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Vaccination Coverage of 2-Year-Old Children -- United States, 1992- 1993

The principal goal of the Childhood Immunization Initiative (CII) is to increase, by 1996, vaccination levels for 2-year-old children to at least 90% for the most critical doses in the vaccination series (i.e., one dose of measles-mumps-rubella vaccine {MMR} and at least three doses each of diphtheria and tetanus toxoids and pertussis vaccine {DTP}, oral poliovirus vaccine {OPV}, and Haemophilus influenzae type b vaccine {Hib}) and to at least 70% for at least three doses of hepatitis B vaccine (Hep B) (1). Since 1991, annual national estimates of vaccination coverage levels of preschool-aged children have been available through the National Health Interview Survey (NHIS) conducted by CDC (2,3). This report presents vaccination coverage levels of children aged 19-35 months for 1992 and provisional estimates of vaccination coverage for the combined first and second quarters of 1993 (Table_1). Vaccination coverage increased for three vaccines from 1992 to 1993: for three or more doses of Hib, from 28.0% to 49.9% (p less than 0.05); for three or more doses of poliomyelitis vaccine, from 72.4% to 78.4% (p less than 0.05); and for three or more doses of DTP/ diphtheria and tetanus toxoids (DT), from 83.0% to 87.2% (p greater than 0.05). Coverage with measles-containing vaccine decreased from 82.5% to 80.8% (p greater than 0.05). Among 19- 35-month-olds, 12.7% had received three or more doses of Hep B. From 1992 to 1993, the proportion of children who had received a combined series of four or more doses of DTP/DT, three or more doses of polio vaccine, and one dose of MMR increased from 55.3% to 64.8% (p less than 0.05), primarily because of increased coverage with the fourth DTP/DT dose (from 59.0% to 71.1% {p less than 0.05}).

Reported by: National Immunization Program; Div of Health Interview Statistics, National Center for Health Statistics, CDC.

Editorial Note

Editorial Note: In 1993, processing of the NHIS was modified to produce national vaccination coverage estimates for each quarter. The findings in this report represent the first provisional quarterly estimates and indicate substantial progress in efforts to attain the 1996 antigen-specific vaccination goals for DTP and polio vaccine. However, coverage with measles-containing vaccines has not improved since 1991, when 82.0% of 2-year-old children were reported to be vaccinated. Although the coverage levels for Hib and hepatitis B remain suboptimal, the levels described in this report may underestimate coverage because many children were born before the recommendations for universal infant vaccination that were promulgated in October 1990 (4) and November 1991 (5). Less than 1% of 19-35-month-old children surveyed during January-June 1993 were born after recommendations for universal infant vaccination against hepatitis B went into effect. Similarly, only approximately two thirds of the children aged 19-35 months included in this survey were born after October 1990 -- when Hib was approved for infants. Provisional results from NHIS for the first two quarters of 1993 indicate that the combined efforts of public and private health-care providers at local, state, and national levels have facilitated progress toward both the 1996 CII goal and the year 2000 national health objective to increase vaccination levels for 2-year-olds to 90% (objective 20.11) for the complete series of recommended vaccine doses against all nine diseases (i.e., four or more doses of DTP, three or more doses of OPV, three or more doses of Hib, one dose of MMR, and three or more doses of Hep B) (6). However, based on the reported 1993 coverage levels, approximately 1.25 million children require at least one dose of OPV, and 1.12 million require a dose of measles-containing vaccine; approximately 740,000 children have not received at least three doses of DTP/DT. These findings emphasize the need for public and private health-care providers and local, state, and national public health officials to collaborate on implementation of the CII to achieve higher levels of vaccination coverage among 2-year-olds.


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

  2. Massey JT, Moore TF, Parsons VL, et al. Design and estimation for the National Health Interview Survey, 1985-94. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1989. (Vital and health statistics; series 2, no. 110.)

  3. CDC. Vaccination coverage of 2-year-old children -- United States, 1991-1992. MMWR 1994;42:985-8.

  4. ACIP. Haemophilus b conjugate vaccines for prevention of Haemophilus influenzae type b disease among infants and children two months of age and older -- recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 1991;40(no. RR-1).

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

  6. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

TABLE 1. Vaccination levels of children aged 19-35 months, by selected vaccines --
United States, 1992 and 1993 *
                                  1992                       1993
                           -------------------        ------------------
Vaccine                     %      (95% CI +)          %      (95% CI)
  >=3 doses                83.0    (80.8-85.2)        87.2   (84.3-90.4)
  >=4 doses                59.0    (56.1-61.9)        71.1   (67.1-75.1)

  >=3 doses                72.4    (70.1-74.7)        78.4   (74.8-82.0)

Haemophilus influenzae
  type b
  >=3 doses                28.2    (25.6-30.9)        49.6   (45.4-53.8)

Measles-containing         82.5    (80.2-84.8)        80.8   (77.2-84.4)

Hepatitis B
  >=3 doses                 --          --            12.7   ( 9.4-16.0)

3 DTP/3 polio/1 MMR @      68.7    (66.2-71.2)        72.0   (68.1-75.9)

4 DTP/3 polio/1 MMR        55.3    (52.5-58.1)        64.8   (60.6-68.9)
* Provisional data based on first and second quarters.
+ Confidence interval.
& Diphtheria and tetanus toxoids and pertussis vaccine/Diphtheria and tetanus toxoids.
@ Measles-mumps-rubella vaccine.

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