Vaccination Coverage Levels Among Children Aged 19-35 Months -- United States, April-June 1994

A national health objective for the year 2000 is to increase to at least 90% the proportion of children aged 2 years who have received the complete series of routinely recommended childhood vaccinations (objective 20.11) (1). To assist in achieving the year 2000 objective, the Childhood Immunization Initiative (CII) was begun to increase vaccination coverage levels among preschool-aged children and to reduce or eliminate vaccine-preventable diseases in the United States by 1996 (2). Vaccination coverage goals were established for each routinely recommended vaccination. In addition, interim goals for 1994 and 1995 * were established to assist in monitoring progress toward CII's 1996 goals. This report presents national estimates of vaccination coverage among children aged 19-35 months derived from provisional data from CDC's National Health Interview Survey (NHIS) for the second quarter of 1994 (April-June; the most recent period for which data were available), compares these data with the previous three quarters, and summarizes progress toward the CII's interim goals for 1994.

NHIS is an annual cross-sectional household interview survey of the civilian, noninstitutionalized U.S. population (3). An Immunization Supplement was added to NHIS in 1992 to collect data about vaccinations among children aged less than 6 years. Vaccination information is obtained from vaccination records; for children for whom no vaccination records are available, information is based on parental recall. Quarterly estimates are based on sample sizes ranging from 483 to 622 per quarter. Respondents surveyed during the second quarter of 1994 provided information for their children who were born during May 1991-November 1992; the median age of the children was 27 months. For the last two quarters in 1993, 37% of NHIS respondents used a vaccination record for reporting vaccination information. In the first and second quarters of 1994, 52% and 49% of respondents, respectively, used a vaccination record. The analysis excluded respondents (range: 12%-16%) who reported not knowing whether their children had received a particular vaccination or not knowing the number of doses the child had received. Confidence intervals (CIs) were calculated using the Software for Survey Data Analysis (SUDAAN).

During the second quarter of 1994, vaccination coverage levels among children aged 19-35 months for the most critical doses in the 1996 objectives ranged from 75.6% (three or more doses of Haemophilus influenzae type b vaccine {Hib}) to 91.6% (one dose of measles-containing vaccine {MCV}) Table_1. The coverage level for hepatitis B vaccine (Hep B) was 29.4%. For the combined series of four doses of diphtheria and tetanus toxoids and pertussis vaccine (DTP), three doses of poliovirus vaccine, and one dose of MCV, coverage was 67.7%; for the combined series that includes at least three doses of Hib, coverage was 60.2%.

Quarterly levels of coverage with three doses of Hib increased significantly from the third quarter of 1993 to the second quarter of 1994, from 53.1% to a record high level of 75.6%; coverage with Hep B increased from 15.7% during third quarter 1993 to 29.4% during second quarter 1994. Quarterly levels during the previous four quarters (April 1993-March 1994) were statistically unchanged for the combined series and for DTP, poliovirus vaccine, and MCV. Reported by: Assessment Br, Data Management Div, National Immunization Program; Div of Health Interview Statistics, National Center for Health Statistics, CDC.

Editorial Note

Editorial Note: Based on the most recent NHIS data available, the findings in this report document statistically significant increases and record high levels in national vaccination coverage with Hib and with Hep B during April-June 1994. In addition, during that period, coverage was at or near the highest levels ever recorded for three doses of DTP, three doses of poliovirus vaccine, one dose of MCV, and for the combined series.

The quarterly NHIS data also indicated that the 1994 interim goals of the CII were attained during April-June 1994 for all vaccines except Hep B; however, for annual coverage levels for these vaccines to meet the 1994 goals, coverage would have had to be maintained for the remainder of the year. Although only 65% of the children during the second quarter of 1994 were required to receive Hep B (recommendations for universal hepatitis B vaccination of infants became effective in November 1991), coverage with Hep B was still within one percentage point of the 1994 goal. Because future estimates based on NHIS quarterly data will include a progressively larger proportion of children required to receive Hep B, quarterly coverage levels are expected to increase for the remainder of 1994.

Based on the findings in this report, as of April-June 1994, only 60% of children aged 19-35 months had received the recommended number of doses for the combined series of DTP, poliovirus vaccine, MCV, and Hib. To assist in achieving the year 2000 national health objective of 90% coverage with the complete series of routinely recommended vaccinations, increased efforts are needed to vaccinate all children (4,5).

References

1. 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.

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

3. Massey JT, Moore TF, Parsons VL, Tadros W. Design and estimation for the National Health Interview Survey, 1985-1994. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1989. (Vital and health statistics; series 2, no. 110).

4. CDC. Vaccination coverage of 2-year-old children -- United States, January-March 1994. MMWR 1995;44:142-50.

5. CDC. Vaccination coverage of 2-year-old children -- United States, 1993. MMWR 1994;43:705-9.

   
   

* For 1994: 85% coverage for three or more doses of diphtheria and tetanus toxoids and pertussis vaccine (DTP) and one dose of measles-mumps-rubella vaccine (MMR), 75% coverage for three or more doses each of poliovirus vaccine and Haemophilus influenzae type b vaccine (Hib), and 30% coverage for three or more doses of hepatitis B vaccine (Hep B). For 1995: 87% coverage for three or more doses of DTP, 85% coverage for three or more doses each of poliovirus vaccine and Hib, 90% coverage for one dose of MMR, and 50% coverage for three or more doses of Hep B.

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