Evaluating vaccination coverage and timeliness in American Indian/Alaska Native and non-Hispanic White children using state immunization information system data, 2015-2017

Abstract

Comprehensive estimates of vaccination coverage and timeliness of vaccine receipt among American Indian/Alaska Native (AI/AN) children in the United States are lacking. This study's objectives were to quantify vaccination coverage and timeliness, as well as the proportion of children with specific undervaccination patterns, among AI/AN and non-Hispanic White (NHW) children ages 0-24 months in Montana, a large and primarily rural U.S. state. Data from Montana's immunization information system (IIS) for children born 2015-2017 were used to calculate days undervaccinated for all doses of seven recommended vaccine series. After stratifying by race/ethnicity, up-to-date coverage at key milestone ages and the proportion of children demonstrating specific patterns of undervaccination were reported. Among n = 3,630 AI/AN children, only 23.1% received all recommended vaccine doses on-time (i.e., zero days undervaccinated), compared to 40.4% of n = 18,022 NHW children (chi-square p < 0.001). A greater proportion of AI/AN children were delayed at each milestone age, resulting in lower overall combined 7-vaccine series completion, by age 24 months (AI/AN: 56.6%, NHW: 64.3%, chi-square p < 0.001). As compared with NHW children, a higher proportion of AI/AN children had undervaccination patterns suggestive of structural barriers to accessing immunization services and delayed starts to vaccination. More than three out of four AI/AN children experienced delays in vaccination or were missing doses needed to complete recommended vaccine series. Interventions to ensure on-time initiation of vaccine series at age 2 months, as well initiatives to encourage completion of multi-dose vaccine series, are needed to reduce immunization disparities and increase vaccination coverage among AI/AN children in Montana.

Keywords: ACIP, Advisory Committee on Immunization Practices; AI/AN, American Indian/Alaska Native; American Indian/Alaska Native; CI, Confidence interval; Childhood immunization; DTaP, Diphtheria, tetanus, acellular pertussis; Health equity; HepB, Hepatitis B; Hib, Haemophilus influenzae type b; I/T/U, Indian Health Service/Tribal/Urban Indian health services; IHS, Indian Health Service; IIS, Immunization Information System; IPV, Inactivated poliovirus vaccine; Immunization information system (IIS); MMR, Measles, mumps, and rubella; MSA, Metropolitan statistical area; NHW, non-Hispanic White; NIS, National Immunization Survey; NVAC, National Vaccine Advisory Committee; PCV, Pneumococcal conjugate vaccine; Schedule; Timeliness; UTD, Up-to-date; Undervaccination; VAR, Varicella; VPD, Vaccine Preventable Disease.

Fig. 1

Up-to-date vaccination coverage at key milestone ages for American Indian/Alaska Native (n = 3,630) and Non-Hispanic White (n = 18,022) Montana children born 2015–2017.