Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan-Dec;23(1):740-749.
doi: 10.1080/14760584.2024.2389922. Epub 2024 Aug 14.

National trends in patterns of under-vaccination in early childhood: National Immunization Survey-Child, United States, 2011-2021

Matthew F Daley  1   2 , Christina L Clarke  1 , Jason M Glanz  1   3 , Alexandria N Albers  4   5 , Sarah Y Michels  4   5 , Rain E Freeman  4   5   6 , Sophia R Newcomer  4   5
Affiliations

National trends in patterns of under-vaccination in early childhood: National Immunization Survey-Child, United States, 2011-2021

Matthew F Daley et al. Expert Rev Vaccines. 2024 Jan-Dec.

Abstract

Background: The study's objective was to examine national trends in patterns of under-vaccination in the United States.

Research design and methods: The National Immunization Survey-Child (NIS-Child) is an annual cross-sectional survey that collects provider-verified vaccination records from a large national probability sample of children. Records from the 2011-2021 NIS-Child were used to assess receipt of the combined 7-vaccine series by age 24 months. Based on prior work, patterns indicative of hesitancy included zero vaccines, not starting ≥1 series, and consistent vaccine-limiting. Patterns indicative of practical issues included starting all series but missing doses. Up-to-date (UTD) was defined as receiving all doses in the combined 7-vaccine series.

Results: The study population comprised 127,257 children. Over the observation period, patterns indicative of hesitancy significantly decreased (p-trend < 0.0001), patterns indicative of practical issues significantly decreased (p-trend < 0.0001), and UTD significantly increased (p-trend < 0.0001). In 2021, the weighted percentage in each category was as follows: probable hesitancy 6.3% (95% confidence interval [CI] 5.4%, 7.2%), probable practical issues 26.0% (95% CI 24.4%, 27.6%), and UTD 67.7% (95% CI 66.0%, 69.4%).

Conclusion: Over an 11-year period, vaccination coverage in the United States for the combined 7-vaccine series has improved, with patterns suggestive of practical issues or hesitancy declining.

Keywords: Under-vaccination; barriers; vaccination coverage; vaccine; vaccine hesitancy.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Figures

Figure 1.
Figure 1.
The weighted percentage of children in three mutually exclusive vaccination categories for vaccination with the combined 7-vaccine series by age 24 months, US National Immunization Survey-Child, 2011–2021; bars represent the 95% confidence intervals.
See this image and copyright information in PMC

References

    1. Wodi AP, Murthy N, McNally V, Cineas S, Ault K. Advisory Committee on Immunization Practices recommended immunization schedule for children and adolescents aged 18 years or younger - United States, 2023. MMWR Morb Mortal Wkly Rep, 72(6), 137–140 (2023). - PMC - PubMed
    1. Centers for Disease Control and Prevention. Impact of vaccines universally recommended for children--United States, 1990–1998. MMWR Morb Mortal Wkly Rep, 48(12), 243–248 (1999). - PubMed
    1. Centers for Disease Control and Prevention. Ten great public health achievements--United States, 2001–2010. MMWR Morb Mortal Wkly Rep, 60(19), 619–623 (2011). - PubMed
    1. Whitney CG, Zhou F, Singleton J, Schuchat A. Benefits from immunization during the vaccines for children program era - United States, 1994–2013. MMWR Morb Mortal Wkly Rep, 63(16), 352–355 (2014). - PMC - PubMed
    1. Hill HA, Yankey D, Elam-Evans LD, Chen M, Singleton JA. Vaccination coverage by age 24 months among children born in 2019 and 2020 - National Immunization Survey-Child, United States, 2020–2022. MMWR Morb Mortal Wkly Rep, 72(44), 1190–1196 (2023). - PMC - PubMed