaccinated, 16 administered 2 doses, four administered 1 dose, two with unknown vaccination history) in a population with 96% vaccination coverage (2). Clusters of children who did not receive any vaccine doses were found in specific geographic areas, with the largest numbers of unvaccinated children living in counties in California, Illinois, New York, Washington, Pennsylvania, Texas, Oklahoma, Colorado, Utah, and Michigan (3). In Ashland, Oregon, 12.3% of all children attending public schools and 18.8% of children attending day-care facilities in 2002 claimed an exemption from mandatory vaccination laws, compared with 2.4% for the entire state (4,5).

Children of parents who refuse vaccine doses have an increased risk for acquiring and transmitting measles and pertussis (6), and in small geographic areas with a preponderance of children whose parents have refused vaccine doses, an increased risk for pertussis and measles exists among members in the community (6--8). In 2008, the index cases for three of four measles outbreaks outbreaks in small geographic areas were in children whose parents had refused vaccine doses (9,10). Measles is not endemic in the United States, and index cases in the measles outbreaks were imported from other counties.

Although a particular state estimate of vaccination coverage might be high overall, geographic areas with underimmunized children can exist within a state when unvaccinated children or children with lower vaccination coverage live in the same geographical location. In this case, vaccination coverage in those areas might not be sufficient to inhibit the widespread transmission of a vaccine-preventable disease (11).

To characterize trends in estimated vaccination coverage among children aged 19--35 months in 257 selected U. S. counties, CDC analyzed 1995--2008 data from the National Immunization Survey (NIS) to determine achievement of Healthy People 2010 objectives of 90% vaccination coverage for individual vaccines and 80% for vaccine series of certain routinely recommended childhood vaccines (12). Data were analyzed to identify increases and decreases in vaccination coverage among children aged 19--35 months in selected counties and associations between county-level vaccination coverage rates and county-level indices of access to care, economic conditions, and demographic composition. Estimated trends in vaccination coverage in small geographic areas such as counties might assist local public health officials with determining the current and past level of vaccination coverage and whether the coverage is likely to increase or decrease if current trends persist. This type of information might help local public health officials improve vaccination coverage.

Methods

NIS is an annual survey conducted by CDC to monitor vaccination coverage rates among U.S. children aged 19--35 months. During 1995--2008, NIS was conducted in all 50 states and the District of Columbia and selected urban areas. Data are collected in NIS in two phases. The first phase is a list-assisted random-digit--dialed telephone survey of households with landline telephones and an age-eligible child (aged 19--35 months). At the conclusion of the interview, the interviewer requests parental permission to contact the children's vaccination providers. The second phase is a mail survey of doctors and other vaccination providers named by the respondent when permission is given. In all survey years during 1995--2008, provider-reported vaccination histories obtained from the mailed survey were used to evaluate vaccination status. During 1995--2008, the response rate (13) of the telephone survey of NIS ranged from 65% to 76%, and the percentages of sampled children with complete telephone interviews having a sufficiently detailed vaccination history returned from vaccination providers to accept as a complete report ranged from 62% to 73%. The response rate of the telephone portion of NIS is the product of the percentage of telephone numbers sampled from NIS list-assisted sampling frame that were determined to be working residential telephone numbers, the percentage of sampled residential telephone numbers that were successfully screened to determine whether the household had children aged 19--25 months, and the percentage of sampled households with children aged 19--35 months that had completed the NIS telephone interview. Detailed descriptions of the statistical methods used by NIS have been published previously (14,15).

Measures of Childhood Vaccination Status

In 2009, 10 vaccines were recommended for routine use among children aged 0--24 months (16). The Advisory Committee on Immunization Practices (ACIP) recommendations for routine administration of childhood vaccines were used to evaluate the vaccination status of sampled children for all seven biennial periods during 1995--2008, regardless of vaccine shortages during which ACIP issued interim recommendations (Box 1). Sampled children were determined to be up to date with respect to selected vaccines if, by the date of the NIS telephone interview, they had been administered ≥4 doses of diphtheria and tetanus toxoids and acellular pertussis or diphtheria and tetanus toxoids and pertussis (DTaP/DTP) vaccine; ≥3 doses of polio vaccine; ≥1 dose of measles, mumps, and rubella (MMR) vaccine; ≥3 doses of Haemophilus influenzae type B (Hib) vaccine; ≥3 doses of hepatitis B vaccine; ≥1 dose of varicella vaccine; ≥2 doses of hepatitis A vaccine; and ≥4 doses of the 7-valent pneumococcal conjugate vaccine (PCV7) (Box 2). For a given survey year, sampled children aged 6--23 months were considered to be up to date for the seasonal influenza vaccine if they were administered 1 dose of the seasonal influenza vaccine during the most recent seasonal influenza season, unless they were not administered an influenza vaccine dose before the most recent influenza season, in which case they required 2 doses of the vaccine during the most recent influenza season (17). Other measures of vaccination coverage that were evaluated include ≥3 doses of DTaP/DTP, ≥3 doses of PCV7, ≥1 dose of the seasonal influenza vaccine, and ≥1 dose of hepatitis A vaccine.

Sample Sizes and Number of Counties with Coverage Estimates

To ensure the confidentiality of survey information during each of the seven biennial periods (1995--1996, 1997--1998, 1999--2000, 2001--2002, 2003--2004, 2005--2006, and 2007--2008), vaccination coverage was estimated only for counties where the sample size of children with sufficient vaccination and health-care provider data from the mailed survey portion of NIS was ≥35 for the combined survey years during the biennial period and ≥14 for each year during the biennial period.

For each of the 257 counties (among the 3,141 counties in the United States) that met the sample size requirement for at least one biennial period, an averaged estimate over the biennial period was calculated. The estimate of the number of children aged 19--35 months as of July 1, 2007, living in the 257 counties was determined from U.S. Census data (18), as well as the rank of those 257 counties according to their population of children aged 19--35 months as of July 1, 2007 (Table 1). In addition, the number of counties for which estimates were reported for each biennial period and vaccine or vaccine series type were calculated (Table 2). Because the sample size in counties fluctuated from year to year, not all counties met the sample size requirement in every biennial period. If not achieved for a biennial period, estimates were reported for fewer than 257 counties (Table 2). During 1995--2008, 185,336 children aged 19--35 months sampled by NIS had adequate provider data and lived in one of the 257 counties where the combined sample size for at least one of the seven biennial periods during 1995--2008 was ≥35.

Statistical Analysis

Coverage rates for the seven biennial periods were estimated using James-Stein statistical methods (19) to obtain estimates with greater precision. James-Stein estimates of vaccination coverage were obtained for each vaccine and vaccine series by averaging the two county-level annual estimates for each biennial period and then, for each biennial period, modeling the averaged estimates using multivariable regression as a function of 35 variables derived from the U.S. Department of Health and Human Services Area Resource File. Estimates were compared with the Healthy People 2010 vaccination coverage objectives of 90% vaccination coverage for individual vaccines and 80% for vaccine series to determine which counties achieved the Healthy People 2010 objectives.

Variables from the Area Resource File, including county-level indices of access to care, economic conditions, and demographic composition (Table 2), were used to evaluate the association between averaged county-level vaccination coverage rates and county-level indices of access to care, economic conditions, and demographic composition. Forward stepwise regression was used to select predictors among the 35 variables to explain variation in the log odds of averaged county estimates.

Among the 257 counties that achieved the sample size requirement for at least two biennial periods, trends were evaluated across time by comparing the difference of the James-Stein composite estimate for the earliest biennial period with the most recent biennial period. A p value of <0.05 from a one-sided statistical z score test was considered statistically significant.

Although comparison of the 1995--1996 and 2007--2008 biennial periods was preferred, certain counties did not have large enough sample sizes to protect the confidentiality of survey respondents during these periods. Therefore, the trend analysis included counties that met the sample size requirement for at least two biennial periods at any time during 1995--2008 (comparing the earliest and most recent periods), and the overall number of counties used to examine trends differed from the number of counties studied (Table 3).

Results

Representation of Selected Counties

During the 2007--2008 biennial period, a total of 20,552 children aged 19--35 months who were sampled by NIS had 1) sufficient provider data returned from the mail survey sent to the vaccination providers of the sampled children and 2) lived in the 193 counties where the sample size was ≥35 for the combined years and ≥14 for each survey year. During the 2007--2008 biennial period, the percentage of children aged 19--35 months living in these 193 counties comprised 49% of all children aged 19--35 months living in the United States. County-level estimates from the 2007--2008 biennial period includes 106 of the 150 counties with the greatest number of children aged 19--35 months as of July 1, 2007, as estimated from U.S. Census data.

Estimated County-Level Vaccination Coverage for Individual Vaccines During 2007--2008

During the 2007--2008 biennial period, estimated vaccination coverage ranges were as follows for individual vaccines: ≥3 doses of DTaP/DTP ranged from 91.1% in Clark County, Nevada, to 97.4% in New York County, New York (Table 4); ≥4 doses of DTaP/DTP ranged from 72.2% in Clark County, Nevada, to 95.6% in Grafton County, New Hampshire (Table 5); ≥3 doses of polio ranged from 86.8% in Pierce County, Washington, to 96.8% in Washington County, Rhode Island (Table 6); ≥1 dose of MMR ranged from 86.4% in Clark County, Nevada, to 96.6% in Suffolk County, Massachusetts (Table 7); ≥3 doses of Hib ranged from 79.2% in San Juan County, New Mexico, to 96.5% in Suffolk County, Massachusetts (Table 8); ≥3 doses of hepatitis B vaccine ranged from 85.8% in Clark County, Nevada, to 96.2% in New Castle, Delaware (Table 9); ≥1 dose of varicella vaccine ranged from 74.9% in Flathead County, Montana, to 95.0% in Hartford County, Connecticut (Table 10); ≥4 doses of PCV7 ranged from 57.8% in Hinds County, Mississippi, to 91.0% in Howard County, Maryland (≥3 doses also was measured) (Tables 11 and 12); ≥1 dose of the seasonal influenza vaccine ranged from 22.2% in El Paso County, Texas, to 68.8% in New York County, New York (Table 13); the required number of doses to be up-to-date on the seasonal influenza vaccine ranged from 10.2% in El Paso County, Texas, to 55.7% in New York, New York (Table 14); ≥1 dose of hepatitis A vaccine ranged from 24.2% in Gallatin County, Montana, to 88.6% in Dona Ana County, New Mexico (Table 15); and ≥2 doses of hepatitis A vaccine ranged from 17.5% in Sedgwick County, Kansas, to 47.6% in El Paso County, Texas (Table 16).

County-Level Trends

During the first and last biennial periods for which James-Stein estimates were available, statistically significant increases in estimated vaccination coverage occurred in 27 of 233 counties (12%) with ≥4 doses of DTaP; 38 of 233 counties (16%) with ≥3 doses of polio vaccine; eight of 233 counties (3%) with ≥1 dose of MMR; nine of 233 counties (4%) with ≥3 doses of Hib; 193 of 233 counties (83%) with ≥3 doses of hepatitis B vaccine; 228 of 232 counties (98%) with ≥1 dose of varicella vaccine; and 187 of 192 counties (97%) with ≥4 doses of PCV7. For the vaccination series, statistically significant increases occurred in 29 of 233 counties (12%) with 4:3:1; in 30 of 233 counties (13%) with 4:3:1:3; in 159 of 233 counties (68%) with 4:3:1:3:3; in 139 of 213 counties (65%) with 4:3:1:3:3:1; and in 181 of 192 counties (94%) with 4:3:1:3:3:1:4.

In six of 233 counties, statistically significant decreases occurred in the estimated percentage of administered doses or vaccination coverage rate for certain vaccines and vaccine series: ≥4 doses of the DTaP/DTP vaccine (one county: Collin County, Texas); ≥3 doses of the Hib vaccine (five counties: Hartford County, Connecticut; Pennington County, South Dakota; King County, Washington; Laramie County, Wyoming; Sweetwater County, Wyoming); the 4:3:1 series (one county: Collin County, Texas); and the 4:3:1:3 series (one county: Collin County, Texas).

Achievement of Healthy People 2010 Objectives During 2007--2008

For individual vaccines recommended during the 2007--2008 biennial period, the number of counties that achieved the Healthy People 2010 objective of 90% coverage for individual vaccines were as follows: 15 of 193 counties (8%) for ≥4 doses of DTaP (Table 5), 179 of 193 counties (93%) for ≥3 doses of polio vaccine (Table 6), 166 of 193 counties (86%) for ≥1 dose of MMR (Table 7), 137 of 193 counties (71%) for ≥3 doses of Hib (Table 8), 182 of 193 counties (94%) for ≥3 doses of hepatitis B vaccine (Table 9), 97 of 193 counties (50%) for ≥1 dose of varicella vaccine (Table 10), and one of 193 counties (<1%) for ≥4 doses of PCV7 (Table 12). Among the counties that did not achieve the Healthy People 2010 vaccination coverage objective of 90% coverage for DTaP, the estimated coverage rates ranged from <1 to 9.9 percentage points lower than the coverage objective; for MMR, coverage ranged from <1 to 3.6 percentage points lower than the objective; for Hib, coverage ranged from <1 to 7.6 percentage points lower than the objective; for hepatitis B vaccine, coverage ranged from <1 to 4.2 percentage points lower than the objective; and for varicella vaccine, coverage ranged from <1 to 9.0 percentage points lower than the objective.

County-level estimates of the 3:3:1 series (Table 17) provide an estimate of what coverage would be in those counties had all children who received 3 doses of DTaP also received the recommended fourth dose. For vaccine series recommended during the most recent 2007--2008 biennial period, the number of counties achieving the Healthy People 2010 objective of 80% coverage was 151 of 193 counties (77%) for the 4:3:1 series (Table 18), 113 of 193 counties (58%) for the 4:3:1:3 series (Table 19), 77 of 193 counties (40%) for the 4:3:1:3:3 series (Table 20), 30 of 193 counties (16%) for the 4:3:1:3:3:1 series (Table 21), and two of 193 counties (1%) for the 4:3:1:3:3:1:4 series (Table 22). Among the counties that did not achieve the Healthy People 2010 objective for the 4:3:1 series, vaccination coverage rates ranged from <1 to 9.2 percentage points lower than the coverage objective; for the 4:3:1:3 series, coverage ranged from <1 to 9.2 percentage points lower than the objective; for the 4:3:1:3:3 series, coverage ranged from <1 to 9.5 percentage points lower than the coverage objective; and for the 4:3:1:3:3:1 series, coverage ranged from <1 to 9.8 percentage points below the coverage objective.

Association of County-Level Factors with Estimated County-Level Vaccination Coverage Rates During 2007--2008

In fitting the forward stepwise regressions to obtain modeled estimates of the log-odds of county-level vaccination coverage rates for the James-Stein estimates, counties with lower estimated vaccination coverage rates had higher per capita persons in poverty, had higher percentages of black children among children aged <5 years, had a higher number of pediatric intensive care beds per capita, were designated as a nonmetropolitan county with an economy dependent on recreation activities, or were designated as experiencing housing stress (Table 2). Counties with housing stress are defined by the U.S. Department of Agriculture Economic Research Service (USDA ERS) as those in which ≥30% of households meet one or more of the following housing conditions: lack of complete plumbing, lack of complete kitchen, pay ≥30% percent of income for owner costs or rent, or more than one person per room (20). In general, counties with higher estimated vaccination coverage rates were designated as having a higher number of pediatricians per capita, having higher per capita income, having a higher number of Hispanic persons per capita, being designated as having a service-dependent economy, or having a higher number of persons per capita living in group quarters (e.g., college residence halls, residential treatment centers, skilled nursing facilities, group homes, military barracks, correctional facilities, workers' dormitories, and facilities for persons experiencing homelessness) (Table 2).

Discussion

During 2007--2008, the 193 counties included in this report included 49.0% of the population of children aged 19--35 months in the United States and 106 of the 150 most populous counties. With the exception of the hepatitis A vaccine (for which estimates of county-level vaccination coverage were available for only one biennial period), significant increases in county-level estimated vaccination coverage occurred for all the individual vaccines and vaccine series from the earliest and latest biennial periods for which estimates were available. County-level increases for individual vaccines ranged from 3.6% for MMR to 71.4% for varicella vaccine. The percentage of counties with significant increases in county-level vaccination coverage rates was greater for the more recently recommended vaccines, varicella and PCV7, and for the vaccine series that included varicella vaccine and PCV7. However, significant increases in estimated county-level vaccination coverage rates occurred in a moderate number of counties for individual vaccines that were recommended before 1995.

The Healthy People 2010 vaccination coverage objective of 90% for individual vaccines was achieved for a majority of the 193 selected counties during the 2007--2008 biennial period for the recommended number of doses for polio, MMR, Hib, hepatitis B, and varicella vaccines. In December 2007, a shortage of the Hib vaccine began and continued until mid-2009 (21,22). Research is underway to evaluate the extent to which Hib coverage decreased during the shortage.

Since licensure of hepatitis A vaccine during 1995--1996, the hepatitis A childhood immunization strategy has been implemented incrementally, beginning with the 1996 recommendation to vaccinate children living in communities with the highest disease rates, continuing in 1999 with recommendations for vaccination of children living in states, counties, and communities with consistently high hepatitis A rates, and culminating in 2006 with the recommendation for routine hepatitis A vaccination of children nationwide (23). Healthy People 2010 vaccination coverage objectives were not specified for hepatitis A vaccine. However, a vaccination coverage objective of 60% has been proposed for the Healthy People 2020 objective (24) for national hepatitis A vaccine coverage.

The findings in this report indicate that higher county-level estimated vaccination coverage is associated with greater access to primary care (e.g., more pediatricians per capita). In addition, high county-level vaccination coverage rates were found to be positively associated with per capita living in group quarters. Because the per capita living in group quarters variable used measures the extent to which a county provides housing, custodial, medical, and other services to residents who live in group quarters, the variable might provide an indirect measure of the extent to which the infrastructure of a county is organized to provide access to other medical services for other county residents (e.g., primary care services to infants). At the county level, per capita income was found to be positively associated with higher vaccination coverage rates. In other research, family income has been found to be a significant predictor of whether individual children have received all recommended childhood vaccines (25,26).

County-level factors associated with lower county-level estimated vaccination coverage include correlates of poverty. In particular, lower county-level vaccination coverage rates were found to be associated with higher levels of housing stress. Because the housing stress variable measures the extent to which ≥30% of the residents in a county live in substandard housing conditions or pay a disproportionate amount of their income for rent or mortgage, the variable can be considered an indicator of county-level poverty. Poverty is significantly correlated with lower levels of vaccination coverage (25,26). In counties where housing stress is pervasive, lower county-level estimates of vaccination coverage among infants are likely (27).

Lower county-level coverage also was associated with a higher number of pediatric intensive care beds per capita. This finding might be a result of counties allocating resources for care at hospitals rather than for primary care at medical facilities where vaccinations are administered.

The Vaccines for Children Program, implemented during 1994, was designed to mitigate the effect of the cost of childhood vaccines by providing vaccines at no cost to children entitled to the program. In 2009, VFC children had vaccination coverage levels that were similar to but slightly below coverage levels attained by fully insured children. However, determining what the coverage level would be without the VFC program is not possible.

Because the data in this report were obtained from a large national survey, the data were pooled for 2 consecutive years, and the James-Stein estimation method was used, precise estimates of vaccination coverage for many counties were obtained, making increasing trends in counties easier to detect with higher statistical power (27). In addition, ACIP definitions were used for up-to-date vaccination status for routine vaccine administration. During a vaccine shortage, ACIP usually suspends its recommendations for the routinely recommended number of doses and issues interim recommendations that require fewer doses. Therefore, the up-to-date status of children in this report was determined using ACIP routine recommendations that are used when no shortages exist, rather than ACIP interim recommendations that temporarily decrease the number of vaccine doses until a shortage has been resolved.

The findings in this report are subject to at least five limitations. First, NIS has moderate response rates, and nonresponse bias might have resulted in an overestimation of vaccination coverage. However, the statistical methods of NIS (15) are designed to reduce potential nonresponse bias, and some research suggests that the bias in NIS might be small (28). Second, NIS is a survey of children living in households with landline telephones. Therefore, the results in this report might not be generalizable to children who live in households with no telephone service or in households with cellular telephones but no landline. However, recent evidence suggests that bias in surveys that only sample households with landline telephones might be small (29,30). Third, counties with ≥90% vaccination coverage for individual vaccines and ≥80% vaccination coverage for vaccine series were categorized as meeting the Healthy People 2010 vaccination coverage objectives. In some counties, the results have wide confidence intervals, which indicates that those estimates are less precise. Fourth, because the county coverage estimates for a biennial period are reported only when the sample size during the biennial period is ≥35, the number of biennial periods used to track trends in coverage varied from county to county. From two to seven biennial estimates are available to track trends depending on the sample size for each biennial period. Because the number of estimates available for a trend analysis was small, a simple method for evaluating whether coverage had increased or decreased over the time period covered by those biennial estimates was used, in which the two biennial estimates at the beginning and end of that period were compared. Those two biennial estimates do not necessarily correspond to the first and last biennial periods during 1995--2008. As additional years of NIS data become available, more sophisticated trend analyses might be conducted to allow the evaluation of differential trends between counties for the same vaccine and to assess whether vaccination coverage increased at certain points but decreased thereafter. Finally, of the approximately 2,300 of 3,141 counties in the United States that were sampled by NIS during the 2007--2008 biennial period, only 193 counties met the sample size requirement. However, those counties represented approximately 49% of all children aged 19--35 months in the United States, and the estimates of vaccination coverage among children living in all of those counties were very close to the estimated vaccination coverage for the United States. However, a more careful analysis of counties that did not meet the sample size requirement is merited when sufficient sample size has accrued over time.

A goal of a vaccination program is to maintain a sufficiently high level of vaccination coverage to minimize the effects of vaccine-preventable diseases. The Healthy People 2010 and Healthy People 2020 (31) vaccination coverage objectives are milestones toward achieving high levels of vaccination coverage. Those milestones must be achieved in small areas (e.g., counties and communities) to eventually achieve high levels of vaccination coverage for all 50 states and the District of Columbia. Surveillance of vaccination coverage in small geographic areas might be useful for local health authorities to identify areas with low vaccination coverage and in need of policy or program intervention and might further decrease actual and potential morbidity from vaccine-preventable diseases. County estimates from NIS can supplement other local area methods of assessment, including Immunization Information Systems, retrospective school assessment surveys, and area-specific telephone or household surveys. The Guide to Community Preventive Services (32) provides a summary of interventions that have been evaluated to increase community vaccination coverage. Interventions that have been found to be effective include provider reminder-recall systems that recall parents to clinics to administer missed doses to children, assessment and feedback for vaccination providers that retrospectively evaluates the performance of providers in delivering one or more vaccinations to a client population, and use of Immunization Information Systems at the point of clinical care and to aid in surveillance and investigations of vaccination coverage (33).

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  24. US Department of Health and Human Services. Healthypeople.gov. 2020 topics & objectives. IID-7.8. Washington, DC: US Department of Health and Human Services; 2011. Available at http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=23. Accessed March 9, 2011.
  25. Klevens RM, Luman ET. Children living in and near poverty. Am J Prev Med 2001;20(4 Suppl):41--6.
  26. Smith PJ, Jain N, Stevenson J, et al. Progress in timely vaccination coverage among children living in low-income households. Arch Pediatr Adolesc Med 2009;63:462--9.
  27. Smith PJ, Singleton JA. Assessment of vaccination coverage for 181 selected counties in the U.S.: attainment of the healthy people 2010 goals and association with county-level indices of access to care, economic conditions, and demographic composition. Public Health Rep 2008;123:1--25.
  28. Molinari NA, Wolter K, Skalland B, et al. Quantifying bias in a health survey: modeling total survey error in the National Immunization Survey. Stat Med 2011;30:505--14.
  29. Blumberg SJ, Luke JV. Coverage bias in traditional telephone surveys of low-income and young adults. Public Opin Q 2007;71:734--49.
  30. Blumberg SJ, Luke JV. Reevaluating the need for concern regarding noncoverage bias in landline surveys. Am J Public Health 2009;99:1806--10.
  31. US Department of Health and Human Services. Healthypeople.gov. 2020 topics & objectives. Immunization and infectious diseases. Washington, DC: US Department of Health and Human Services; 20111. Available at http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=23. Accessed March 9, 2011.
  32. CDC; Task Force on Community Preventive Services. Guide to community preventive services: the community guide. Atlanta, GA: Task Force on Community Preventive Services. Available at http://www.thecommunityguide.org. Accessed December 15, 2010.
  33. Briss PA, Rodewald LE, Hinman AR, et al. Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. Am J Prev Med 2000;18:97--140.


BOX 1. Biennial periods in which recommended childhood vaccines were included in the National Immunization Survey during 1995--2008

DTP/DTaP: 1995--2008*

Polio: 1995--2008

MMR: 1995--2008

Hib: 1995--2008

Hepatitis B: 1995--2008

Varicella : 1997--2008

PCV7§: 2003--2008

Seasonal influenza : 2003--2008

Hepatitis A**: 2003--2008

_______________________________

* Includes the following biennial periods: 1995--1996, 1997--1998, 1999--2000, 2001--2002, 2003--2004, 2005--2006, and 2007--2008.

Varicella vaccine was recommended by ACIP in 1996. (Source: CDC. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 1996;45[No. RR-11].)

§ PCV7 was recommended by ACIP in 2000. (Source: CDC. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2000;49[No. RR-9].)

The initial 2002 ACIP recommendation for routine administration during the 2001--2003 season with 1 or 2 doses of influenza vaccine for children aged 6--23 months encouraged vaccination of this age group when feasible. (Source: CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2002;51[No. RR-3].) In 2004, ACIP recommended 1 or 2 doses of influenza vaccination for children aged 6--23 months. (Source: CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2004;53[No. RR-6].) Influenza vaccination coverage estimates in each biennial period represent an average of two influenza seasons (e.g., the 2003--2004 biennial period represents an average of the 2002--03 and 2003--04 influenza seasons as estimated by the 2003 and 2004 NIS data, respectively).

** Hepatitis A vaccine was recommended by ACIP for routine administration in 2006. (Source: CDC. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2006;55[No. RR-7].)



BOX 2. Vaccine components of selected vaccine series

4:3:1 series: ≥4 doses DTaP/DTP vaccine, ≥3 doses of polio vaccine, ≥1 dose of MMR vaccine

4:3:1:3 series: 4:3:1 plus ≥3 doses Hib vaccine

4:3:1:3:3 series: 4:3:1:3 plus ≥3 doses of hepatitis B vaccine

4:3:1:3:3:1 series: 4:3:1:3:3 plus ≥1 dose of varicella vaccine

4:3:1:3:3:1:4 series: 4:3:1:3:3:1 plus ≥4 doses of PCV7



TABLE 1. Counties with vaccination coverage estimates (N = 257), by number of children aged 19--35 months and population rank --- United States, 1995--2008

County/Area

No. of children aged 19--35 months

Population rank*

Jefferson, Alabama

12,806

95

Madison, Alabama

5,662

215

Mobile, Alabama

8,361

148

Montgomery, Alabama

4,789

249

Shelby, Alabama

3,980

293

Anchorage, Alaska

6,126

196

Fairbanks North Star, Alaska

2,299

479

Kenai Peninsula, Alaska

900

963

Matanuska-Susitna, Alaska

1,675

616

Cochise, Arizona

2,543

439

Coconino, Arizona

2,703

413

Maricopa, Arizona

91,761

4

Mohave, Arizona

3,491

326

Pima, Arizona

19,022

48

Pinal, Arizona

6,516

188

Yavapai, Arizona

3,250

350

Yuma, Arizona

4,778

250

Benton, Arkansas

4,666

258

Pulaski, Arkansas

8,306

150

Washington, Arkansas

4,669

257

Alameda, California

28,378

23

Los Angeles, California

201,522

1

Orange, California

59,594

6

Riverside, California

46,871

9

San Bernardino, California

46,713

10

San Diego, California

62,746

5

San Mateo, California

13,338

88

Santa Clara, California

35,963

17

Adams, Colorado

10,768

114

Arapahoe, Colorado

11,617

104

Boulder, Colorado

4,875

242

Denver, Colorado

14,477

74

Douglas, Colorado

6,310

192

El Paso, Colorado

12,204

99

Jefferson, Colorado

8,711

139

Larimer, Colorado

4,914

239

Weld, Colorado

5,784

207

Fairfield, Connecticut

16,472

62

Hartford, Connecticut

15,008

71

New Haven, Connecticut

14,642

72

New London, Connecticut

4,439

270

Kent, Delaware

3,167

364

New Castle, Delaware

10,155

121

Sussex, Delaware

3,358

336

District of Columbia

10,261

120

Broward, Florida

32,234

19

Duval, Florida

18,435

52

Hillsborough, Florida

23,907

30

Dade, Florida

44,556

11

Orange, Florida

23,094

31

Palm Beach, Florida

21,582

36

Pinellas, Florida

12,998

91

Cobb, Georgia

15,421

68

DeKalb, Georgia

15,527

67

Fulton, Georgia

20,310

43

Gwinnett, Georgia

19,582

46

Hawaii, Hawaii

3,196

358

Honolulu, Hawaii

17,649

54

Maui, Hawaii

2,596

432

Ada, Idaho

8,081

157


TABLE 1. (Continued) Counties with vaccination coverage estimates (N = 257), by number of children aged 19--35 months and population rank --- United States, 1995--2008

County/Area

No. of children aged 19--35 months

Population rank*

Bannock, Idaho

2,044

527

Bonneville, Idaho

2,598

431

Canyon, Idaho

4,909

240

Kootenai, Idaho

2,423

462

Twin Falls, Idaho

1,641

623

Cook, Illinois

107,617

2

DuPage, Illinois

17,014

56

Lake, Illinois

14,551

73

Will, Illinois

15,174

70

Allen, Indiana

7,512

170

Hamilton, Indiana

5,831

204

Lake, Indiana

9,933

122

Marion, Indiana

20,522

40

Linn, Iowa

4,047

292

Polk, Iowa

9,434

131

Scott, Iowa

3,280

346

Johnson, Kansas

10,963

110

Sedgwick, Kansas

10,815

111

Shawnee, Kansas

3,530

324

Fayette, Kentucky

5,405

223

Jefferson, Kentucky

13,826

81

Caddo, Louisiana

5,162

228

East Baton Rouge, Louisiana

8,402

147

Jefferson, Louisiana

7,594

165

Lafayette, Louisiana

4,268

283

Orleans, Louisiana

3,570

317

St. Tammany, Louisiana

4,354

275

Androscoggin, Maine

1,915

552

Aroostook, Maine

982

905

Cumberland, Maine

4,373

272

Kennebec, Maine

1,767

585

Penobscot, Maine

2,290

480

York, Maine

3,025

372

Anne Arundel, Maryland

9,653

130

Baltimore, Maryland

13,665

84

Frederick, Maryland

4,473

267

Harford, Maryland

4,297

280

Howard, Maryland

4,946

237

Montgomery, Maryland

18,663

51

Prince George's, Maryland

17,071

55

City of Baltimore, Maryland

13,162

90

Bristol, Massachusetts

9,022

134

Essex, Massachusetts

12,848

93

Hampden, Massachusetts

7,995

160

Middlesex, Massachusetts

24,021

29

Norfolk, Massachusetts

10,804

113

Plymouth, Massachusetts

8,568

144

Suffolk, Massachusetts

12,342

96

Worcester, Massachusetts

13,673

83

Kent, Michigan

13,170

89

Macomb, Michigan

14,213

77

Oakland, Michigan

20,567

39

Wayne, Michigan

38,216

15

Anoka, Minnesota

6,312

190

Dakota, Minnesota

7,885

163

Hennepin, Minnesota

22,663

33

Ramsey, Minnesota

9,784

127

Washington, Minnesota

4,372

273

Harrison, Mississippi

3,596

316

Hinds, Mississippi

5,692

213


TABLE 1. (Continued) Counties with vaccination coverage estimates (N = 257), by number of children aged 19--35 months and population rank --- United States, 1995--2008

County/Area

No. of children aged 19--35 months

Population rank*

Greene, Missouri

4,797

247

Jackson, Missouri

14,458

75

Jefferson, Missouri

4,111

288

St. Charles, Missouri

6,740

184

St. Louis, Missouri

16,829

59

City of St. Louis, Missouri

7,359

175

Cascade, Montana

1,614

628

Flathead, Montana

1,601

631

Gallatin, Montana

1,633

625

Lewis and Clark, Montana

1,019

873

Missoula, Montana

1,705

605

Yellowstone, Montana

2,691

418

Douglas, Nebraska

11,697

101

Lancaster, Nebraska

5,757

209

Sarpy, Nebraska

3,554

319

Clark, Nevada

41,370

13

Washoe, Nevada

8,198

154

Grafton, New Hampshire

1,161

790

Hillsborough, New Hampshire

7,215

177

Merrimack, New Hampshire

2,214

497

Rockingham, New Hampshire

4,982

235

Strafford, New Hampshire

2,017

532

Bergen, New Jersey

13,838

79

Burlington, New Jersey

7,537

166

Camden, New Jersey

9,812

125

Essex, New Jersey

16,173

63

Hudson, New Jersey

11,309

108

Middlesex, New Jersey

14,292

76

Monmouth, New Jersey

10,730

115

Morris, New Jersey

8,352

149

Ocean, New Jersey

10,807

112

Passaic, New Jersey

10,401

118

Union, New Jersey

10,384

119

Bernalillo, New Mexico

13,369

86

Dona Ana, New Mexico

4,791

248

Sandoval, New Mexico

2,257

485

San Juan, New Mexico

2,711

411

Santa Fe, New Mexico

2,340

472

Bronx, New York

30,960

20

Erie, New York

13,797

82

Kings, New York

53,672

8

Monroe, New York

11,837

100

Nassau, New York

20,696

38

New York, New York

27,666

24

Queens, New York

39,770

14

Suffolk, New York

26,079

25

Westchester, New York

16,936

58

Durham, North Carolina

5,787

206

Guilford, North Carolina

8,901

136

Mecklenburg, North Carolina

20,314

42

Wake, North Carolina

18,748

49

Burleigh, North Dakota

1,372

701

Cass, North Dakota

2,694

417

Grand Forks, North Dakota

1,198

773

Ward, North Dakota

1,282

736

Cuyahoga, Ohio

22,725

32

Franklin, Ohio

24,164

27

Hamilton, Ohio

16,011

64

Lucas, Ohio

8,696

140

Montgomery, Ohio

9,855

124


TABLE 1. (Continued) Counties with vaccination coverage estimates (N = 257), by number of children aged 19--35 months and population rank --- United States, 1995--2008

County/Area

No. of children aged 19--35 months

Population rank*

Cleveland, Oklahoma

4,065

291

Oklahoma, Oklahoma

16,958

57

Tulsa, Oklahoma

13,393

85

Clackamas, Oregon

5,808

205

Lane, Oregon

5,128

231

Marion, Oregon

6,706

186

Multnomah, Oregon

13,828

80

Washington, Oregon

11,085

109

Allegheny, Pennsylvania

18,190

53

Delaware, Pennsylvania

9,674

129

Lancaster, Pennsylvania

9,747

128

Montgomery, Pennsylvania

13,350

87

Philadelphia, Pennsylvania

30,360

21

Kent, Rhode Island

2,476

453

Newport, Rhode Island

1,168

787

Providence, Rhode Island

11,386

106

Washington, Rhode Island

1,711

603

Charleston, South Carolina

6,712

185

Greenville, South Carolina

8,593

143

Horry, South Carolina

4,492

265

Richland, South Carolina

6,909

181

Spartanburg, South Carolina

5,148

230

York, South Carolina

4,107

289

Minnehaha, South Dakota

3,813

301

Pennington, South Dakota

2,128

508

Davidson, Tennessee

12,820

94

Hamilton, Tennessee

5,723

212

Knox, Tennessee

7,391

173

Shelby, Tennessee

20,004

45

Bexar, Texas

38,010

16

Collin, Texas

16,619

60

Dallas, Texas

59,454

7

El Paso, Texas

20,365

41

Harris, Texas

98,100

3

Hidalgo, Texas

24,153

28

Tarrant, Texas

41,645

12

Travis, Texas

22,315

35

Cache, Utah

3,283

345

Davis, Utah

8,171

156

Salt Lake, Utah

26,047

26

Utah, Utah

15,821

65

Weber, Utah

5,602

216

Addison, Vermont

521

1,452

Bennington, Vermont

516

1,457

Chittenden, Vermont

2,305

478

Franklin, Vermont

868

989

Lamoille, Vermont

408

1,685

Orange, Vermont

407

1,687

Rutland, Vermont

843

1,015

Washington, Vermont

851

1,008

Windham, Vermont

613

1,297

Windsor, Vermont

782

1,074

Fairfax, Virginia

19,255

47

Loudoun, Virginia

7,513

169

Virginia Beach, Virginia

8,603

142

Clark, Washington

8,195

155

King, Washington

32,833

18

Kitsap, Washington

4,104

290

Pierce, Washington

15,339

69

Snohomish, Washington

12,867

92


TABLE 1. (Continued) Counties with vaccination coverage estimates (N = 257), by number of children aged 19--35 months and population rank --- United States, 1995--2008

County/Area

No. of children aged 19--35 months

Population rank*

Spokane, Washington

8,213

151

Thurston, Washington

3,965

294

Whatcom, Washington

3,106

368

Yakima, Washington

5,947

201

Kanawha, West Virginia

3,268

347

Brown, Wisconsin

4,696

255

Dane, Wisconsin

8,606

141

Milwaukee, Wisconsin

20,927

37

Outagamie, Wisconsin

3,263

348

Waukesha, Wisconsin

6,082

198

Albany, Wyoming

523

1,450

Campbell, Wyoming

911

953

Fremont, Wyoming

778

1,077

Laramie, Wyoming

1,810

576

Natrona, Wyoming

1,432

677

Sweetwater, Wyoming

908

957

Uinta, Wyoming

443

1,599

* Population rank among 3,141 counties in the United States according to the population of children aged 19--35 months as of July 1, 2007. Vaccination coverage was estimated for counties where the sample size of children with sufficient vaccination and health-care provider data from the mailed survey portion of the National Immunization Survey was ≥35 for the combined survey years during the biennial period and ≥14 for each year during the biennial period. For each of the 257 counties that that met the sample size requirement for at least one biennial period, an averaged estimate over the biennial period was calculated.


TABLE 2. Predictors of low or high vaccination coverage, by vaccine and vaccine series*

Indices used as candidates for county-level predictors§

Predicted coverage levels for vaccines and vaccine series

≥3 doses DTaP/DTP

≥4 doses DTaP/DTP

≥3 doses polio

≥1 dose MMR

≥3 doses Hib

≥3 doses hepatitis B

≥1 dose varicella

Indices of economic conditions

Urban influence

---

---

---

---

---

---

---

Farming-dependent county

---

---

---

---

---

---

---

Mining-dependent county

---

---

---

---

---

---

---

Manufacturing-dependent county

---

---

---

---

---

---

---

Federal/state government-dependent county

---

---

---

---

---

---

---

Service-dependent county

---

---

High

---

High

---

---

Nonspecialized-dependent county

---

---

---

---

---

---

---

Housing stress**

Low

---

Low

---

---

Low

Low

Low education††

---

---

---

---

---

---

---

Persistent poverty§§

---

---

---

---

---

---

---

Population loss¶¶

---

---

---

---

---

---

---

Nonmetro recreation***

---

---

---

---

---

---

---

Retirement destination†††

---

---

---

---

---

---

---

Indices of access to care§§§

Per capita pediatricians

---

High

---

High

---

---

High

Per capita general practitioners

---

---

---

---

---

---

---

Per capita hospitals

---

---

---

---

---

---

---

Per capita children's hospitals

---

---

---

---

---

---

---

Per capita bassinets set up

---

---

---

---

---

---

---

Per capita pediatric intensive care beds set up

---

---

---

---

---

---

---

Indices of demographic composition§§§

Percentage white children among children aged <5 yrs

---

---

---

---

---

---

---

Percentage black children among children aged <5 yrs

---

---

---

---

---

---

---

Percentage American Indian children among children aged <5 yrs

---

---

---

---

---

---

---

Percent Asian children among children aged <5 yrs

---

---

---

---

---

---

---

Percentage Hispanic children among children aged <5 yrs

---

---

---

---

---

---

---

Per capita white population

---

---

---

---

---

---

---

Per capita black population

---

---

---

---

---

---

Low

Per capita American Indian population

---

---

---

---

Low

---

---

Per capita Asian population

---

---

---

---

---

---

---

Per capita Hispanic population

---

---

---

---

---

---

High

Per capita single-family households

---

---

---

---

---

---

---

Per capita living in group quarters¶¶¶

---

---

---

---

---

---

---

Average family size

---

---

---

---

---

---

---

Per capita female head of household

---

---

---

---

---

---

---

Per capita income

---

---

---

---

---

---

---

Per capita persons aged <18 yrs in poverty

---

Low

---

---

---

---

Low


TABLE 2. (Continued) Predictors of low or high vaccination coverage, by vaccine and vaccine series*

Indices used as candidates for county-level predictors§

Predicted coverage levels for vaccines and vaccine series

≥3 doses PCV7

≥4 doses PCV7

≥1 dose seasonal influenza

Up to date on seasonal influenza

≥1 dose hepatitis A

≥2 doses hepatitis A

Indices of economic conditions

Urban influence

---

---

---

---

---

---

Farming-dependent county

---

---

---

---

---

---

Mining-dependent county

---

---

---

---

---

---

Manufacturing-dependent county

---

---

---

---

---

---

Federal/state government-dependent county

---

---

---

---

---

---

Service-dependent county

---

---

---

---

---

---

Nonspecialized-dependent county

---

---

---

---

---

---

Housing stress**

Low

Low

Low

---

---

---

Low education††

---

---

---

---

---

---

Persistent poverty§§

---

---

---

---

---

---

Population loss¶¶

---

---

---

---

---

---

Nonmetro recreation***

---

---

---

---

Low

---

Retirement destination†††

---

---

---

---

---

---

Indices of access to care§§§

Per capita pediatricians

High

High

---

---

---

---

Per capita general practitioners

---

---

---

---

High

High

Per capita hospitals

---

---

---

---

---

---

Per capita children's hospitals

---

---

---

---

---

---

Per capita bassinets set up

---

---

---

---

---

---

Per capita pediatric intensive care beds set up

Low

Low

---

---

---

---

Indices of demographic composition§§§

Percentage white children among children aged <5 yrs

---

---

---

---

---

---

Percentage black children among children aged <5 yrs

---

---

Low

---

---

---

Percentage American Indian children among children aged <5 yrs

---

---

---

---

---

---

Percent Asian children among children aged <5 yrs

---

---

---

---

---

---

Percentage Hispanic children among children aged <5 yrs

---

---

---

---

High

High

Per capita white population

---

---

---

---

---

---

Per capita black population

---

---

---

---

---

Per capita American Indian population

---

---

---

---

---

---

Per capita Asian population

---

---

---

---

---

---

Per capita Hispanic population

---

---

---

---

---

Per capita single-family households

---

---

---

---

---

---

Per capita living in group quarters¶¶¶

---

---

High

High

---

---

Average family size

---

---

---

---

---

---

Per capita female head of household

---

---

---

---

---

---

Per capita income

---

---

High

High

---

---

Per capita persons aged <18 yrs in poverty

---

---

---

Low

---

---


TABLE 2. (Continued) Predictors of low or high vaccination coverage, by vaccine and vaccine series*

Indices used as candidates for county-level predictors§

Predicted coverage levels for vaccines and vaccine series

3:3:1

4:3:1

4:3:1:3

4:3:1:3:3

4:3:1:3:3:1

4:3:1:3:3:1:4

Indices of economic conditions

Urban influence

---

---

---

---

---

---

Farming-dependent county

---

---

---

---

---

---

Mining-dependent county

---

---

---

---

---

---

Manufacturing-dependent county

---

---

---

---

---

---

Federal/state government-dependent county

---

---

---

---

---

---

Service-dependent county

---

---

---

---

---

---

Nonspecialized-dependent county

---

---

---

---

---

---

Housing stress**

Low

Low

---

---

---

Low

Low education††

---

---

---

---

---

---

Persistent poverty§§

---

---

---

---

---

---

Population loss¶¶

---

---

---

---

---

---

Nonmetro recreation***

---

---

---

---

---

---

Retirement destination†††

---

---

---

---

---

---

Indices of access to care§§§

Per capita pediatricians

High

High

High

High

High

High

Per capita general practitioners

---

---

---

---

---

---

Per capita hospitals

---

---

---

---

---

---

Per capita children's hospitals

---

---

---

---

---

---

Per capita bassinets set up

---

---

---

---

---

---

Per capita pediatric intensive care beds set up

---

---

---

---

---

Low

Indices of demographic composition§§§

Percentage white children among children aged <5 yrs

---

---

---

---

---

---

Percentage black children among children aged <5 yrs

---

---

---

---

---

---

Percentage American Indian children among children aged <5 yrs

---

---

---

---

---

---

Percent Asian children among children aged <5 yrs

---

---

---

---

---

---

Percentage Hispanic children among children aged <5 yrs

---

---

---

---

---

---

Per capita white population

---

---

---

---

---

---

Per capita black population

---

---

---

---

---

---

Per capita American Indian population

---

---

---

---

---

---

Per capita Asian population

---

---

---

---

---

---

Per capita Hispanic population

---

---

---

---

---

---

Per capita single-family households

---

---

---

---

---

---

Per capita living in group quarters¶¶¶

---

---

---

---

Average family size

---

---

---

---

---

---

Per capita female head of household

---

---

---

---

---

---

Per capita income

---

---

---

---

---

---

Per capita persons aged <18 yrs in poverty

---

---

---

Low

---

---

Abbreviations: DTaP = diphtheria and tetanus toxoids and acellular pertussis; DTP = diphtheria and tetanus toxoids and pertussis; MMR = measles, mumps, and rubella; Hib = Haemophilus influenzae type B; PCV7 = 7-valent pneumococcal conjugate vaccine.

* 3:3:1 = ≥3 doses of DTaP/DTP vaccine, ≥3 doses of polio vaccine, and ≥1 dose of MMR; 4:3:1= ≥4 doses DTaP/DTP vaccine, ≥3 doses of polio vaccine, ≥1 dose of MMR vaccine; 4:3:1:3 = 4:3:1 plus ≥3 doses Hib vaccine; 4:3:1:3:3 = 4:3:1:3 plus ≥3 doses of hepatitis B vaccine, 4:3:1:3:3:1 = 4:3:1:3:3 plus ≥1 dose of varicella vaccine; 4:3:1:3:3:1:4 = 4:3:1:3:3:1 plus ≥4 doses of PCV7.

Low indicates that the regression coefficient from the regression of the log odds of the direct estimate on the predictor variable was negative; high indicates that the regression coefficient was positive.

§ U.S. Department of Agriculture Economic Research Service (ERS) economic-dependent 2004 typology codes are available at http://www.ers.usda.gov/briefing/rurality/typology.

An area with urban influence is categorized by ERS as 1) a county designated as a metropolitan area with ≥1 million residents, 2) a county designated as a metropolitan area with <1 million residents, 3) a micropolitan area (i.e., an urban area based around a core city or town with a population of 10,000--49,999) adjacent to a large metropolitan area, or 4) a noncore adjacent to a large metropolitan area. Information on the ERS urban influence codes is available at http://www.ers.usda.gov/Data/UrbanInfluenceCodes.

** ERS defines counties with housing stress as those in which ≥30% of households meet one or more of the following housing conditions: lack of complete plumbing, lack of complete kitchen, pay ≥30% percent of income for owner costs or rent, or >1 person per room. ERS designations of county-level housing stress are available at http://www.ers.usda.gov/briefing/rurality/typology/maps/housing.htm.

†† ERS defines counties with low education as those in which ≥25% of residents aged 25--64 years have neither a high school diploma nor a general educational development (GED) diploma. ERS designations of county-level low education are available at http://www.ers.usda.gov/briefing/rurality/typology/maps/education.htm.

§§ ERS defines counties with persistent poverty as those in which ≥20% of residents are poor as measured by each of the previous four censuses: 1970, 1980, 1990, and 2000. ERS designations of county-level persistent poverty are available at http://www.ers.usda.gov/briefing/rurality/typology/maps/poverty.htm and http://www.ers.usda.gov/data/typologycodes/2004/all_final_codes.xls.

¶¶ ERS defines population loss (for the year 2000) as counties in which the number of residents decreased both between the 1980 and 1990 censuses and between the 1990 and 2000 censuses. The ERS designations of county-level population loss are available at http://www.ers.usda.gov/briefing/rurality/typology/maps/population.htm.

*** ERS defines nonmetro recreation by a combination of factors, including share of employment or share of earnings in recreation-related industries, share of seasonal or occasional use housing units, and per capita receipts from motels and hotels. ERS designations of nonmetro recreation are available at http://www.ers.usda.gov/briefing/rurality/typology/maps/recreation.htm.

††† ERS defines retirement destination counties as those where the number of residents aged ≥60 years increased by ≥15% during 1990--2000 because of immigration. ERS designations of retirement destinations are at http://www.ers.usda.gov/briefing/rurality/typology/maps/retirement.htm and http://www.ers.usda.gov/data/typologycodes/2004/all_final_codes.xls.

§§§ Source: US Department of Health and Human Services, Health Resources and Services Administration: Area resource file. National county-level health resource information database. Available at http://www.arfsys.com.

¶¶¶ The U.S. Census Bureau defines group quarters as a place where persons live or stay that is normally owned or managed by an entity or organization providing housing or services for the residents. These services might include custodial or medical care as well as other types of assistance, and residency is commonly restricted to those receiving these services. Persons living in group quarters are usually not related to each other. Group quarters include college residence halls, residential treatment centers, skilled nursing facilities, group homes, military barracks, correctional facilities, workers' dormitories, and facilities for persons experiencing homelessness. Additional information is available at http://www.census.gov/acs/www/data_documentation/documentation_main.


TABLE 3. Number of counties included in county-level vaccination coverage estimates, by vaccine and vaccine series and biennial survey period --- United States, 1995--2008

Vaccine or vaccine series

No. of counties

1995--1996

1997--1998

1999--2000

2001--2002

2003--2004

2005--2006

2007--2008

≥3 doses DTaP/DTP

NA

211

215

210

206

171

193

≥4 doses DTaP/DTP

169

211

215

210

206

171

193

≥3 doses polio

169

211

215

210

206

171

193

≥1 dose MMR

169

211

215

210

206

171

193

≥3 doses Hib

169

211

215

210

206

171

193

≥3 doses hepatitis B

169

211

215

210

206

171

193

≥1 dose varicella

NA

211

215

210

206

171

193

≥3 doses PCV7

NA

NA

NA

NA

206

171

193

≥4 doses PCV7

NA

NA

NA

NA

206

171

193

≥1 dose seasonal influenza

NA

NA

NA

NA

124

112

104

Fully vaccinated with seasonal influenza

NA

NA

NA

NA

NA

112

104

≥1 dose hepatitis A

NA

NA

NA

NA

NA

NA

193

≥2 doses hepatitis A

NA

NA

NA

NA

NA

NA

193

3:3:1*

NA

NA

215

210

206

171

193

4:3:1

169

211

215

210

206

171

193

4:3:1:3§

169

211

215

210

206

171

193

4:3:1:3:3

169

211

215

210

206

171

193

4:3:1:3:3:1**

NA

NA

NA

210

206

171

193

4:3:1:3:3:1:4††

NA

NA

NA

NA

206

171

193

Abbreviations: DTaP = diphtheria and tetanus toxoids and acellular pertussis; DTP = diphtheria and tetanus toxoids and pertussis; Hib = Haemophilus influenzae type B; MMR = measles, mumps, and rubella; NA = not available; PCV7 = 7-valent pneumococcal conjugate vaccine.

* Administered ≥3 doses of DTaP/DTP and up to date on the polio and MMR vaccines.

Up to date for DTaP/DTP, polio, and MMR vaccines.

§ Up to date for 4:3:1 and Hib.

Up to date for 4:3:1:3 and hepatitis B.

** Up to date for 4:3:1:3:3 and varicella.

†† Up to date for 4:3:1:3:3:1 and PCV7.


TABLE 4. Estimated vaccination coverage with ≥3 doses of DTaP/DTP vaccine among children aged 19--35 months, by county/area and biennial survey period --- National Immunization Survey, selected counties, United States, 1995--2006*

County/Area

1995--1996

1997--1998

1999--2000

2001--2002

2003--2004

2005--2006

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Jefferson, Alabama

96.5

(±1.1)

96.1

(±1.6)

95.7

(±1.8)

96.4

(±1.3)

96.8

(±0.7)

96.5

(±1.4)

Madison, Alabama

95.0

(±2.6)

95.1

(±2.6)

NA

NA

96.4

(±1.3)

94.9

(±2.5)

96.2

(±1.7)

Mobile, Alabama

94.9

(±2.2)

94.5

(±2.8)

93.9

(±3.5)

96.1

(±1.7)

94.1

(±2.8)

95.5

(±2.3)

Montgomery, Alabama

93.9

(±3.0)

94.8

(±2.8)

NA

NA

NA

NA

NA

NA

NA

NA

Shelby, Alabama

NA

NA

95.2

(±2.7)

96.6

(±1.0)

95.8

(±1.8)

NA

NA

96.1

(±2.0)

Anchorage, Alaska

NA

NA

92.7

(±2.6)

94.2

(±2.4)

95.1

(±1.7)

94.6

(±2.2)

94.5

(±2.3)

Fairbanks North Star, Alaska

NA

NA

94.9

(±2.6)

92.7

(±3.2)

93.1

(±2.6)

93.4

(±2.8)

94.4

(±2.7)

Kenai Peninsula, Alaska

NA

NA

94.7

(±2.7)

NA

NA

NA

NA

NA

NA

NA

NA

Matanuska-Susitna, Alaska

NA

NA

93.7

(±3.0)

92.6

(±3.6)

95.0

(±2.1)

94.5

(±2.5)

94.2

(±2.7)

Cochise, Arizona

92.1

(±3.7)

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Coconino, Arizona

92.1

(±3.6)

NA

NA

NA

NA

94.5

(±2.5)

NA

NA

NA

NA

Maricopa, Arizona

93.0

(±1.9)

91.5

(±2.4)

93.3

(±2.1)

95.8

(±1.3)

94.4

(±1.8)

93.7

(±2.4)

Mohave, Arizona

NA

NA

91.0

(±4.1)

91.1

(±4.2)

NA

NA

NA

NA

NA

NA

Pima, Arizona

93.5

(±2.4)

94.4

(±2.6)

92.2

(±2.9)

95.2

(±1.9)

94.4

(±2.4)

94.1

(±2.9)

Pinal, Arizona

91.8

(±4.0)

93.1

(±3.6)

94.7

(±2.6)

93.7

(±2.6)

93.7

(±3.2)

NA

NA

Yavapai, Arizona

NA

NA

NA

NA

94.2

(±3.0)

95.1

(±2.0)

NA

NA

NA

NA

Yuma, Arizona

92.9

(±3.6)

93.0

(±3.8)

93.6

(±3.5)

95.8

(±1.3)

93.9

(±3.3)

NA

NA

Benton, Arkansas§

91.6

(±3.5)

NA

NA

94.4

(±3.0)

95.5

(±2.0)

95.0

(±2.5)

96.2

(±1.6)

Pulaski, Arkansas

95.6

(±2.1)

92.2

(±3.4)

95.0

(±2.6)

96.7

(±1.5)

94.4

(±2.7)

95.8

(±2.1)

Washington, Arkansas

93.8

(±2.8)

NA

NA

93.2

(±3.3)

NA

NA

NA

NA

93.8

(±2.8)

Alameda, California

NA

NA

94.9

(±2.6)

95.4

(±2.4)

95.7

(±1.9)

95.7

(±1.8)

94.6

(±2.6)

Los Angeles, California§

93.5

(±2.0)

91.9

(±2.4)

93.6

(±2.5)

95.1

(±1.6)

95.8

(±1.6)

96.8

(±1.1)

Orange, California

95.3

(±2.1)

93.2

(±3.5)

94.8

(±2.7)

95.4

(±2.0)

96.1

(±1.9)

95.2

(±2.4)

Riverside, California

NA

NA

93.1

(±3.5)

93.2

(±3.4)

93.7

(±2.6)

NA

NA

94.8

(±2.4)

San Bernardino, California

92.4

(±3.3)

94.1

(±3.1)

93.2

(±3.3)

93.8

(±2.6)

93.6

(±2.2)

95.2

(±1.8)

San Diego, California

93.9

(±1.7)

93.7

(±2.0)

94.3

(±1.8)

94.9

(±1.6)

95.5

(±1.9)

94.8

(±2.7)

San Mateo, California

96.2

(±1.9)

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Santa Clara, California

96.1

(±1.4)

95.3

(±1.6)

95.2

(±1.6)

96.2

(±1.4)

96.7

(±1.3)

NA

NA

Adams, Colorado

94.0

(±2.7)

92.8

(±3.4)

93.0

(±3.5)

94.8

(±2.1)

NA

NA

NA

NA

Arapahoe, Colorado

95.5

(±2.2)

94.7

(±3.0)

95.2

(±2.6)

95.6

(±1.9)

NA

NA

96.7

(±1.8)

Boulder, Colorado

95.9

(±2.0)

94.9

(±2.7)

94.1

(±3.0)

94.3

(±2.2)

95.9

(±2.1)

95.2

(±2.4)

Denver, Colorado

95.2

(±2.2)

93.6

(±3.1)

95.1

(±2.7)

95.9

(±1.8)

NA

NA

NA

NA

Douglas, Colorado

NA

NA

94.9

(±2.9)

94.8

(±3.0)

95.8

(±1.9)

NA

NA

NA

NA

El Paso, Colorado

94.6

(±2.6)

93.9

(±3.0)

92.0

(±3.7)

95.0

(±2.0)

95.5

(±2.2)

94.7

(±2.6)

Jefferson, Colorado

95.4

(±2.2)

94.4

(±3.0)

95.0

(±2.6)

95.1

(±2.0)

95.9

(±2.1)

96.3

(±1.8)

Larimer, Colorado

NA

NA

93.8

(±3.1)

94.1

(±3.0)

NA

NA

95.3

(±2.5)

NA

NA

Weld, Colorado

NA

NA

93.7

(±3.3)

93.9

(±3.3)

94.0

(±2.4)

NA

NA

93.7

(±3.1)

Fairfield, Connecticut

96.7

(±1.1)

94.8

(±2.3)

96.6

(±1.5)

96.9

(±0.6)

97.3

(±1.3)

96.8

(±0.9)

Hartford, Connecticut

96.3

(±1.5)

95.3

(±2.4)

95.3

(±2.1)

96.4

(±1.3)

96.2

(±1.7)

96.5

(±1.7)

New Haven, Connecticut

96.3

(±1.7)

95.7

(±2.0)

92.2

(±3.3)

96.7

(±1.0)

95.9

(±2.0)

95.2

(±2.3)

New London, Connecticut

95.0

(±2.4)

95.1

(±2.7)

NA

NA

95.2

(±2.1)

95.6

(±2.3)

96.2

(±1.9)

Kent, Delaware

95.7

(±1.8)

95.7

(±2.0)

94.9

(±2.6)

96.9

(±0.4)

94.7

(±2.6)

95.7

(±2.2)

New Castle, Delaware

96.4

(±1.3)

93.1

(±2.2)

93.9

(±2.2)

96.6

(±1.0)

96.3

(±1.6)

96.8

(±1.0)

Sussex, Delaware

94.6

(±2.6)

95.8

(±2.0)

95.6

(±1.8)

95.8

(±1.7)

95.5

(±2.1)

95.4

(±2.0)

District of Columbia

94.7

(±1.8)

93.6

(±2.1)

93.6

(±2.0)

97.0

(±1.2)

96.1

(±1.5)

95.3

(±1.6)

Broward, Florida

95.2

(±2.3)

95.8

(±1.8)

94.6

(±3.0)

96.4

(±1.4)

94.9

(±2.5)

94.5

(±2.7)

Duval, Florida

95.8

(±1.6)

94.9

(±1.8)

94.6

(±2.2)

95.8

(±1.4)

96.2

(±1.4)

NA

NA

Hillsborough, Florida

94.1

(±2.8)

94.2

(±3.0)

94.8

(±2.7)

95.7

(±1.8)

93.7

(±2.9)

NA

NA

Dade, Florida

NA

NA

94.9

(±2.2)

95.2

(±1.7)

96.3

(±1.3)

96.5

(±0.9)

96.3

(±1.6)

Orange, Florida

NA

NA

93.6

(±3.3)

NA

NA

96.1

(±1.7)

NA

NA

96.1

(±1.2)

Palm Beach, Florida

94.7

(±2.5)

95.1

(±2.5)

95.3

(±2.6)

96.0

(±1.8)

96.2

(±2.0)

95.4

(±2.4)

Pinellas, Florida

94.3

(±2.7)

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Cobb, Georgia

95.6

(±2.1)

94.9

(±2.7)

94.3

(±2.8)

95.8

(±1.8)

95.7

(±2.2)

95.9

(±1.9)

DeKalb, Georgia

94.4

(±2.4)

95.2

(±2.2)

94.0

(±2.3)

95.6

(±1.7)

94.0

(±2.5)

94.7

(±2.7)

Fulton, Georgia

96.3

(±1.6)

94.5

(±2.2)

93.6

(±2.3)

96.2

(±1.4)

96.7

(±1.5)

95.5

(±2.2)

Gwinnett, Georgia

96.0

(±1.7)

94.7

(±3.0)

94.7

(±2.9)

95.0

(±2.1)

95.5

(±2.2)

95.6

(±2.2)

Hawaii, Hawaii

94.8

(±2.4)

95.6

(±2.1)

96.0

(±1.4)

95.5

(±1.8)

93.4

(±2.9)

94.0

(±2.9)

Honolulu, Hawaii

94.3

(±1.9)

94.2

(±2.1)

92.6

(±2.7)

94.2

(±1.7)

94.5

(±2.0)

95.0

(±1.9)

Maui, Hawaii

95.7

(±2.1)

94.9

(±2.7)

93.7

(±3.3)

95.7

(±1.5)

94.8

(±2.7)

94.1

(±3.0)

Ada, Idaho

94.0

(±2.3)

93.8

(±2.7)

94.6

(±2.6)

95.1

(±1.8)

95.7

(±2.0)

94.6

(±2.2)

Bannock, Idaho

94.3

(±2.8)

93.7

(±3.1)

93.2

(±3.5)

NA

NA

NA

NA

NA

NA

Bonneville, Idaho

93.5

(±2.9)

95.1

(±2.6)

94.0

(±3.1)

95.8

(±1.5)

94.6

(±2.7)

95.6

(±2.3)

Canyon, Idaho

93.2

(±2.9)

91.7

(±3.6)

92.5

(±3.6)

94.8

(±2.2)

92.5

(±3.3)

91.6

(±3.6)

Kootenai, Idaho

94.0

(±3.1)

95.6

(±2.2)

91.2

(±4.2)

NA

NA

NA

NA

NA

NA

Twin Falls, Idaho

93.5

(±3.0)

NA

NA

93.9

(±3.4)

NA

NA

NA

NA

NA

NA

Cook, Illinois

93.8

(±2.1)

92.3

(±2.2)

94.8

(±1.6)

95.8

(±1.4)

95.7

(±1.5)

93.8

(±2.0)

DuPage, Illinois

96.0

(±1.9)

94.9

(±2.9)

95.6

(±2.4)

96.7

(±1.5)

NA

NA

96.7

(±1.6)


TABLE 4. (Continued) Estimated vaccination coverage with ≥3 doses of DTaP/DTP vaccine among children aged 19--35 months, by county/area and biennial survey period --- National Immunization Survey, selected counties, United States, 1995--2006*

County/Area

1995--1996

1997--1998

1999--2000

2001--2002

2003--2004

2005--2006

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Lake, Illinois

96.2

(±1.8)

94.2

(±3.0)

95.8

(±2.3)

95.7

(±1.8)

NA

NA

95.4

(±2.4)

Will, Illinois

NA

NA

94.8

(±3.0)

93.3

(±3.3)

95.5

(±2.0)

94.9

(±2.5)

95.7

(±2.1)

Allen, Indiana

94.4

(±2.6)

95.0

(±2.9)

93.2

(±3.4)

95.0

(±2.0)

NA

NA

95.9

(±2.1)

Hamilton, Indiana

96.2

(±2.0)

95.1

(±2.8)

95.2

(±2.6)

96.3

(±1.6)

NA

NA

96.5

(±1.8)

Lake, Indiana

92.8

(±3.2)

93.7

(±3.1)

94.2

(±3.1)

95.7

(±1.8)

NA

NA

95.8

(±2.0)

Marion, Indiana

95.1

(±1.6)

93.6

(±2.2)

93.7

(±2.0)

96.0

(±1.3)

96.2

(±1.5)

95.8

(±1.9)

Linn, Iowa

95.1

(±2.4)

NA

NA

94.7

(±2.9)

95.7

(±1.9)

NA

NA

95.6

(±2.1)

Polk, Iowa

94.5

(±2.4)

95.4

(±2.4)

93.7

(±3.0)

96.2

(±1.3)

94.8

(±2.4)

96.5

(±1.4)

Scott, Iowa

NA

NA

94.3

(±2.9)

94.0

(±3.2)

95.3

(±2.0)

NA

NA

NA

NA

Johnson, Kansas

96.5

(±1.7)

95.6

(±2.2)

94.3

(±2.5)

96.6

(±1.4)

96.6

(±1.5)

96.7

(±1.5)

Sedgwick, Kansas

95.0

(±2.3)

94.5

(±2.7)

93.4

(±3.3)

95.5

(±1.8)

95.4

(±2.3)

95.9

(±1.9)

Shawnee, Kansas

NA

NA

94.7

(±2.9)

NA

NA

NA

NA

94.4

(±2.7)

95.8

(±2.2)

Fayette, Kentucky

96.1

(±2.0)

95.2

(±2.7)

NA

NA

97.1

(±1.3)

NA

NA

NA

NA

Jefferson, Kentucky

94.9

(±2.3)

95.4

(±2.4)

93.9

(±3.1)

96.9

(±1.1)

96.3

(±1.5)

96.4

(±1.7)

Caddo, Louisiana

94.5

(±2.6)

94.1

(±2.9)

NA

NA

NA

NA

95.0

(±2.6)

95.9

(±2.1)

East Baton Rouge, Louisiana

93.9

(±2.8)

95.2

(±2.7)

94.1

(±3.1)

96.3

(±1.5)

96.2

(±1.4)

96.0

(±2.0)

Jefferson, Louisiana

95.4

(±2.2)

96.9

(±0.4)

94.1

(±3.0)

96.5

(±1.4)

95.3

(±2.4)

96.2

(±1.8)

Lafayette, Louisiana

93.6

(±3.0)

NA

NA

NA

NA

95.6

(±1.8)

NA

NA

96.1

(±1.8)

Orleans, Louisiana

92.7

(±2.3)

94.4

(±1.7)

91.4

(±2.4)

94.3

(±1.7)

95.2

(±2.3)

94.1

(±2.8)

St. Tammany, Louisiana

NA

NA

NA

NA

94.2

(±3.1)

96.7

(±1.5)

94.9

(±2.4)

NA

NA

Androscoggin, Maine

94.2

(±3.0)

95.5

(±2.3)

94.1

(±3.4)

95.7

(±1.9)

95.2

(±2.4)

96.0

(±1.8)

Aroostook, Maine

94.4

(±2.9)

95.7

(±2.2)

NA

NA

95.9

(±1.8)

NA

NA

NA

NA

Cumberland, Maine

96.0

(±1.8)

95.8

(±2.0)

94.8

(±2.6)

96.8

(±1.3)

95.5

(±2.1)

96.4

(±1.7)

Kennebec, Maine

95.4

(±2.3)

95.2

(±2.8)

94.3

(±3.0)

96.3

(±1.4)

NA

NA

96.2

(±1.6)

Penobscot, Maine

95.8

(±1.5)

93.6

(±3.0)

94.2

(±3.2)

96.4

(±1.6)

94.7

(±2.8)

95.2

(±2.3)

York, Maine

95.1

(±2.3)

95.9

(±1.9)

94.2

(±2.8)

96.2

(±1.6)

94.7

(±2.6)

95.9

(±2.0)

Anne Arundel, Maryland

95.5

(±2.2)

94.2

(±3.0)

94.8

(±2.6)

95.5

(±1.8)

96.0

(±2.1)

96.4

(±1.8)

Baltimore, Maryland

95.8

(±2.0)

94.7

(±2.6)

95.5

(±2.2)

96.7

(±1.4)

95.6

(±2.2)

96.4

(±1.8)

Frederick, Maryland

NA

NA

95.3

(±2.6)

94.8

(±2.8)

95.7

(±1.9)

NA

NA

NA

NA

Harford, Maryland

NA

NA

NA

NA

NA

NA

95.3

(±2.1)

NA

NA

NA

NA

Howard, Maryland

97.9

(±1.3)

95.0

(±2.8)

95.2

(±2.7)

97.5

(±1.3)

NA

NA

96.8

(±1.6)

Montgomery, Maryland

97.4

(±1.3)

93.8

(±2.8)

95.3

(±2.2)

96.7

(±1.5)

97.0

(±1.1)

97.1

(±1.5)

Prince George's, Maryland

94.9

(±2.3)

95.4

(±2.3)

95.1

(±2.5)

95.5

(±2.0)

96.5

(±1.1)

95.0

(±2.4)

City of Baltimore, Maryland

NA

NA

93.3

(±2.2)

93.0

(±2.1)

94.8

(±1.6)

95.3

(±1.8)

96.0

(±2.0)

Bristol, Massachusetts

94.6

(±2.7)

95.0

(±2.6)

94.5

(±2.9)

95.8

(±1.8)

95.2

(±2.5)

NA

NA

Essex, Massachusetts

95.8

(±1.9)

95.6

(±2.1)

95.7

(±2.0)

96.1

(±1.7)

96.1

(±1.9)

94.7

(±2.6)

Hampden, Massachusetts

94.7

(±2.7)

95.0

(±2.6)

93.6

(±3.4)

96.1

(±1.7)

NA

NA

NA

NA

Middlesex, Massachusetts

96.7

(±1.6)

95.3

(±2.3)

95.4

(±2.1)

96.8

(±1.3)

96.6

(±1.7)

96.9

(±1.2)

Norfolk, Massachusetts

97.0

(±0.2)

93.5

(±3.2)

95.5

(±2.4)

97.1

(±1.3)

96.7

(±1.6)

96.9

(±1.5)

Plymouth, Massachusetts

95.3

(±2.4)

95.4

(±2.5)

94.9

(±2.7)

96.2

(±1.7)

NA

NA

96.3

(±2.0)

Suffolk, Massachusetts

96.9

(±0.8)

95.5

(±1.6)

95.4

(±1.6)

97.0

(±1.1)

96.8

(±0.9)

96.6

(±0.9)

Worcester, Massachusetts

96.1

(±1.7)

94.9

(±2.6)

96.2

(±1.4)

96.5

(±1.5)

95.5

(±2.4)

96.2

(±1.8)

Kent, Michigan

93.7

(±2.9)

94.6

(±2.9)

94.4

(±3.2)

95.8

(±1.9)

NA

NA

95.7

(±2.0)

Macomb, Michigan

95.0

(±2.6)

95.1

(±2.8)

95.2

(±2.4)

95.8

(±1.7)

95.5

(±2.3)

NA

NA

Oakland, Michigan

96.7

(±1.6)

94.7

(±2.7)

96.1

(±1.9)

96.6

(±1.5)

96.8

(±1.6)

96.7

(±1.7)

Wayne, Michigan§

90.8

(±2.6)

91.9

(±2.3)

90.7

(±3.4)

94.9

(±1.9)

93.9

(±2.6)

94.8

(±2.2)

Anoka, Minnesota

95.0

(±2.6)

95.3

(±2.6)

95.2

(±2.5)

NA

NA

NA

NA

96.2

(±1.8)

Dakota, Minnesota

95.2

(±2.5)

95.7

(±2.1)

95.8

(±1.9)

95.8

(±1.8)

96.2

(±1.7)

96.3

(±1.9)

Hennepin, Minnesota

95.5

(±2.0)

95.4

(±2.4)

96.1

(±1.7)

96.5

(±1.4)

96.5

(±1.7)

96.5

(±1.6)

Ramsey, Minnesota

95.6

(±2.2)

95.5

(±2.3)

95.0

(±2.7)

96.3

(±1.6)

95.5

(±2.2)

96.6

(±1.3)

Washington, Minnesota

95.3

(±2.3)

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Harrison, Mississippi

93.2

(±3.0)

NA

NA

NA

NA

NA

NA

94.8

(±2.6)

NA

NA

Hinds, Mississippi

94.4

(±2.7)

94.9

(±2.7)

93.9

(±3.3)

NA

NA

95.7

(±1.8)

93.2

(±3.1)

Greene, Missouri

NA

NA

NA

NA

93.6

(±3.4)

NA

NA

NA

NA

NA

NA

Jackson, Missouri

94.8

(±2.6)

94.3

(±2.8)

94.3

(±3.0)

96.1

(±1.6)

96.5

(±1.0)

95.3

(±2.2)

Jefferson, Missouri

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

95.7

(±2.1)

St. Charles, Missouri

95.4

(±2.3)

NA

NA

NA

NA

NA

NA

NA

NA

96.2

(±1.7)

St. Louis, Missouri

96.2

(±1.4)

94.9

(±2.5)

95.4

(±2.4)

96.9

(±1.3)

96.6

(±1.4)

96.7

(±1.7)

City of St. Louis, Missouri

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

93.7

(±3.1)

Cascade, Montana

95.0

(±2.3)

95.3

(±2.6)

93.9

(±3.1)

96.2

(±1.7)

94.9

(±2.6)

95.6

(±2.2)

Flathead, Montana

93.1

(±3.1)

95.2

(±2.6)

87.4

(±5.0)

94.6

(±2.4)

93.8

(±3.0)

93.7

(±3.0)

Gallatin, Montana

95.0

(±2.4)

95.1

(±2.6)

93.1

(±3.4)

96.3

(±1.6)

94.5

(±2.7)

93.2

(±3.1)

Lewis and Clark, Montana

95.1

(±2.4)

95.1

(±2.8)

94.3

(±3.1)

NA

NA

NA

NA

95.5

(±2.3)

Missoula, Montana

95.2

(±2.1)

94.7

(±2.8)

94.0

(±3.1)

95.8

(±1.8)

94.2

(±2.5)

93.0

(±3.1)

Yellowstone, Montana

94.7

(±2.4)

94.0

(±2.9)

94.2

(±2.7)

96.1

(±1.6)

95.1

(±2.4)

94.6

(±2.4)

Douglas, Nebraska

96.0

(±1.7)

95.6

(±2.1)

96.0

(±1.7)

96.3

(±1.5)

96.1

(±1.8)

96.4

(±1.6)

Lancaster, Nebraska

95.2

(±2.2)

95.5

(±2.3)

94.4

(±3.0)

96.2

(±1.6)

95.2

(±2.5)

96.0

(±2.0)


TABLE 4. (Continued) Estimated vaccination coverage with ≥3 doses of DTaP/DTP vaccine among children aged 19--35 months, by county/area and biennial survey period --- National Immunization Survey, selected counties, United States, 1995--2006*

County/Area

1995--1996

1997--1998

1999--2000

2001--2002

2003--2004

2005--2006

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Sarpy, Nebraska

94.6

(±2.6)

94.1

(±3.0)

94.1

(±3.1)

95.8

(±1.8)

NA

NA

NA

NA

Clark, Nevada

91.2

(±2.5)

90.9

(±2.5)

89.4

(±3.0)

91.7

(±2.1)

91.1

(±2.5)

91.1

(±2.7)

Washoe, Nevada

95.5

(±2.0)

94.9

(±2.4)

94.7

(±2.8)

95.5

(±1.9)

96.3

(±1.5)

94.7

(±2.4)

Grafton, New Hampshire

96.6

(±1.7)

95.7

(±2.2)

94.5

(±3.2)

98.1

(±1.0)

NA

NA

96.2

(±2.0)

Hillsborough, New Hampshire

96.7

(±1.0)

95.5

(±2.2)

96.1

(±1.5)

96.3

(±1.5)

96.3

(±1.5)

96.5

(±1.6)

Merrimack, New Hampshire

96.3

(±1.9)

95.2

(±2.8)

95.3

(±2.4)

96.1

(±1.7)

94.9

(±2.5)

96.1

(±2.0)

Rockingham, New Hampshire

96.5

(±1.2)

95.7

(±2.1)

95.7

(±2.1)

96.3

(±1.5)

96.3

(±1.7)

96.6

(±1.4)

Strafford, New Hampshire

95.6

(±2.2)

94.7

(±2.7)

95.0

(±2.6)

96.1

(±1.7)

95.1

(±2.5)

95.8

(±2.2)

Bergen, New Jersey

97.4

(±1.2)

94.9

(±2.7)

95.8

(±2.5)

97.4

(±1.1)

96.9

(±1.8)

95.8

(±2.2)

Burlington, New Jersey

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

96.2

(±1.9)

Camden, New Jersey

95.1

(±2.5)

94.9

(±2.8)

94.3

(±3.0)

NA

NA

95.0

(±2.5)

94.5

(±2.8)

Essex, New Jersey

96.4

(±1.2)

96.5

(±1.0)

91.0

(±3.7)

96.0

(±1.6)

95.4

(±2.1)

94.4

(±2.7)

Hudson, New Jersey

94.4

(±2.7)

93.4

(±3.7)

92.4

(±3.7)

95.2

(±2.0)

NA

NA

93.9

(±2.9)

Middlesex, New Jersey

96.6

(±1.8)

94.7

(±3.0)

95.0

(±2.6)

96.7

(±1.5)

95.1

(±2.4)

95.0

(±2.5)

Monmouth, New Jersey

96.4

(±1.8)

95.0

(±2.5)

93.0

(±3.4)

NA

NA

96.3

(±2.0)

95.3

(±2.5)

Ocean, New Jersey

NA

NA

NA

NA

NA

NA

95.9

(±1.8)

95.7

(±2.0)

93.9

(±2.9)

Passaic, New Jersey

NA

NA

93.4

(±3.5)

94.4

(±3.2)

95.3

(±1.9)

NA

NA

NA

NA

Union, New Jersey

96.4

(±1.8)

95.4

(±2.2)

95.1

(±2.8)

96.0

(±1.6)

NA

NA

95.1

(±2.5)

Bernalillo, New Mexico

93.3

(±2.6)

91.4

(±3.7)

93.1

(±2.7)

95.8

(±1.7)

93.0

(±2.7)

94.6

(±2.5)

Dona Ana, New Mexico§

90.9

(±4.6)

92.3

(±4.0)

93.4

(±3.3)

93.6

(±2.9)

NA

NA

96.1

(±2.0)

Sandoval, New Mexico

NA

NA

NA

NA

NA

NA

94.4

(±2.4)

NA

NA

93.1

(±3.3)

San Juan, New Mexico

NA

NA

95.7

(±1.9)

94.4

(±2.9)

94.9

(±2.1)

94.3

(±3.0)

93.0

(±3.3)

Santa Fe, New Mexico

NA

NA

91.5

(±4.1)

NA

NA

94.7

(±2.3)

NA

NA

NA

NA

Bronx, New York

92.7

(±3.6)

91.5

(±4.2)

94.2

(±2.9)

94.1

(±2.4)

92.1

(±3.5)

96.4

(±1.6)

Erie, New York

95.7

(±1.9)

95.1

(±2.8)

94.9

(±2.6)

96.4

(±1.5)

95.8

(±1.8)

NA

NA

Kings, New York

93.6

(±3.1)

94.2

(±2.4)

93.1

(±2.9)

94.7

(±1.9)

94.4

(±2.3)

95.4

(±1.9)

Monroe, New York

95.8

(±2.2)

94.9

(±2.9)

94.1

(±3.1)

96.9

(±1.4)

95.6

(±2.2)

96.1

(±2.1)

Nassau, New York

97.8

(±1.3)

94.3

(±2.7)

95.7

(±2.3)

97.6

(±1.1)

96.8

(±1.8)

95.8

(±2.3)

New York, New York

95.9

(±2.3)

94.8

(±2.6)

97.3

(±1.3)

97.0

(±1.0)

98.2

(±1.1)

97.4

(±1.6)

Queens, New York

96.2

(±1.5)

93.2

(±2.8)

94.9

(±2.4)

96.2

(±1.4)

95.6

(±2.0)

95.5

(±1.8)

Suffolk, New York

96.0

(±2.0)

94.6

(±2.6)

96.0

(±1.7)

96.3

(±1.3)

95.7

(±2.1)

95.4

(±2.1)

Westchester, New York

97.4

(±1.4)

95.0

(±2.6)

96.0

(±2.5)

97.5

(±1.2)

97.1

(±1.7)

NA

NA

Durham, North Carolina

NA

NA

NA

NA

NA

NA

96.2

(±1.6)

NA

NA

NA

NA

Guilford, North Carolina

95.2

(±2.5)

94.8

(±2.8)

NA

NA

NA

NA

NA

NA

NA

NA

Mecklenburg, North Carolina

95.8

(±2.0)

95.9

(±1.8)

95.0

(±2.9)

96.4

(±1.6)

96.0

(±2.1)

96.6

(±1.5)

Wake, North Carolina

96.4

(±1.8)

94.6

(±2.9)

95.3

(±2.5)

96.6

(±1.4)

95.7

(±2.2)

96.6

(±1.3)

Burleigh, North Dakota

95.5

(±2.1)

95.5

(±2.4)

94.0

(±3.3)

95.4

(±2.0)

95.2

(±2.4)

96.4

(±1.4)

Cass, North Dakota

96.3

(±1.7)

95.4

(±2.4)

94.4

(±2.9)

97.0

(±1.3)

95.5

(±2.1)

96.3

(±1.7)

Grand Forks, North Dakota

94.5

(±2.6)

94.5

(±2.6)

93.7

(±3.2)

96.1

(±1.6)

95.6

(±1.9)

95.8

(±2.2)

Ward, North Dakota

94.9

(±2.3)

94.8

(±2.6)

94.1

(±3.0)

96.0

(±1.7)

95.1

(±2.5)

95.8

(±2.1)

Cuyahoga, Ohio

94.3

(±1.8)

93.2

(±2.1)

94.3

(±1.9)

96.8

(±0.8)

96.7

(±0.9)

96.4

(±1.7)

Franklin, Ohio

94.8

(±1.7)

95.5

(±1.5)

95.8

(±1.5)

96.3

(±1.3)

95.6

(±2.2)

96.2

(±1.8)

Hamilton, Ohio

95.9

(±2.0)

94.4

(±2.9)

94.8

(±2.6)

96.8

(±1.3)

94.7

(±2.5)

96.3

(±1.9)

Lucas, Ohio

94.7

(±2.5)

NA

NA

95.1

(±2.5)

NA

NA

NA

NA

NA

NA

Montgomery, Ohio

NA

NA

NA

NA

94.0

(±3.1)

NA

NA

NA

NA

NA

NA

Cleveland, Oklahoma

94.2

(±3.0)

NA

NA

94.2

(±3.1)

94.7

(±2.2)

94.8

(±2.7)

95.8

(±2.1)

Oklahoma, Oklahoma

94.4

(±2.6)

94.1

(±2.6)

93.3

(±2.9)

94.5

(±2.0)

94.6

(±2.5)

94.9

(±2.2)

Tulsa, Oklahoma

94.8

(±2.4)

95.0

(±2.5)

94.6

(±2.8)

95.9

(±1.7)

95.5

(±2.0)

96.1

(±1.8)

Clackamas, Oregon

95.5

(±2.1)

95.2

(±2.7)

93.9

(±3.1)

95.7

(±1.9)

NA

NA

94.1

(±2.7)

Lane, Oregon

94.9

(±2.3)

95.0

(±2.9)

93.8

(±3.1)

96.2

(±1.6)

93.4

(±3.1)

93.7

(±3.1)

Marion, Oregon

94.0

(±2.8)

94.4

(±2.8)

94.3

(±3.1)

95.0

(±2.1)

94.9

(±2.6)

93.3

(±3.3)

Multnomah, Oregon

93.6

(±2.4)

93.6

(±2.9)

94.6

(±2.5)

96.1

(±1.6)

95.6

(±2.1)

95.1

(±2.3)

Washington, Oregon

95.3

(±2.2)

92.6

(±3.2)

95.1

(±2.6)

95.9

(±1.6)

95.1

(±2.4)

95.3

(±2.1)

Allegheny, Pennsylvania

95.9

(±2.0)

95.7

(±2.1)

95.2

(±2.6)

96.4

(±1.6)

96.5

(±1.2)

96.4

(±1.7)

Delaware, Pennsylvania

95.4

(±2.2)

NA

NA

NA

NA

96.8

(±1.4)

NA

NA

NA

NA

Lancaster, Pennsylvania

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

96.0

(±2.0)

Montgomery, Pennsylvania

97.2

(±1.5)

93.8

(±3.1)

NA

NA

97.3

(±1.3)

NA

NA

96.9

(±1.7)

Philadelphia, Pennsylvania

94.6

(±1.8)

95.4

(±1.5)

93.6

(±2.0)

96.4

(±1.1)

95.3

(±1.6)

95.1

(±1.8)

Kent, Rhode Island

95.9

(±2.0)

95.8

(±2.0)

94.9

(±2.7)

96.7

(±1.4)

95.9

(±1.9)

96.1

(±2.0)

Newport, Rhode Island

95.2

(±2.5)

94.4

(±3.0)

94.8

(±2.8)

NA

NA

95.3

(±2.3)

NA

NA

Providence, Rhode Island

96.5

(±1.0)

95.7

(±1.9)

95.9

(±1.6)

96.6

(±1.2)

96.1

(±1.5)

95.1

(±2.1)

Washington, Rhode Island

96.2

(±1.8)

95.6

(±2.2)

95.2

(±2.5)

97.0

(±1.3)

95.6

(±2.3)

96.2

(±1.9)

Charleston, South Carolina

94.5

(±2.5)

95.5

(±2.3)

93.8

(±3.4)

97.4

(±1.2)

95.2

(±2.5)

93.5

(±3.0)

Greenville, South Carolina

95.1

(±2.3)

95.4

(±2.5)

94.8

(±2.8)

96.4

(±1.6)

94.3

(±2.8)

95.5

(±2.1)

Horry, South Carolina

NA

NA

NA

NA

93.9

(±3.5)

NA

NA

NA

NA

95.6

(±2.3)

Richland, South Carolina

95.1

(±2.4)

96.0

(±1.8)

94.7

(±2.8)

NA

NA

95.0

(±2.5)

95.7

(±2.2)


TABLE 4. (Continued) Estimated vaccination coverage with ≥3 doses of DTaP/DTP vaccine among children aged 19--35 months, by county/area and biennial survey period --- National Immunization Survey, selected counties, United States, 1995--2006*

County/Area

1995--1996

1997--1998

1999--2000

2001--2002

2003--2004

2005--2006

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Spartanburg, South Carolina

94.1

(±2.8)

95.1

(±2.7)

NA

NA

NA

NA

94.5

(±2.8)

95.5

(±2.2)

York, South Carolina

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

96.4

(±1.3)

Minnehaha, South Dakota

94.5

(±2.4)

95.3

(±2.6)

94.3

(±2.7)

96.4

(±1.2)

96.5

(±1.1)

96.4

(±1.5)

Pennington, South Dakota

94.8

(±2.4)

95.4

(±2.4)

94.9

(±2.6)

95.9

(±1.8)

95.1

(±2.4)

95.7

(±2.1)

Davidson, Tennessee

96.0

(±1.4)

93.2

(±2.0)

95.3

(±1.5)

96.5

(±1.2)

94.9

(±2.3)

96.4

(±1.8)

Hamilton, Tennessee

94.5

(±2.5)

95.2

(±2.6)

94.4

(±3.3)

NA

NA

NA

NA

NA

NA

Knox, Tennessee

95.8

(±2.0)

95.3

(±2.5)

93.4

(±3.3)

96.9

(±1.4)

95.2

(±2.5)

95.9

(±2.1)

Shelby, Tennessee

94.8

(±1.7)

95.7

(±1.6)

94.9

(±1.8)

96.4

(±1.2)

95.1

(±1.7)

94.5

(±2.6)

Bexar, Texas

94.2

(±1.9)

90.7

(±2.6)

93.9

(±1.8)

93.6

(±2.1)

94.4

(±2.0)

94.8

(±1.9)

Collin, Texas

NA

NA

NA

NA

96.4

(±1.2)

NA

NA

96.0

(±2.1)

NA

NA

Dallas, Texas

93.6

(±1.8)

91.8

(±2.3)

92.0

(±2.0)

93.7

(±1.7)

94.7

(±1.9)

93.9

(±1.8)

El Paso, Texas§

90.7

(±2.4)

89.6

(±2.9)

93.9

(±1.9)

93.9

(±2.0)

93.3

(±2.0)

95.5

(±1.7)

Harris, Texas

90.3

(±2.4)

90.3

(±2.5)

92.6

(±2.2)

92.1

(±2.1)

94.4

(±1.8)

93.8

(±2.7)

Hidalgo, Texas

NA

NA

NA

NA

NA

NA

NA

NA

93.3

(±3.7)

NA

NA

Tarrant, Texas

94.0

(±2.8)

92.8

(±3.6)

94.2

(±2.9)

95.0

(±2.1)

94.9

(±2.5)

95.8

(±2.0)

Travis, Texas

NA

NA

93.6

(±3.4)

NA

NA

95.9

(±1.9)

96.1

(±1.7)

NA

NA

Cache, Utah

93.8

(±2.8)

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Davis, Utah

95.1

(±2.3)

92.9

(±3.2)

93.4

(±3.2)

95.1

(±2.1)

94.4

(±2.6)

95.6

(±2.1)

Salt Lake, Utah

94.9

(±1.9)

94.5

(±2.4)

94.4

(±2.5)

94.8

(±1.8)

95.0

(±2.4)

93.7

(±2.7)

Utah, Utah

93.7

(±2.6)

91.8

(±3.3)

92.6

(±3.3)

94.6

(±2.0)

93.8

(±2.8)

92.8

(±3.1)

Weber, Utah

94.3

(±2.5)

94.4

(±2.9)

94.1

(±3.1)

95.2

(±2.0)

NA

NA

NA

NA

Addison, Vermont

96.7

(±1.7)

NA

NA

94.2

(±3.2)

97.5

(±1.2)

NA

NA

NA

NA

Bennington, Vermont

94.9

(±2.6)

95.1

(±2.8)

NA

NA

NA

NA

NA

NA

NA

NA

Chittenden, Vermont

97.0

(±0.8)

96.5

(±1.1)

95.9

(±1.7)

96.5

(±1.3)

96.4

(±1.3)

96.1

(±1.8)

Franklin, Vermont

95.1

(±2.5)

96.0

(±1.8)

93.9

(±3.5)

96.4

(±1.6)

NA

NA

95.6

(±2.3)

Lamoille, Vermont

NA

NA

NA

NA

NA

NA

95.9

(±1.8)

NA

NA

NA

NA

Orange, Vermont

95.7

(±2.2)

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Rutland, Vermont

95.0

(±2.5)

95.0

(±2.5)

94.1

(±3.4)

96.1

(±1.8)

NA

NA

NA

NA

Washington, Vermont

95.4

(±2.2)

95.1

(±2.8)

94.3

(±3.3)

96.3

(±1.6)

95.4

(±2.2)

96.4

(±1.5)

Windham, Vermont

95.1

(±2.5)

95.6

(±2.2)

94.3

(±3.1)

NA

NA

NA

NA

95.7

(±2.1)

Windsor, Vermont

95.7

(±2.0)

95.7

(±2.2)

95.1

(±2.4)

95.8

(±1.9)

95.1

(±2.5)

NA

NA

Fairfax, Virginia

95.6

(±2.0)

95.4

(±2.3)

95.0

(±2.6)

96.5

(±1.5)

97.0

(±1.5)

97.1

(±1.3)

Loudoun, Virginia

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

96.3

(±1.9)

Virginia Beach, Virginia

95.2

(±2.3)

94.5

(±2.8)

NA

NA

NA

NA

NA

NA

94.5

(±2.8)

Clark, Washington

94.6

(±2.6)

94.7

(±2.7)

93.7

(±3.3)

95.6

(±1.9)

95.2

(±2.4)

NA

NA

King, Washington§

96.0

(±1.4)

93.5

(±1.9)

93.5

(±1.9)

96.2

(±1.3)

95.4

(±1.8)

92.9

(±2.7)

Kitsap, Washington

NA

NA

95.5

(±2.3)

NA

NA

94.3

(±2.4)

NA

NA

94.1

(±2.7)

Pierce, Washington

95.3

(±2.1)

95.1

(±2.4)

93.9

(±3.0)

96.0

(±1.5)

95.0

(±2.4)

93.9

(±2.8)

Snohomish, Washington

94.9

(±2.4)

94.4

(±2.7)

94.1

(±2.8)

95.4

(±1.9)

95.4

(±2.3)

94.2

(±2.8)

Spokane, Washington

94.3

(±2.6)

95.5

(±2.3)

88.5

(±4.7)

95.3

(±2.0)

NA

NA

92.6

(±3.3)

Thurston, Washington

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

94.1

(±2.6)

Whatcom, Washington

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

94.1

(±2.9)

Yakima, Washington

93.4

(±3.2)

NA

NA

93.2

(±3.7)

NA

NA

NA

NA

NA

NA

Kanawha, West Virginia

95.9

(±1.6)

95.5

(±2.3)

NA

NA

96.6

(±1.5)

94.7

(±2.5)

96.0

(±2.0)

Brown, Wisconsin

NA

NA

NA

NA

94.3

(±3.0)

NA

NA

NA

NA

NA

NA

Dane, Wisconsin

96.4

(±1.9)

95.1

(±2.6)

95.3

(±2.5)

96.7

(±1.4)

96.3

(±1.5)

95.7

(±2.1)

Milwaukee, Wisconsin

93.4

(±2.0)

93.7

(±2.0)

92.2

(±2.4)

96.3

(±1.3)

95.3

(±2.0)

94.9

(±2.4)

Outagamie, Wisconsin

95.0

(±2.5)

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Waukesha, Wisconsin

96.5

(±1.7)

95.2

(±2.7)

96.8

(±0.6)

97.0

(±1.4)

96.1

(±2.1)

NA

NA

Albany, Wyoming

95.2

(±2.3)

94.8

(±3.0)

NA

NA

92.4

(±4.1)

NA

NA

NA

NA

Campbell, Wyoming

94.7

(±2.6)

94.0

(±3.0)

94.8

(±2.7)

96.4

(±1.5)

94.7

(±2.5)

96.3

(±1.6)

Fremont, Wyoming

93.9

(±3.0)

95.4

(±2.4)

93.6

(±3.5)

95.3

(±2.1)

NA

NA

NA

NA

Laramie, Wyoming

95.1

(±2.3)

94.5

(±2.8)

93.1

(±3.4)

94.6

(±2.1)

95.1

(±2.4)

94.8

(±2.3)

Natrona, Wyoming

94.8

(±2.4)

95.1

(±2.5)

94.7

(±2.9)

95.7

(±1.8)

95.5

(±2.2)

96.3

(±1.8)

Sweetwater, Wyoming

91.9

(±3.3)

95.1

(±2.6)

93.6

(±3.2)

NA

NA

93.0

(±3.0)

95.7

(±2.0)

Uinta, Wyoming

NA

NA

95.8

(±1.9)

NA

NA

NA

NA

NA

NA

NA

NA

United States

95.2

(±0.3)

94.7

(±0.4)

94.4

(±0.4)

96.1

(±0.3)

95.9

(±0.3)

95.8

(±0.4)

Sample size, no.

44,855

45,623

45,052

43,308

38,607

35,447

All selected counties

94.9

(±0.4)

94.1

(±0.5)

94.3

(±0.5)

96.0

(±0.4)

95.8

(±0.4)

95.7

(±0.5)

Sample size, no.

29,227

30,362

29,851

28,845

23,485

20,552

Range, %

90.3--97.9

89.6--96.9

87.4--97.3

91.7--98.1

91.1--98.2

91.1--97.4

Abbreviations: CI = confidence interval; DTaP = diphtheria and tetanus toxoids and acellular pertussis; DTP = diphtheria and tetanus toxoids and pertussis; NA = not available.

* All estimates exceed the Healthy People 2010 objective of 90% vaccination coverage.

Estimates increased significantly between the first and last biennial periods (p<0.05).


TABLE 5. Estimated vaccination coverage with ≥4 doses of DTaP/DTP vaccine among children aged 19--35 months, by county/area and biennial survey period --- National Immunization Survey, selected counties, United States, 1995--2008

County/Area

1995--1996

1997--1998

1999--2000

2001--2002

2003--2004

2005--2006

2007--2008

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Jefferson, Alabama

85.2

(±3.2)

86.4

(±2.8)

86.7

(±3.0)

86.1

(±3.2)

87.6

(±3.6)

92.1

(±2.7)*

87.0

(±6.0)

Madison, Alabama

NA

NA

81.5

(±7.5)

83.3

(±6.0)

NA

NA

85.4

(±6.5)

86.4

(±5.5)

87.6

(±6.7)

Mobile, Alabama

75.5

(±8.7)

82.8

(±6.4)

80.4

(±6.6)

82.5

(±6.6)

83.0

(±7.1)

82.5

(±6.3)

81.2

(±8.2)

Montgomery, Alabama

NA

NA

77.1

(±8.3)

81.4

(±7.2)

NA

NA

NA

NA

NA

NA

NA

NA

Shelby, Alabama

NA

NA

NA

NA

86.4

(±5.5)

87.5

(±5.7)

89.0

(±5.3)

NA

NA

88.8

(±6.1)

Anchorage, Alaska

NA

NA

NA

NA

82.3

(±4.2)

79.5

(±5.0)

82.8

(±4.8)

84.3

(±4.9)

83.7

(±5.6)

Fairbanks North Star, Alaska

NA

NA

NA

NA

79.7

(±6.2)

78.2

(±6.5)

80.0

(±6.4)

82.5

(±6.0)

81.2

(±7.3)

Kenai Peninsula, Alaska

NA

NA

NA

NA

82.6

(±6.2)

NA

NA

NA

NA

NA

NA

NA

NA

Matanuska-Susitna, Alaska

NA

NA

NA

NA

82.1

(±6.1)

76.3

(±7.9)

85.9

(±5.9)

80.4

(±6.3)

74.1

(±8.3)

Cochise, Arizona

NA

NA

74.3

(±8.8)

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Coconino, Arizona

NA

NA

68.3

(±9.5)

NA

NA

NA

NA

87.0

(±9.9)

NA

NA

NA

NA

Maricopa, Arizona

75.6

(±4.4)

80.3

(±3.5)

76.9

(±3.8)

78.3

(±3.6)

83.7

(±3.2)

81.7

(±3.6)

82.5

(±4.9)

Mohave, Arizona

NA

NA

NA

NA

74.6

(±7.8)

74.4

(±8.7)

NA

NA

NA

NA

NA

NA

Pima, Arizona

77.9

(±5.7)

80.5

(±5.0)

84.3

(±4.5)

76.5

(±5.4)

82.3

(±5.1)

80.7

(±5.5)

85.0

(±6.5)

Pinal, Arizona

75.0

(±8.3)

69.5

(±9.8)

77.3

(±7.8)

72.5

(±8.2)

86.8

(±5.9)

77.5

(±8.2)

NA

NA

Yavapai, Arizona

NA

NA

NA

NA

NA

NA

76.8

(±8.5)

83.7

(±6.5)

NA

NA

NA

NA

Yuma, Arizona

76.0

(±8.4)

74.8

(±9.2)

77.2

(±7.5)

74.6

(±8.5)

85.1

(±7.0)

80.0

(±7.9)

NA

NA

Benton, Arkansas

NA

NA

79.1

(±7.1)

NA

NA

80.9

(±7.1)

88.1

(±5.2)

79.7

(±7.1)

83.6

(±6.9)

Pulaski, Arkansas

77.6

(±7.4)

84.0

(±5.6)

75.1

(±6.9)

77.4

(±7.2)

83.6

(±7.1)

84.8

(±6.0)

84.9

(±6.7)

Washington, Arkansas

80.7

(±7.2)

79.8

(±6.9)

NA

NA

75.1

(±8.5)

NA

NA

NA

NA

80.0

(±7.9)

Alameda, California

78.6

(±7.5)

NA

NA

80.5

(±6.8)

85.9

(±6.5)

87.5

(±5.8)

86.9

(±4.2)

87.0

(±5.8)

Los Angeles, California

78.3

(±4.4)

77.1

(±3.9)

78.7

(±3.7)

81.0

(±3.8)

84.2

(±3.3)

84.1

(±3.4)

85.0

(±3.2)

Orange, California

80.1

(±6.7)

84.3

(±5.5)

78.6

(±6.4)

83.1

(±6.3)

84.3

(±5.8)

85.5

(±5.6)

88.1

(±5.7)

Riverside, California

NA

NA

NA

NA

78.8

(±7.3)

73.7

(±8.7)

79.8

(±6.8)

NA

NA

84.1

(±7.8)

San Bernardino, California

NA

NA

74.2

(±7.9)

77.9

(±7.4)

75.3

(±8.3)

83.9

(±6.4)

75.1

(±6.0)

80.1

(±6.7)

San Diego, California

80.1

(±3.8)

82.1

(±3.1)

80.7

(±3.3)

83.2

(±3.2)

84.9

(±3.3)

85.8

(±4.6)

87.6

(±6.2)

San Mateo, California

NA

NA

85.5

(±6.0)

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Santa Clara, California

82.9

(±3.5)

84.8

(±3.2)

86.0

(±2.8)

86.2

(±2.8)

88.7

(±3.0)

86.8

(±4.8)

NA

NA

Adams, Colorado

78.0

(±7.7)

82.8

(±5.9)

77.0

(±7.0)

73.9

(±8.5)

83.4

(±6.2)

NA

NA

NA

NA

Arapahoe, Colorado

85.8

(±5.9)

85.5

(±5.6)

85.1

(±5.5)

74.4

(±7.5)

85.1

(±5.8)

NA

NA

86.9

(±6.8)

Boulder, Colorado

NA

NA

86.4

(±5.2)

86.5

(±5.6)

77.6

(±7.8)

82.2

(±6.6)

86.3

(±5.5)

87.2

(±6.6)

Denver, Colorado

81.7

(±6.9)

84.4

(±5.4)

82.1

(±5.8)

80.8

(±6.5)

83.3

(±6.5)

NA

NA

NA

NA

Douglas, Colorado

NA

NA

NA

NA

87.5

(±5.2)

87.3

(±5.7)

90.2

(±4.6)*

NA

NA

NA

NA

El Paso, Colorado

80.3

(±6.9)

81.1

(±6.8)

79.6

(±6.1)

79.3

(±6.9)

78.5

(±6.9)

83.3

(±6.0)

81.5

(±7.5)

Jefferson, Colorado

83.6

(±6.2)

83.3

(±5.4)

85.9

(±5.4)

89.7

(±4.3)

87.8

(±5.1)

89.9

(±4.3)

85.9

(±6.5)

Larimer, Colorado

NA

NA

NA

NA

81.6

(±6.2)

82.7

(±7.0)

NA

NA

84.9

(±6.2)

NA

NA

Weld, Colorado

NA

NA

NA

NA

82.6

(±6.7)

75.2

(±8.6)

84.5

(±6.1)

NA

NA

84.0

(±7.7)

Fairfield, Connecticut

85.5

(±5.4)

88.1

(±3.8)

89.7

(±3.6)

90.4

(±3.8)*

91.0

(±4.1)*

89.0

(±4.1)

86.7

(±5.3)

Hartford, Connecticut

87.1

(±5.0)

89.6

(±4.3)

88.0

(±4.3)

86.5

(±4.8)

91.9

(±3.5)*

89.6

(±3.8)

89.6

(±4.9)

New Haven, Connecticut

85.1

(±5.4)

91.2

(±3.5)*

87.6

(±4.3)

83.6

(±5.5)

89.1

(±4.8)

87.8

(±4.8)

89.3

(±4.6)

New London, Connecticut

87.5

(±5.8)

85.3

(±5.7)

85.4

(±5.5)

NA

NA

93.5

(±3.3)*

87.7

(±5.1)

85.6

(±6.5)

Kent, Delaware

83.0

(±5.8)

84.4

(±5.3)

82.2

(±5.4)

84.6

(±5.2)

84.8

(±5.7)

83.7

(±6.3)

83.6

(±6.4)

New Castle, Delaware

83.5

(±4.2)

84.7

(±3.6)

82.9

(±3.6)

88.0

(±3.2)

89.1

(±3.3)

88.4

(±3.6)

85.7

(±4.3)

Sussex, Delaware

79.4

(±6.5)

81.9

(±6.0)

85.4

(±5.1)

86.2

(±5.5)

87.3

(±5.0)

88.8

(±4.5)

86.0

(±5.3)

District of Columbia

81.7

(±4.1)

78.6

(±3.9)

80.0

(±3.7)

79.3

(±4.1)

87.0

(±3.6)

85.2

(±3.2)

85.2

(±3.5)

Broward, Florida

79.6

(±7.1)

81.7

(±5.9)

83.9

(±5.4)

84.3

(±6.4)

86.3

(±5.3)

84.5

(±5.9)

87.2

(±6.5)

Duval, Florida

78.3

(±4.2)

79.9

(±3.8)

82.7

(±3.4)

81.1

(±3.9)

84.0

(±3.5)

84.3

(±3.2)

NA

NA

Hillsborough, Florida

76.3

(±8.4)

84.6

(±6.3)

81.3

(±6.2)

80.2

(±7.0)

83.8

(±6.1)

82.6

(±6.3)

NA

NA

Dade, Florida

NA

NA

NA

NA

84.1

(±3.5)

81.0

(±3.8)

87.2

(±3.1)

86.6

(±4.4)

86.3

(±3.5)

Orange, Florida

NA

NA

NA

NA

80.5

(±6.5)

NA

NA

86.0

(±6.2)

NA

NA

88.7

(±4.4)

Palm Beach, Florida

NA

NA

82.1

(±6.4)

86.6

(±5.2)

85.8

(±5.9)

89.2

(±4.8)

84.0

(±6.1)

86.0

(±8.0)

Pinellas, Florida

NA

NA

81.5

(±6.6)

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Cobb, Georgia

81.0

(±7.1)

82.6

(±6.3)

84.7

(±5.6)

84.8

(±5.9)

89.9

(±4.7)

87.3

(±4.8)

83.4

(±6.8)

DeKalb, Georgia

81.2

(±6.2)

77.6

(±5.4)

85.3

(±4.3)

81.0

(±4.6)

84.8

(±3.8)

81.6

(±5.7)

90.4

(±5.1)*

Fulton, Georgia

80.2

(±5.8)

83.1

(±4.2)

84.1

(±4.0)

83.8

(±4.3)

86.6

(±3.7)

85.4

(±4.7)

81.7

(±7.4)

Gwinnett, Georgia

82.8

(±7.1)

83.9

(±5.8)

86.0

(±5.5)

85.0

(±6.1)

85.2

(±5.6)

88.7

(±4.8)

78.5

(±9.1)

Hawaii, Hawaii

81.4

(±6.8)

82.1

(±7.8)

79.1

(±6.7)

79.3

(±7.8)

84.7

(±5.9)

78.4

(±7.0)

86.6

(±6.2)

Honolulu, Hawaii

84.8

(±4.0)

82.4

(±4.1)

82.4

(±4.0)

78.0

(±4.7)

83.8

(±3.5)

85.7

(±3.8)

83.6

(±4.4)

Maui, Hawaii

79.5

(±7.1)

84.9

(±6.9)

78.8

(±7.0)

78.9

(±7.6)

84.9

(±5.9)

83.2

(±7.0)

88.4

(±6.1)

Ada, Idaho

79.3

(±6.0)

83.8

(±4.7)

82.2

(±5.1)

78.4

(±6.1)

87.4

(±4.5)

85.1

(±4.8)

80.5

(±6.4)

Bannock, Idaho

NA

NA

82.2

(±6.6)

81.7

(±6.5)

80.8

(±7.4)

NA

NA

NA

NA

NA

NA

Bonneville, Idaho

76.0

(±7.3)

77.2

(±7.2)

85.9

(±5.3)

83.3

(±6.5)

87.0

(±5.3)

83.5

(±6.2)

81.5

(±8.6)

Canyon, Idaho

NA

NA

74.9

(±7.1)

75.0

(±7.0)

76.6

(±7.6)

83.7

(±6.3)

75.4

(±7.1)

75.0

(±8.7)

Kootenai, Idaho

79.3

(±7.3)

83.2

(±6.3)

83.0

(±6.1)

79.6

(±7.7)

NA

NA

NA

NA

NA

NA

Twin Falls, Idaho

NA

NA

77.7

(±7.5)

NA

NA

82.1

(±7.0)

NA

NA

NA

NA

NA

NA

Cook, Illinois

78.3

(±4.1)

75.7

(±4.2)

76.8

(±3.9)

82.4

(±3.3)

85.8

(±3.4)

85.5

(±3.4)

80.2

(±4.0)

DuPage, Illinois

84.8

(±6.0)

86.2

(±5.1)

86.1

(±4.9)

86.0

(±6.0)

91.7

(±4.0)*

NA

NA

86.5

(±5.8)


TABLE 5. (Continued) Estimated vaccination coverage with ≥4 doses of DTaP/DTP vaccine among children aged 19--35 months, by county/area and biennial survey period --- National Immunization Survey, selected counties, United States, 1995--2008

County/Area

1995--1996

1997--1998

1999--2000

2001--2002

2003--2004

2005--2006

2007--2008

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Lake, Illinois

84.1

(±6.4)

85.8

(±5.6)

87.2

(±5.1)

85.3

(±5.9)

87.4

(±5.5)

NA

NA

92.6

(±3.6)*

Will, Illinois

NA

NA

NA

NA

85.1

(±5.9)

82.4

(±6.7)

89.7

(±4.5)

87.0

(±5.4)

84.8

(±6.7)

Allen, Indiana

NA

NA

81.5

(±6.4)

84.4

(±5.9)

78.2

(±7.5)

88.5

(±5.0)

NA

NA

83.9

(±8.0)

Hamilton, Indiana

82.1

(±7.6)

86.9

(±5.6)

91.3

(±3.5)*

88.6

(±5.2)

90.1

(±4.6)*

NA

NA

90.0

(±5.4)

Lake, Indiana

72.2

(±9.0)

74.2

(±7.9)

75.6

(±7.0)

78.8

(±7.4)

84.3

(±6.5)

NA

NA

78.8

(±8.6)

Marion, Indiana

79.6

(±4.0)

83.0

(±3.3)

79.8

(±3.8)

78.9

(±4.0)

84.2

(±3.4)

87.0

(±4.7)

85.4

(±5.4)

Linn, Iowa

NA

NA

86.3

(±5.8)

NA

NA

85.8

(±5.8)

91.2

(±4.4)*

NA

NA

84.3

(±7.7)

Polk, Iowa

83.9

(±6.2)

84.9

(±5.0)

85.5

(±5.2)

82.3

(±6.0)

91.0

(±4.0)*

86.7

(±4.8)

85.6

(±5.9)

Scott, Iowa

NA

NA

NA

NA

84.0

(±6.0)

84.7

(±6.5)

86.5

(±5.5)

NA

NA

NA

NA

Johnson, Kansas

84.5

(±5.8)

87.1

(±4.5)

87.6

(±4.1)

88.9

(±4.1)

89.4

(±4.3)

89.9

(±3.3)

87.2

(±5.5)

Sedgwick, Kansas

74.8

(±7.2)

83.5

(±5.5)

81.7

(±5.5)

81.9

(±6.5)

86.5

(±5.6)

85.2

(±5.3)

81.5

(±7.2)

Shawnee, Kansas

NA

NA

NA

NA

81.6

(±6.6)

NA

NA

NA

NA

83.9

(±6.2)

83.7

(±9.1)

Fayette, Kentucky

NA

NA

89.2

(±4.7)

86.2

(±5.5)

NA

NA

89.9

(±4.6)

NA

NA

NA

NA

Jefferson, Kentucky

78.9

(±6.8)

85.0

(±4.9)

87.0

(±4.7)

79.9

(±6.4)

86.6

(±5.6)

87.2

(±4.7)

88.7

(±5.1)

Caddo, Louisiana

NA

NA

78.9

(±7.1)

77.4

(±7.3)

NA

NA

NA

NA

88.8

(±5.2)

82.7

(±7.8)

East Baton Rouge, Louisiana

80.4

(±7.5)

78.2

(±7.5)

82.8

(±6.0)

78.9

(±7.4)

84.7

(±6.2)

84.8

(±5.9)

87.4

(±6.8)

Jefferson, Louisiana

80.5

(±7.1)

85.1

(±5.7)

82.7

(±6.0)

78.9

(±7.3)

78.1

(±7.8)

84.1

(±5.8)

83.2

(±6.9)

Lafayette, Louisiana

NA

NA

77.1

(±7.9)

NA

NA

NA

NA

82.5

(±6.7)

NA

NA

86.9

(±6.5)

Orleans, Louisiana

77.4

(±4.6)

78.8

(±4.0)

76.5

(±4.2)

71.7

(±4.7)

81.8

(±3.9)

66.2

(±10.1)§

80.8

(±8.7)

St. Tammany, Louisiana

NA

NA

NA

NA

NA

NA

82.1

(±6.8)

87.1

(±6.0)

85.9

(±5.1)

NA

NA

Androscoggin, Maine

85.0

(±6.5)

87.0

(±5.7)

85.7

(±5.6)

87.0

(±5.6)

90.5

(±4.6)*

85.9

(±5.9)

85.2

(±6.9)

Aroostook, Maine

NA

NA

88.2

(±4.8)

86.0

(±5.9)

NA

NA

88.4

(±5.3)

NA

NA

NA

NA

Cumberland, Maine

86.7

(±4.7)

89.1

(±3.7)

87.5

(±4.2)

86.9

(±4.6)

90.4

(±3.7)*

89.4

(±3.8)

88.1

(±4.7)

Kennebec, Maine

86.0

(±6.2)

92.0

(±3.1)*

86.6

(±5.5)

85.1

(±6.0)

85.8

(±6.3)

NA

NA

86.6

(±6.9)

Penobscot, Maine

87.6

(±5.6)

85.4

(±5.6)

82.9

(±5.8)

84.4

(±6.3)

89.6

(±4.5)

87.7

(±5.2)

84.1

(±6.9)

York, Maine

86.2

(±6.0)

87.0

(±4.8)

86.6

(±4.9)

86.9

(±5.0)

89.0

(±4.4)

86.5

(±5.2)

87.6

(±5.8)

Anne Arundel, Maryland

84.9

(±6.0)

83.5

(±6.1)

85.1

(±5.7)

84.7

(±6.0)

86.5

(±6.0)

89.6

(±4.6)

87.4

(±6.3)

Baltimore, Maryland

84.3

(±6.1)

85.6

(±5.0)

84.8

(±5.1)

84.5

(±5.9)

87.9

(±5.1)

90.3

(±4.0)*

90.8

(±4.8)*

Frederick, Maryland

NA

NA

NA

NA

86.4

(±5.3)

87.2

(±5.8)

92.5

(±3.6)*

NA

NA

NA

NA

Harford, Maryland

NA

NA

NA

NA

NA

NA

NA

NA

82.2

(±8.1)

NA

NA

NA

NA

Howard, Maryland

NA

NA

89.4

(±5.0)

86.7

(±5.5)

86.9

(±5.8)

90.4

(±4.6)*

NA

NA

92.9

(±4.0)*

Montgomery, Maryland

80.9

(±6.4)

90.6

(±3.9)*

84.9

(±4.7)

86.8

(±4.5)

88.5

(±4.2)

93.7

(±3.0)*

92.9

(±3.7)*

Prince George's, Maryland

82.5

(±6.1)

77.1

(±7.4)

80.6

(±6.1)

76.4

(±7.8)

80.0

(±7.5)

84.3

(±5.8)

88.5

(±5.0)

City of Baltimore, Maryland

NA

NA

NA

NA

78.1

(±3.8)

78.2

(±4.0)

85.0

(±3.3)

80.5

(±4.5)

88.6

(±4.4)

Bristol, Massachusetts

84.5

(±6.5)

86.2

(±5.4)

86.6

(±5.2)

85.5

(±5.9)

90.1

( ±4.5)*

87.4

(±5.3)

NA

NA

Essex, Massachusetts

84.4

(±6.2)

88.7

(±4.6)

85.7

(±5.0)

87.2

(±5.2)

88.3

(±5.2)

87.3

(±5.2)

85.6

(±7.1)

Hampden, Massachusetts

83.5

(±6.3)

87.5

(±5.2)

84.2

(±5.7)

81.1

(±7.3)

88.1

(±5.8)

NA

NA

NA

NA

Middlesex, Massachusetts

86.1

(±4.7)

91.6

(±3.2)*

86.9

(±4.3)

87.4

(±4.4)

92.5

(±3.2)*

93.7

(±2.7)*

90.1

(±4.4)*

Norfolk, Massachusetts

85.8

(±5.6)

91.9

(±3.8)*

86.6

(±5.1)

89.8

(±4.7)

97.0

(±0.1)*

93.6

(±2.8)*

89.8

(±5.2)

Plymouth, Massachusetts

84.0

(±6.5)

88.3

(±5.0)

87.4

(±5.3)

87.0

(±5.5)

91.0

(±4.1)*

NA

NA

86.7

(±7.0)

Suffolk, Massachusetts

84.7

(±4.7)

91.6

(±2.5)*

88.3

(±2.8)

87.0

(±3.2)

90.3

(±3.2)*

88.5

(±4.6)

91.1

(±5.3)*

Worcester, Massachusetts

86.8

(±5.5)

87.8

(±5.0)

86.3

(±5.2)

88.2

(±4.8)

90.3

(±4.0)*

90.0

(±4.3)

87.1

(±6.0)

Kent, Michigan

83.6

(±7.0)

84.7

(±6.2)

84.7

(±6.0)

85.7

(±6.5)

89.0

(±5.1)

NA

NA

87.7

(±6.3)

Macomb, Michigan

82.4

(±6.9)

87.6

(±5.4)

85.1

(±5.6)

83.8

(±6.1)

89.4

(±4.8)

86.8

(±5.3)

NA

NA

Oakland, Michigan

80.6

(±6.7)

88.7

(±4.4)

87.9

(±4.7)

86.8

(±5.2)

87.0

(±5.1)

88.9

(±4.2)

87.5

(±5.9)

Wayne, Michigan

74.3

(±4.7)

73.4

(±4.7)

76.1

(±4.5)

73.4

(±5.4)

81.9

(±4.5)

79.6

(±5.3)

78.7

(±7.1)

Anoka, Minnesota

82.9

(±7.1)

85.2

(±6.7)

86.5

(±5.4)

87.7

(±5.8)

NA

NA

NA

NA

85.1

(±7.1)

Dakota, Minnesota

85.7

(±6.3)

85.7

(±5.8)

87.7

(±5.2)

87.0

(±5.6)

89.8

(±4.8)

87.1

(±5.3)

88.1

(±6.5)

Hennepin, Minnesota

85.2

(±5.2)

87.5

(±4.1)

89.0

(±4.3)

86.2

(±4.9)

89.3

(±4.4)

90.9

(±3.9)*

88.6

(±4.3)

Ramsey, Minnesota

84.6

(±6.1)

86.9

(±5.3)

85.4

(±5.5)

81.1

(±6.9)

88.3

(±5.1)

88.4

(±4.7)

87.4

(±6.3)

Washington, Minnesota

NA

NA

83.5

(±6.7)

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Harrison, Mississippi

NA

NA

80.3

(±6.8)

NA

NA

NA

NA

NA

NA

81.4

(±6.7)

NA

NA

Hinds, Mississippi

81.3

(±7.2)

77.2

(±7.5)

77.4

(±7.2)

77.6

(±8.4)

NA

NA

83.7

(±6.6)

77.5

(±9.4)

Greene, Missouri

NA

NA

NA

NA

NA

NA

83.8

(±6.8)

NA

NA

NA

NA

NA

NA

Jackson, Missouri

76.5

(±7.6)

82.2

(±6.4)

81.6

(±6.4)

86.9

(±5.6)

87.8

(±5.0)

88.7

(±4.7)

83.2

(±6.8)

Jefferson, Missouri

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

82.9

(±8.0)

St. Charles, Missouri

NA

NA

85.0

(±6.3)

NA

NA

NA

NA

NA

NA

NA

NA

88.6

(±6.0)

St. Louis, Missouri

82.2

(±6.0)

86.8

(±5.0)

87.4

(±4.6)

88.0

(±5.1)

90.4

(±4.2)*

88.8

(±3.7)

88.6

(±5.5)

City of St. Louis, Missouri

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

80.7

(±8.7)

Cascade, Montana

73.6

(±8.0)

85.0

(±5.1)

86.3

(±5.4)

82.4

(±6.4)

86.9

(±5.9)

84.8

(±5.6)

81.9

(±7.5)

Flathead, Montana

75.7

(±8.2)

78.4

(±7.2)

83.6

(±6.1)

72.3

(±7.4)

82.1

(±6.6)

72.8

(±8.8)

76.5

(±8.6)

Gallatin, Montana

82.6

(±6.3)

81.2

(±6.7)

82.9

(±6.0)

81.6

(±6.9)

85.0

(±6.1)

85.9

(±5.4)

82.9

(±7.0)

Lewis and Clark, Montana

NA

NA

85.4

(±5.4)

83.0

(±6.3)

84.9

(±6.2)

NA

NA

NA

NA

85.6

(±7.2)

Missoula, Montana

83.9

(±6.1)

85.4

(±5.5)

85.2

(±5.8)

85.0

(±5.9)

86.7

(±5.2)

80.0

(±6.1)

75.3

(±8.6)

Yellowstone, Montana

76.7

(±6.8)

84.7

(±5.1)

83.9

(±5.5)

83.9

(±5.6)

85.7

(±5.0)

87.0

(±4.6)

79.1

(±7.9)

Douglas, Nebraska

80.2

(±5.6)

84.9

(±4.4)

87.6

(±4.1)

85.2

(±4.8)

85.7

(±4.4)

88.3

(±4.0)

88.9

(±3.8)

Lancaster, Nebraska

86.0

(±5.2)

80.6

(±5.5)

85.3

(±4.8)

85.6

(±5.5)

92.3

(±3.6)*

88.8

(±4.7)

88.9

(±5.5)


TABLE 5. (Continued) Estimated vaccination coverage with ≥4 doses of DTaP/DTP vaccine among children aged 19--35 months, by county/area and biennial survey period --- National Immunization Survey, selected counties, United States, 1995--2008

County/Area

1995--1996

1997--1998

1999--2000

2001--2002

2003--2004

2005--2006

2007--2008

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Sarpy, Nebraska

83.1

(±6.7)

82.0

(±6.5)

84.2

(±6.0)

84.6

(±6.4)

84.5

(±7.2)

NA

NA

NA

NA

Clark, Nevada

71.7

(±5.1)

77.1

(±4.3)

75.6

(±4.0)

74.7

(±4.6)

75.1

(±4.3)

72.3

(±4.7)

72.2

(±5.3)

Washoe, Nevada

83.4

(±6.0)

86.6

(±4.7)

86.4

(±4.6)

84.2

(±6.0)

88.9

(±4.7)

87.8

(±4.4)

86.0

(±5.9)

Grafton, New Hampshire

NA

NA

88.0

(±4.8)

86.9

(±5.3)

85.1

(±6.4)

95.6

(±2.6)*

NA

NA

95.6

(±1.8)*

Hillsborough, New Hampshire

87.1

(±4.1)

90.2

(±3.4)*

86.3

(±4.3)

89.1

(±3.7)

91.7

(±3.2)*

89.6

(±3.5)

88.7

(±4.3)

Merrimack, New Hampshire

86.3

(±5.6)

89.1

(±4.3)

88.2

(±4.9)

87.8

(±5.1)

91.8

(±3.6)*

88.5

(±4.8)

89.1

(±6.2)

Rockingham, New Hampshire

86.1

(±5.2)

88.6

(±4.2)

88.5

(±3.8)

89.8

(±3.9)

90.5

(±4.1)*

87.9

(±4.3)

89.7

(±4.8)

Strafford, New Hampshire

87.0

(±5.4)

87.6

(±5.3)

86.6

(±5.1)

86.7

(±5.6)

92.9

(±3.6)*

87.1

(±5.2)

86.9

(±7.0)

Bergen, New Jersey

80.5

(±7.1)

91.3

(±3.8)*

87.6

(±4.7)

88.8

(±5.3)

88.6

(±5.1)

92.4

(±3.7)*

91.5

(±4.9)*

Burlington, New Jersey

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

87.9

(±6.3)

Camden, New Jersey

NA

NA

84.6

(±6.4)

81.8

(±6.6)

83.6

(±6.6)

NA

NA

86.6

(±5.5)

88.1

(±6.1)

Essex, New Jersey

81.3

(±5.9)

82.1

(±5.3)

80.4

(±5.6)

72.7

(±7.0)

80.3

(±6.2)

84.2

(±5.5)

81.1

(±7.5)

Hudson, New Jersey

78.0

(±8.1)

83.6

(±6.2)

78.3

(±7.7)

75.6

(±8.9)

79.7

(±7.3)

NA

NA

77.9

(±8.7)

Middlesex, New Jersey

NA

NA

85.4

(±5.6)

84.5

(±5.5)

83.7

(±6.2)

90.5

(±4.5)*

88.7

(±4.8)

85.1

(±6.9)

Monmouth, New Jersey

NA

NA

87.6

(±5.2)

86.6

(±4.9)

82.4

(±6.7)

NA

NA

90.3

(±4.3)*

86.7

(±6.1)

Morris, New Jersey

81.3

(±7.2)

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Ocean, New Jersey

NA

NA

NA

NA

NA

NA

NA

NA

86.6

(±5.8)

83.8

(±6.1)

83.8

(±7.2)

Passaic, New Jersey

NA

NA

NA

NA

80.2

(±6.9)

79.1

(±7.6)

84.5

(±6.1)

NA

NA

NA

NA

Union, New Jersey

NA

NA

82.0

(±7.0)

83.9

(±6.0)

85.4

(±6.2)

86.7

(±5.3)

NA

NA

88.8

(±6.0)

Bernalillo, New Mexico

75.2

(±7.2)

78.3

(±5.7)

80.8

(±5.6)

74.8

(±6.0)

85.1

(±5.3)

80.8

(±5.4)

84.8

(±6.1)

Dona Ana, New Mexico

75.4

(±8.5)

78.1

(±8.1)

75.5

(±7.7)

72.8

(±9.2)

82.2

(±7.8)

NA

NA

80.1

(±9.0)

Sandoval, New Mexico

NA

NA

NA

NA

NA

NA

NA

NA

85.9

(±6.9)

NA

NA

79.3

(±9.4)

San Juan, New Mexico

NA

NA

NA

NA

78.0

(±7.7)

75.1

(±8.4)

85.4

(±8.8)

77.9

(±7.7)

80.1

(±8.8)

Santa Fe, New Mexico

84.4

(±6.5)

NA

NA

77.5

(±7.4)

NA

NA

80.0

(±7.8)

NA

NA

NA

NA

Bronx, New York

73.8

(±8.6)

77.1

(±7.7)

72.9

(±8.1)

81.6

(±7.4)

77.7

(±7.1)

74.5

(±8.1)

83.1

(±6.8)

Erie, New York

82.5

(±6.8)

87.4

(±5.3)

86.5

(±5.5)

84.8

(±6.5)

87.7

(±5.6)

86.1

(±5.6)

NA

NA

Kings, New York

79.6

(±6.6)

79.0

(±6.1)

78.6

(±5.3)

79.0

(±6.1)

77.9

(±6.2)

81.6

(±5.1)

79.8

(±5.1)

Monroe, New York

NA

NA

88.6

(±4.9)

85.9

(±5.6)

82.9

(±6.9)

89.9

(±4.6)

89.5

(±4.2)

89.7

(±5.7)

Nassau, New York

83.4

(±7.0)

91.6

(±3.7)*

84.3

(±5.0)

86.9

(±5.4)

87.8

(±5.1)

93.3

(±3.5)*

90.8

(±4.2)*

New York, New York

83.4

(±7.2)

89.7

(±4.6)

89.8

(±4.6)

93.3

(±3.6)*

87.1

(±5.6)

86.2

(±5.5)

89.4

(±4.9)

Queens, New York

82.4

(±6.1)

84.7

(±5.2)

78.3

(±5.6)

83.9

(±5.5)

85.8

(±4.8)

87.8

(±4.5)

88.0

(±4.8)

Suffolk, New York

82.9

(±5.9)

88.0

(±4.6)

84.0

(±5.1)

84.7

(±5.8)

89.6

(±4.7)

87.0

(±5.0)

84.6

(±5.9)

Westchester, New York

NA

NA

90.3

(±4.3)*

87.6

(±5.2)

89.1

(±5.3)

88.4

(±5.5)

93.3

(±3.4)*

NA

NA

Durham, North Carolina

NA

NA

NA

NA

NA

NA

NA

NA

87.1

(±5.7)

NA

NA

NA

NA

Guilford, North Carolina

NA

NA

82.2

(±6.7)

84.5

(±5.9)

NA

NA

NA

NA

NA

NA

NA

NA

Mecklenburg, North Carolina

82.7

(±6.6)

82.5

(±6.4)

84.1

(±6.1)

83.2

(±6.6)

89.5

(±5.0)

89.2

(±4.7)

85.8

(±6.7)

Wake, North Carolina

87.1

(±5.5)

85.7

(±5.9)

84.9

(±5.7)

86.9

(±5.7)

91.1

(±4.2)*

91.1

(±3.8)*

90.8

(±4.8)*

Burleigh, North Dakota

82.4

(±6.3)

86.7

(±4.8)

85.4

(±5.2)

84.8

(±6.3)

88.3

(±5.2)

86.7

(±5.3)

82.6

(±6.7)

Cass, North Dakota

84.8

(±5.1)

85.5

(±4.5)

85.5

(±4.6)

85.9

(±5.2)

89.6

(±3.9)

89.9

(±3.6)

89.1

(±5.1)

Grand Forks, North Dakota

85.1

(±5.9)

84.1

(±5.9)

85.7

(±5.3)

82.6

(±6.2)

90.5

(±4.5)*

88.0

(±4.9)

86.8

(±7.1)

Ward, North Dakota

86.2

(±5.7)

81.2

(±6.4)

85.1

(±5.3)

84.4

(±6.1)

85.0

(±6.1)

86.7

(±5.3)

82.6

(±7.1)

Cuyahoga, Ohio

79.9

(±4.0)

81.1

(±3.4)

79.2

(±3.6)

79.5

(±4.1)

86.5

(±3.3)

89.8

(±2.7)

90.1

(±5.2)*

Franklin, Ohio

81.8

(±3.6)

82.2

(±3.3)

84.7

(±2.9)

84.7

(±3.2)

87.5

(±2.9)

86.3

(±5.0)

82.0

(±7.7)

Hamilton, Ohio

81.8

(±6.8)

86.6

(±5.2)

84.7

(±5.8)

87.6

(±5.5)

88.8

(±4.9)

88.5

(±4.6)

92.6

(±3.7)*

Lucas, Ohio

NA

NA

84.4

(±5.9)

NA

NA

82.2

(±7.0)

NA

NA

NA

NA

NA

NA

Montgomery, Ohio

NA

NA

NA

NA

NA

NA

81.6

(±6.7)

NA

NA

NA

NA

NA

NA

Cleveland, Oklahoma

NA

NA

81.9

(±7.0)

NA

NA

84.7

(±6.5)

86.4

(±5.9)

85.6

(±5.8)

85.2

(±7.0)

Oklahoma, Oklahoma

80.7

(±6.9)

78.5

(±6.4)

81.6

(±5.4)

77.5

(±6.6)

77.6

(±6.6)

83.2

(±5.4)

81.5

(±7.2)

Tulsa, Oklahoma

73.9

(±7.2)

81.1

(±5.8)

82.1

(±5.8)

84.5

(±5.9)

85.6

(±5.3)

83.6

(±5.5)

81.3

(±7.0)

Clackamas, Oregon

83.2

(±6.4)

80.4

(±6.2)

87.1

(±5.0)

84.6

(±6.2)

86.7

(±6.0)

NA

NA

81.4

(±7.6)

Lane, Oregon

79.3

(±7.1)

83.9

(±6.1)

83.6

(±6.2)

74.5

(±7.9)

84.9

(±6.2)

81.7

(±6.4)

81.2

(±8.2)

Marion, Oregon

83.8

(±6.5)

82.7

(±6.0)

82.3

(±5.7)

79.5

(±7.4)

83.6

(±6.4)

80.0

(±7.1)

79.7

(±8.9)

Multnomah, Oregon

82.6

(±5.5)

83.3

(±5.2)

84.1

(±5.1)

82.6

(±5.4)

84.9

(±5.4)

84.8

(±5.4)

83.6

(±6.3)

Washington, Oregon

78.0

(±6.7)

83.7

(±5.5)

82.4

(±5.6)

83.6

(±5.9)

85.8

(±4.9)

86.1

(±5.2)

88.6

(±6.1)

Allegheny, Pennsylvania

85.8

(±5.7)

86.3

(±4.9)

86.7

(±5.2)

89.9

(±4.6)

91.7

(±3.9)*

89.1

(±3.8)

87.2

(±5.8)

Delaware, Pennsylvania

NA

NA

87.2

(±5.4)

NA

NA

NA

NA

91.9

(±4.1)*

NA

NA

NA

NA

Lancaster, Pennsylvania

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

83.2

(±7.8)

Montgomery, Pennsylvania

85.4

(±5.9)

90.8

(±4.2)*

85.6

(±5.5)

NA

NA

92.5

(±3.7)*

NA

NA

93.0

(±3.8)*

Philadelphia, Pennsylvania

78.8

(±4.3)

84.1

(±3.2)

81.9

(±3.3)

78.5

(±3.6)

83.2

(±3.4)

83.9

(±3.5)

85.7

(±3.4)

Kent, Rhode Island

84.4

(±5.9)

88.5

(±4.2)

88.8

(±4.6)

87.6

(±4.8)

89.9

(±4.8)

90.7

(±3.6)*

89.7

(±4.6)

Newport, Rhode Island

86.1

(±5.8)

86.5

(±5.3)

83.0

(±6.1)

86.4

(±5.5)

NA

NA

86.6

(±5.3)

NA

NA

Providence, Rhode Island

87.8

(±3.5)

89.3

(±2.9)

88.8

(±3.3)

90.6

(±3.1)*

92.8

(±2.7)*

85.2

(±3.6)

84.4

(±4.6)

Washington, Rhode Island

88.3

(±5.1)

88.7

(±4.5)

86.0

(±4.8)

87.8

(±5.0)

93.2

(±3.3)*

92.9

(±3.3)*

89.9

(±5.1)

Charleston, South Carolina

86.1

(±6.2)

82.3

(±6.3)

82.4

(±6.4)

80.1

(±7.8)

81.7

(±7.3)

90.1

(±4.6)*

86.6

(±6.6)

Greenville, South Carolina

84.7

(±6.4)

84.2

(±5.8)

86.3

(±5.1)

84.2

(±6.4)

89.7

(±4.9)

84.6

(±5.9)

81.8

(±7.5)

Horry, South Carolina

NA

NA

NA

NA

NA

NA

84.4

(±6.7)

NA

NA

NA

NA

83.0

(±8.6)

Richland, South Carolina

NA

NA

81.2

(±7.6)

82.0

(±6.3)

82.3

(±7.6)

NA

NA

85.9

(±5.6)

84.3

(±6.9)


TABLE 5. (Continued) Estimated vaccination coverage with ≥4 doses of DTaP/DTP vaccine among children aged 19--35 months, by county/area and biennial survey period --- National Immunization Survey, selected counties, United States, 1995--2008

County/Area

1995--1996

1997--1998

1999--2000

2001--2002

2003--2004

2005--2006

2007--2008

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Spartanburg, South Carolina

79.3

(±7.4)

79.7

(±7.2)

84.9

(±6.0)

NA

NA

NA

NA

84.0

(±6.2)

84.6

(±7.3)

York, South Carolina

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

84.3

(±6.9)

Minnehaha, South Dakota

84.2

(±5.5)

82.8

(±5.2)

84.3

(±5.0)

81.8

(±6.0)

91.0

(±3.8)*

86.9

(±4.6)

86.7

(±5.3)

Pennington, South Dakota

83.3

(±6.6)

84.0

(±5.7)

85.6

(±5.4)

83.9

(±7.1)

88.1

(±5.4)

84.6

(±5.5)

81.1

(±8.4)

Davidson, Tennessee

81.4

(±3.5)

84.7

(±3.0)

81.4

(±3.4)

85.1

(±3.2)

88.8

(±2.7)

84.8

(±5.0)

88.7

(±5.6)

Hamilton, Tennessee

NA

NA

83.8

(±5.9)

80.8

(±6.5)

83.8

(±7.3)

NA

NA

NA

NA

NA

NA

Knox, Tennessee

85.3

(±6.0)

88.0

(±4.7)

82.8

(±5.9)

82.1

(±6.8)

88.1

(±4.7)

89.6

(±4.8)

89.6

(±5.7)

Shelby, Tennessee

76.2

(±4.0)

77.8

(±3.8)

82.1

(±3.4)

78.9

(±3.9)

82.6

(±3.5)

80.5

(±4.0)

84.5

(±6.6)

Bexar, Texas

77.9

(±4.1)

82.0

(±3.4)

72.6

(±4.1)

80.5

(±3.3)

79.7

(±4.2)

79.3

(±4.2)

82.8

(±3.6)

Collin, Texas

NA

NA

NA

NA

NA

NA

96.2

(±1.4)*

NA

NA

89.4

(±4.8)

NA

NA

Dallas, Texas

76.2

(±4.3)

77.6

(±3.8)

76.9

(±3.8)

76.4

(±3.5)

78.0

(±3.7)

81.0

(±4.0)

80.1

(±3.6)

El Paso, Texas

71.8

(±4.5)

74.6

(±3.6)

75.5

(±3.9)

75.9

(±4.1)

79.0

(±4.0)

78.0

(±3.8)

80.7

(±3.6)

Harris, Texas

74.2

(±4.5)

69.9

(±4.5)

73.8

(±4.1)

76.3

(±4.3)

74.2

(±4.3)

81.6

(±3.9)

81.5

(±5.8)

Hidalgo, Texas

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

76.8

(±9.5)

NA

NA

Tarrant, Texas

80.5

(±7.2)

78.4

(±7.2)

79.6

(±6.7)

81.7

(±7.1)

84.7

(±6.1)

84.5

(±5.5)

82.0

(±7.9)

Travis, Texas

NA

NA

NA

NA

80.9

(±7.0)

NA

NA

87.0

(±6.0)

85.0

(±5.7)

NA

NA

Cache, Utah

NA

NA

81.4

(±7.0)

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Davis, Utah

76.0

(±7.4)

83.8

(±5.7)

81.8

(±6.0)

83.6

(±6.1)

81.8

(±7.1)

83.6

(±6.1)

85.4

(±6.5)

Salt Lake, Utah

73.6

(±5.5)

81.3

(±4.7)

82.7

(±4.4)

82.8

(±5.0)

82.5

(±5.0)

85.6

(±5.1)

83.8

(±5.8)

Utah, Utah

73.9

(±6.7)

75.6

(±6.1)

82.6

(±5.3)

82.0

(±5.6)

86.0

(±4.7)

82.9

(±6.0)

81.1

(±6.6)

Weber, Utah

77.5

(±7.6)

83.8

(±5.6)

83.6

(±6.0)

80.4

(±7.6)

82.6

(±7.3)

NA

NA

NA

NA

Addison, Vermont

88.5

(±5.4)

90.4

(±4.5)*

NA

NA

86.3

(±5.9)

94.4

(±3.0)*

NA

NA

NA

NA

Bennington, Vermont

NA

NA

88.0

(±5.2)

86.9

(±5.5)

NA

NA

NA

NA

NA

NA

NA

NA

Chittenden, Vermont

89.4

(±4.3)

92.7

(±3.0)*

88.3

(±4.3)

87.9

(±4.3)

94.1

(±2.5)*

92.2

(±3.7)*

87.3

(±4.8)

Franklin, Vermont

83.0

(±7.1)

88.0

(±5.2)

86.4

(±5.3)

86.5

(±5.9)

88.4

(±4.9)

NA

NA

86.9

(±6.4)

Lamoille, Vermont

NA

NA

NA

NA

NA

NA

NA

NA

87.9

(±6.0)

NA

NA

NA

NA

Orange, Vermont

84.0

(±7.1)

86.7

(±5.1)

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Rutland, Vermont

81.8

(±6.4)

87.1

(±5.2)

86.2

(±5.1)

87.1

(±6.0)

90.0

(±4.4)

NA

NA

NA

NA

Washington, Vermont

86.3

(±6.1)

87.2

(±4.9)

86.2

(±5.9)

90.2

(±4.3)*

88.9

(±5.1)

88.8

(±4.5)

81.8

(±7.6)

Windham, Vermont

NA

NA

88.2

(±5.2)

87.1

(±5.3)

84.4

(±6.4)

NA

NA

NA

NA

83.5

(±7.1)

Windsor, Vermont

83.4

(±6.6)

86.8

(±5.3)

85.8

(±5.4)

86.9

(±5.4)

89.5

(±5.0)

87.5

(±5.4)

NA

NA

Fairfax, Virginia

84.1

(±5.8)

85.3

(±5.1)

84.5

(±5.3)

86.7

(±5.6)

89.0

(±4.6)

90.7

(±3.5)*

90.7

(±4.2)*

Loudoun, Virginia

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

87.5

(±6.5)

Virginia Beach, Virginia

NA

NA

79.0

(±7.3)

81.5

(±6.6)

NA

NA

NA

NA

NA

NA

84.2

(±7.5)

Clark, Washington

82.4

(±7.3)

84.3

(±5.9)

80.2

(±6.3)

81.7

(±6.9)

84.5

(±6.4)

84.4

(±6.3)

NA

NA

King, Washington

85.5

(±3.0)

86.7

(±2.8)

82.8

(±3.0)

79.3

(±3.4)

88.5

(±2.7)

86.8

(±3.6)

84.4

(±5.2)

Kitsap, Washington

NA

NA

NA

NA

84.8

(±5.8)

NA

NA

78.6

(±8.0)

NA

NA

81.0

(±7.5)

Pierce, Washington

80.6

(±6.7)

83.9

(±5.6)

81.8

(±5.3)

79.5

(±6.8)

82.6

(±6.6)

85.5

(±5.6)

81.1

(±7.5)

Snohomish, Washington

82.4

(±6.4)

83.9

(±5.5)

83.9

(±5.3)

83.2

(±5.7)

86.2

(±5.3)

83.5

(±5.8)

83.0

(±7.8)

Spokane, Washington

81.6

(±7.0)

85.8

(±5.3)

84.4

(±5.4)

76.1

(±7.7)

86.2

(±5.6)

NA

NA

81.4

(±7.6)

Thurston, Washington

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

83.5

(±6.7)

Whatcom, Washington

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

86.6

(±6.2)

Yakima, Washington

78.5

(±8.1)

76.2

(±8.1)

NA

NA

78.0

(±8.9)

NA

NA

NA

NA

NA

NA

Kanawha, West Virginia

78.2

(±7.0)

89.4

(±4.5)

85.6

(±5.3)

NA

NA

86.2

(±6.0)

82.7

(±6.0)

84.2

(±7.0)

Brown, Wisconsin

NA

NA

NA

NA

NA

NA

85.3

(±6.4)

NA

NA

NA

NA

NA

NA

Dane, Wisconsin

86.4

(±5.5)

89.6

(±4.7)

84.8

(±5.6)

85.5

(±6.0)

87.1

(±5.8)

91.4

(±3.9)*

87.5

(±6.5)

Milwaukee, Wisconsin

74.7

(±4.1)

79.5

(±3.4)

77.7

(±3.8)

77.2

(±4.3)

85.2

(±3.4)

84.9

(±4.0)

83.0

(±6.2)

Outagamie, Wisconsin

NA

NA

85.1

(±6.2)

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Waukesha, Wisconsin

85.0

(±6.0)

87.4

(±5.1)

88.4

(±4.7)

89.3

(±5.1)

90.9

(±4.1)*

91.9

(±3.5)*

NA

NA

Albany, Wyoming

NA

NA

82.5

(±6.1)

85.3

(±5.9)

NA

NA

90.2

(±4.9)*

NA

NA

NA

NA

Campbell, Wyoming

NA

NA

83.4

(±6.3)

83.6

(±5.9)

85.6

(±5.8)

86.0

(±5.2)

87.0

(±4.9)

87.4

(±6.0)

Fremont, Wyoming

NA

NA

78.5

(±8.1)

80.3

(±6.7)

80.3

(±7.9)

90.0

(±6.4)

NA

NA

NA

NA

Laramie, Wyoming

81.0

(±6.3)

83.4

(±5.4)

85.3

(±5.0)

79.9

(±6.9)

86.6

(±5.1)

84.6

(±5.5)

72.3

(±8.2)

Natrona, Wyoming

77.3

(±7.3)

84.5

(±5.1)

85.5

(±4.9)

82.4

(±6.1)

86.1

(±5.3)

83.0

(±5.9)

81.9

(±7.0)

Sweetwater, Wyoming

79.8

(±7.1)

75.7

(±7.1)

84.1

(±5.7)

83.1

(±6.8)

NA

NA

83.0

(±6.1)

76.9

(±8.1)

Uinta, Wyoming

NA

NA

NA

NA

84.5

(±6.0)

NA

NA

NA

NA

NA

NA

NA

NA

United States

80.0

(±0.7)

82.5

(±0.6)

82.1

(±0.6)

81.7

(±0.6)

85.6

(±0.6)

85.4

(±0.6)

84.6

(±0.7)

Sample size, no.

37,282

44,855

45,623

45,052

43,308

38,607

35,447

All selected counties

80.2

(±0.9)

82.2

(±0.8)

81.8

(±0.8)

82.2

(±0.8)

85.6

(±0.7)

85.7

(±0.7)

85.1

(±0.8)

Sample size, no.

23,014

29,227

30,362

29,851

28,845

23,485

20,552

Range, %

71.7--89.4

68.3--92.7

72.6--91.3

71.7--96.2

74.2--97

66.2--93.7

72.2--95.6

Abbreviations: DTaP = diphtheria and tetanus toxoids and acellular pertussis; DTP = diphtheria and tetanus toxoids and pertussis; CI = confidence interval; NA = not available.

* Estimate exceeds the Healthy People 2010 objective of 90% vaccination coverage.

Estimates increased significantly between the first and last biennial periods (p<0.05).

§ Estimate has 95% CI half-width that exceeds 10% and might be imprecise.

Estimates decreased significantly between the first and last biennial periods (p<0.05).


TABLE 6. Estimated vaccination coverage with ≥3 doses of polio vaccine among children aged 19--35 months, by county/area and biennial survey period --- National Immunization Survey, selected counties, United States, 1995--2008

County/Area

1995--1996

1997--1998

1999--2000

2001--2002

2003--2004

2005--2006

2007--2008

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Jefferson, Alabama

90.3

(±2.7)*

92.8

(±2.1)*

90.8

(±2.5)*

89.9

(±2.7)

90.6

(±2.8)*

93.8

(±3.3)*

94.3

(±3.2)*

Madison, Alabama

NA

NA

91.8

(±4.4)*

89.7

(±4.6)

NA

NA

95.0

(±2.0)*

93.0

(±4.0)*

95.3

(±2.6)*

Mobile, Alabama

85.3

(±6.0)

91.4

(±4.4)*

87.6

(±5.2)

88.2

(±5.3)

91.5

(±3.9)*

93.0

(±3.8)*

94.3

(±3.4)*

Montgomery, Alabama

NA

NA

90.1

(±5.1)*

88.7

(±5.4)

NA

NA

NA

NA

NA

NA

NA

NA

Shelby, Alabama

NA

NA

NA

NA

90.3

(±4.5)*

91.0

(±4.7)*

92.9

(±3.7)*

NA

NA

94.2

(±3.8)*

Anchorage, Alaska

NA

NA

NA

NA

87.8

(±3.6)

85.4

(±4.4)

91.6

(±2.9)*

91.2

(±3.8)*

92.1

(±3.7)*

Fairbanks North Star, Alaska

NA

NA

NA

NA

89.3

(±4.3)

82.8

(±6.2)

87.0

(±4.6)

90.2

(±4.7)*

92.2

(±4.3)*

Kenai Peninsula, Alaska

NA

NA

NA

NA

90.5

(±4.4)*

NA

NA

NA

NA

NA

NA

NA

NA

Matanuska-Susitna, Alaska

NA

NA

NA

NA

90.1

(±4.4)*

86.9

(±6.2)

90.3

(±4.5)*

91.3

(±4.4)*

92.2

(±4.1)*

Cochise, Arizona

NA

NA

89.8

(±5.2)

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Coconino, Arizona

NA

NA

86.7

(±5.9)

NA

NA

NA

NA

89.7

(±5.3)

NA

NA

NA

NA

Maricopa, Arizona

88.0

(±3.2)

87.5

(±2.8)

85.3

(±3.2)

87.3

(±3.0)

90.7

(±2.5)*

89.1

(±2.8)

90.6

(±3.5)*

Mohave, Arizona

NA

NA

NA

NA

86.7

(±5.5)

86.4

(±6.2)

NA

NA

NA

NA

NA

NA

Pima, Arizona

89.9

(±3.9)

89.1

(±3.8)

90.4

(±3.3)*

82.1

(±4.7)

88.5

(±3.9)

90.5

(±4.1)*

93.4

(±3.9)*

Pinal, Arizona

90.4

(±4.7)*

88.7

(±5.5)

88.1

(±5.6)

89.3

(±5.1)

88.6

(±5.1)

90.4

(±5.4)*

NA

NA

Yavapai, Arizona

NA

NA

NA

NA

NA

NA

88.1

(±5.6)

88.1

(±5.1)

NA

NA

NA

NA

Yuma, Arizona

88.1

(±5.4)

90.6

(±4.9)*

85.1

(±5.9)

86.7

(±5.9)

89.6

(±5.0)

95.6

(±1.8)*

NA

NA

Benton, Arkansas

NA

NA

87.0

(±5.6)

NA

NA

89.7

(±5.1)

92.7

(±3.7)*

94.3

(±3.5)*

95.0

(±2.9)*

Pulaski, Arkansas

88.3

(±5.5)

89.5

(±4.7)

85.4

(±5.4)

89.2

(±4.7)

93.4

(±3.3)*

90.4

(±5.2)*

94.0

(±3.6)*

Washington, Arkansas

89.3

(±5.2)

90.6

(±4.6)*

NA

NA

91.1

(±4.6)*

NA

NA

NA

NA

92.6

(±4.1)*

Alameda, California

86.6

(±5.9)

NA

NA

88.2

(±5.3)

90.1

(±5.7)*

91.5

(±4.1)*

91.0

(±3.7)*

90.1

(±5.0)*

Los Angeles, California

89.0

(±3.2)

89.5

(±2.7)

86.9

(±3.1)

87.2

(±3.5)

92.1

(±2.2)*

92.3

(±2.4)*

94.4

(±1.9)*

Orange, California

92.8

(±3.6)*

91.1

(±4.0)*

86.6

(±5.4)

89.5

(±4.7)

90.8

(±4.0)*

91.1

(±4.8)*

93.5

(±3.7)*

Riverside, California

NA

NA

NA

NA

86.7

(±5.6)

86.2

(±6.2)

88.9

(±4.8)

NA

NA

92.4

(±4.5)*

San Bernardino, California

NA

NA

86.8

(±5.5)

88.2

(±5.1)

86.2

(±6.5)

89.6

(±4.6)

90.6

(±3.1)*

94.2

(±2.0)*

San Diego, California

89.3

(±2.9)

88.0

(±2.6)

88.9

(±2.6)

90.0

(±2.5)

91.1

(±2.4)*

93.3

(±2.9)*

93.0

(±4.0)*

San Mateo, California

NA

NA

91.4

(±4.2)*

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Santa Clara, California

91.5

(±2.7)*

90.2

(±2.5)*

90.5

(±2.3)*

92.0

(±2.1)*

92.8

(±2.4)*

93.7

(±2.8)*

NA

NA

Adams, Colorado

89.3

(±5.1)

89.5

(±4.6)

86.6

(±5.2)

86.9

(±5.9)

91.1

(±4.3)*

NA

NA

NA

NA

Arapahoe, Colorado

93.0

(±3.4)*

92.3

(±4.0)*

88.9

(±4.9)

91.2

(±4.3)*

94.1

(±3.1)*

NA

NA

95.1

(±3.3)*

Boulder, Colorado

NA

NA

92.7

(±3.9)*

90.6

(±4.3)*

91.1

(±4.4)*

90.5

(±4.1)*

91.9

(±4.8)*

93.3

(±4.1)*

Denver, Colorado

90.9

(±4.2)*

89.4

(±4.5)

88.9

(±4.8)

90.8

(±4.5)*

92.2

(±3.6)*

NA

NA

NA

NA

Douglas, Colorado

NA

NA

NA

NA

91.1

(±4.3)*

91.8

(±4.6)*

93.8

(±3.1)*

NA

NA

NA

NA

El Paso, Colorado

88.1

(±5.2)

90.1

(±4.6)*

86.2

(±5.1)

88.0

(±5.1)

86.5

(±5.0)

91.4

(±4.6)*

92.0

(±4.4)*

Jefferson, Colorado

91.6

(±4.1)*

92.2

(±3.8)*

89.5

(±4.7)

91.9

(±4.0)*

92.3

(±3.6)*

95.0

(±2.7)*

93.5

(±3.6)*

Larimer, Colorado

NA

NA

NA

NA

89.3

(±4.7)

89.6

(±4.9)

NA

NA

92.7

(±4.4)*

NA

NA

Weld, Colorado

NA

NA

NA

NA

89.2

(±5.0)

90.7

(±5.0)*

88.8

(±4.9)

NA

NA

91.0

(±5.0)*

Fairfield, Connecticut

90.6

(±4.3)*

91.7

(±3.1)*

92.5

(±3.4)*

95.1

(±2.5)*

95.6

(±1.8)*

92.2

(±3.6)*

95.0

(±2.5)*

Hartford, Connecticut

91.9

(±3.9)*

92.4

(±3.3)*

89.4

(±4.0)

92.2

(±3.6)*

94.5

(±2.5)*

95.0

(±2.8)*

95.5

(±2.7)*

New Haven, Connecticut

89.1

(±4.6)

93.4

(±3.0)*

90.9

(±3.8)*

89.5

(±4.3)

91.6

(±4.0)*

93.3

(±3.7)*

94.2

(±3.3)*

New London, Connecticut

90.6

(±4.9)*

90.7

(±4.4)*

89.1

(±4.7)

NA

NA

93.6

(±3.2)*

93.9

(±4.0)*

94.5

(±3.5)*

Kent, Delaware

90.0

(±4.6)

92.8

(±3.2)*

91.5

(±3.5)*

90.1

(±4.3)*

92.1

(±3.7)*

94.0

(±3.6)*

94.4

(±3.2)*

New Castle, Delaware

88.9

(±3.5)

91.8

(±2.6)*

89.9

(±2.9)

90.2

(±2.9)*

92.0

(±2.7)*

92.1

(±3.0)*

94.4

(±2.6)*

Sussex, Delaware

89.0

(±4.7)

91.5

(±3.9)*

90.5

(±3.8)*

93.6

(±2.9)*

91.2

(±3.4)*

95.2

(±2.5)*

92.3

(±3.3)*

District of Columbia

89.8

(±3.3)

87.6

(±2.9)

86.4

(±3.3)

90.8

(±2.5)*

93.0

(±2.4)*

92.4

(±2.4)*

91.4

(±2.5)*

Broward, Florida

90.5

(±4.6)*

91.1

(±4.2)*

90.6

(±4.4)*

90.1

(±4.9)*

89.5

(±4.3)

87.4

(±6.0)

92.9

(±4.1)*

Duval, Florida

87.3

(±3.3)

90.6

(±2.5)*

90.3

(±2.6)*

89.9

(±3.0)

90.1

(±2.8)*

92.5

(±2.3)*

NA

NA

Hillsborough, Florida

87.3

(±5.8)

88.8

(±5.1)

87.0

(±5.1)

91.0

(±4.7)*

90.8

(±4.3)*

88.9

(±5.6)

NA

NA

Dade, Florida

NA

NA

NA

NA

90.5

(±2.8)*

89.7

(±2.6)

91.5

(±2.6)*

93.5

(±3.1)*

93.4

(±2.4)*

Orange, Florida

NA

NA

NA

NA

88.8

(±5.0)

NA

NA

90.6

(±4.5)*

NA

NA

94.3

(±3.0)*

Palm Beach, Florida

NA

NA

89.9

(±4.6)

88.9

(±4.7)

92.6

(±3.8)*

93.5

(±3.1)*

89.8

(±5.5)

93.1

(±4.3)*

Pinellas, Florida

NA

NA

88.4

(±5.3)

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Cobb, Georgia

90.6

(±5.0)*

91.8

(±4.1)*

90.5

(±4.4)*

90.8

(±4.8)*

93.4

(±3.2)*

94.4

(±3.4)*

94.1

(±3.1)*

DeKalb, Georgia

89.2

(±5.2)

88.7

(±4.0)

91.1

(±3.6)*

88.9

(±3.7)

91.3

(±2.7)*

87.1

(±4.7)

92.6

(±4.3)*

Fulton, Georgia

88.6

(±4.6)

90.2

(±3.4)*

89.7

(±3.3)

91.2

(±3.1)*

91.7

(±2.6)*

93.4

(±3.0)*

92.5

(±4.2)*

Gwinnett, Georgia

90.7

(±4.8)*

90.0

(±4.3)

90.7

(±4.4)*

89.4

(±5.1)

91.7

(±3.8)*

94.7

(±3.1)*

93.3

(±3.8)*

Hawaii, Hawaii

91.9

(±4.3)*

91.6

(±4.0)*

87.8

(±5.1)

86.6

(±6.7)

90.4

(±4.1)*

90.6

(±4.5)*

92.2

(±4.1)*

Honolulu, Hawaii

91.5

(±2.9)*

89.2

(±3.1)

88.9

(±3.1)

86.6

(±4.0)

88.1

(±2.9)

90.6

(±3.2)*

92.6

(±2.8)*

Maui, Hawaii

86.1

(±5.7)

93.7

(±3.0)*

87.0

(±5.4)

85.6

(±6.4)

89.8

(±4.3)

92.6

(±4.4)*

93.0

(±4.5)*

Ada, Idaho

87.4

(±4.6)

91.4

(±3.3)*

88.6

(±4.0)

85.6

(±5.1)

92.3

(±3.2)*