Vital Signs: Trends and Disparities in Childhood Vaccination Coverage by Vaccines for Children Program Eligibility - National Immunization Survey-Child, United States, 2012-2022

Abstract

Introduction: The Vaccines for Children (VFC) program was established in 1994 to provide recommended vaccines at no cost to eligible children and help ensure that all U.S. children are protected from life-threatening vaccine-preventable diseases.

Methods: CDC analyzed data from the 2012-2022 National Immunization Survey-Child (NIS-Child) to assess trends in vaccination coverage with ≥1 dose of measles, mumps, and rubella vaccine (MMR), 2-3 doses of rotavirus vaccine, and a combined 7-vaccine series, by VFC program eligibility status, and to examine differences in coverage among VFC-eligible children by sociodemographic characteristics. VFC eligibility was defined as meeting at least one of the following criteria: 1) American Indian or Alaska Native; 2) insured by Medicaid, Indian Health Service (IHS), or uninsured; or 3) ever received at least one vaccination at an IHS-operated center, Tribal health center, or urban Indian health care facility.

Results: Overall, approximately 52.2% of U.S. children were VFC eligible. Among VFC-eligible children born during 2011-2020, coverage by age 24 months was stable for ≥1 MMR dose (88.0%-89.9%) and the combined 7-vaccine series (61.4%-65.3%). Rotavirus vaccination coverage by age 8 months was 64.8%-71.1%, increasing by an average of 0.7 percentage points annually. Among all children born in 2020, coverage was 3.8 (≥1 MMR dose), 11.5 (2-3 doses of rotavirus vaccine), and 13.8 (combined 7-vaccine series) percentage points lower among VFC-eligible than among non-VFC-eligible children.

Conclusions and implications for public health practice: Although the VFC program has played a vital role in increasing and maintaining high levels of childhood vaccination coverage for 30 years, gaps remain. Enhanced efforts must ensure that parents and guardians of VFC-eligible children are aware of, have confidence in, and are able to obtain all recommended vaccines for their children.

FIGURE

Coverage with ≥1 dose of measles, mumps, and rubella vaccine, rotavirus vaccine, and the 7-vaccine series among children eligible for the Vaccines for Children program (A) and difference in vaccination coverage between program-eligible and nonprogram-eligible children born during 2011–2020 (B) — National Immunization Survey-Child, United States, 2012–2022 Abbreviations: AI/AN = American Indian or Alaska Native; MMR = measles, mumps, and rubella vaccine; VFC = Vaccines for Children. * Coverage with ≥1 dose of MMR and the combined 7-vaccine series assessed before the day the child turns 24 months. Rotavirus vaccination coverage assessed by age 8 months, 0 days. The Kaplan-Meier method was used to estimate vaccination coverage to account for children whose vaccination history was ascertained before age 24 months. ^† Includes children who might have received measles, mumps, rubella, and varicella combination vaccine. ^§ At least two doses of Rotarix monovalent rotavirus vaccine, or ≥3 doses of RotaTeq pentavalent rotavirus vaccine. If any dose in the series is either RotaTeq or unknown, it was assumed a 3-dose series was needed. Maximum age for receipt of the final dose is age 8 mos, 0 days. ^¶ The combined 7-vaccine series (4:3:1:3*:3:1:4) includes ≥4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine, ≥3 doses of poliovirus vaccine, ≥1 dose of measles-containing vaccine, the full series of Haemophilus influenzae type b conjugate vaccine (≥3 or ≥4 doses, depending on product type), ≥3 doses of hepatitis B vaccine, ≥1 dose of varicella vaccine, and ≥4 doses of pneumococcal conjugate vaccine. ** Child is identified as AI/AN; insured by Medicaid or Indian Health Service; uninsured; or received any vaccines at an Indian Health Service–operated center, Tribal health facility, or urban Indian health care facility. ^†† Defined as coverage among VFC-eligible children − coverage among non–VFC eligible children.