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Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. National, State, and Urban Area Vaccination Coverage Levels Among Children Aged 19-35 Months -- United States, July 1994-June 1995The National Immunization Survey (NIS) is an ongoing survey to provide estimates of vaccination coverage levels among children aged 19-35 months in the United States, all 50 states, and selected urban areas. CDC implemented NIS in April 1994 as one element of the five-part Childhood Immunization Initiative (CII), a national strategy to achieve and maintain high vaccination levels among children during the first 2 years of life (1). NIS collects quarterly data from all 50 states, the District of Columbia, and 27 urban areas considered to be at high risk for undervaccination (2,3). This report provides NIS findings for July 1994-June 1995, which indicate that coverage levels for diphtheria and tetanus toxoids and pertussis vaccine (DTP), Haemophilus influenzae type b vaccine (Hib), poliovirus vaccine, and hepatitis B vaccine have met or exceeded the 1995 interim goals of the CII and that coverage for measles-mumps-rubella vaccine (MMR) is within 1 percentage point of the objective. NIS uses a two-phase sample design: the first phase employs a quarterly random sample of telephone numbers for each survey area and includes administration of a screening questionnaire to respondents aged greater than or equal to 18 years to locate households with one or more children aged 19-35 months *. Vaccination information is collected for all age-eligible children. All respondents are asked to refer to written records; however, reports from recall also are accepted. During July 1994-June 1995, approximately 1.6 million telephone numbers were called, and 35,440 interviews were completed (an average of 454 interviews per survey area). The overall response rate for eligible households was 71% (range: 57%-86% among the 78 survey sites). In the second phase, vaccination information is requested from health-care providers for children in surveyed households. During 1994, households were excluded that used records indicating their children received all recommended doses of four specific vaccines. ** All households identified in the first and second quarters of 1995 were included in the second phase. Based on exclusions, 30,543 (86%) children were eligible for the second phase; of these, vaccination information was obtained from providers for 13,755 (45%) children. The demographic characteristics and the reported vaccination histories were similar for children with and without provider information. Overall, for 59% of the children in the survey, either written records of having received all of the required doses for the four vaccines were available (29%) or vaccination information based on provider records was available (30%). As previously described, these provider data were used to adjust responses for the entire group of children surveyed (2-5). Data from four consecutive quarters yielded 12-month estimates for the United States, the 50 states, the District of Columbia, and the 27 urban areas. Compared with the previous reporting period (April 1994-March 1995), there were statistically significant increases in national vaccination coverage with three or more doses of poliovirus vaccine (from 84% {95% confidence interval (CI)=plus or minus 0.9%} to 86% {95% CI=plus or minus 0.8%}) and with three or more doses of hepatitis b vaccine (from 42% {95% CI=plus or minus 1.2%} to 51% {95% CI=plus or minus 1.1%}) (Table_1) ***. The series-complete coverage estimates for 4:3:1 (i.e., four doses of DTP, three doses of poliovirus vaccine, and one dose of MMR) and 4:3:1:3 (i.e., four doses of DTP, three doses of poliovirus vaccine, one dose of MMR, and three doses of Hib) remained stable. For every vaccine or series of vaccines, estimated vaccination coverage for the most recent quarter (April-June 1995) was equal to or higher than that for the most recent 12 months. Coverage increased the most for hepatitis B vaccine (62% {95% CI=plus or minus 1.5%} versus 51% {95% CI=plus or minus 1.1%}) (Table_1). During July 1994-June 1995, state-specific estimated coverage levels for the 4:3:1:3 series ranged from 61% to 87% (median: 75%), and for the 4:3:1 series ranged from 64% to 88% (median: 77%) (Table_2). Estimated coverage levels among selected urban areas ranged from 51% to 86% for the 4:3:1:3 series (median: 72%), and for the 4:3:1 series ranged from 55% to 86% (median: 76%) (Table_3). Compared with April 1994-March 1995 (3), changes for the 4:3:1:3 series were greatest in Illinois (from 64% {95% CI=plus or minus 5.2%} to 72% {95% CI=plus or minus 4.5%}); coverage in Chicago increased from 55% (95% CI=plus or minus 8.7%) to 65% (95% CI=plus or minus 7.4%) (3). The 1995 CII interim goal for coverage with three or more doses of DTP was achieved by all states, the District of Columbia, and by all except one of the 27 urban areas; the goal for coverage with three or more doses of Hib vaccine was achieved by 49 states and 24 urban areas. For coverage with three or more doses of poliovirus vaccine, the 1995 interim goal was achieved by 31 states and 16 urban areas; for coverage with one or more dose of MMR vaccine, by 25 states and 16 urban areas; and for coverage with three or more doses of hepatitis B vaccine, by 20 states and 16 urban areas. Reported by: National Center for Health Statistics; Assessment Br, Data Management Div, National Immunization Program, CDC. Editorial NoteEditorial Note: The findings from the NIS indicate that the 1995 CII interim coverage goals have been met or exceeded for DTP, Hib, poliovirus vaccine, and hepatitis B vaccine (1); the coverage estimate for MMR is within 1 percentage point of the goal. This report presents for the first time national quarterly estimates. However, because these estimates reflect changes in coverage in a more timely manner than 12-month estimates, increased variability must be considered when interpreting these quarterly data. Compared with the previous 12-month estimates, increases in vaccination coverage were greatest for hepatitis B vaccine, probably reflecting substantial progress in the implementation of the infant hepatitis B Advisory Committee on Immunization Practices (ACIP) recommendations (6). In addition, coverage for three doses of poliovirus vaccine exceeded the 1995 goal for the first time, and the results for the second quarter of 1995 suggest a continuation of this upward trend. This increase preceded recommendations by the ACIP to encourage administration of the third dose of oral polio vaccine at age 6 months rather than in the second year of life (7). National vaccination coverage for 4:3:1 series completion did not change for the 12-month period. Thus, approximately 1 million children still need one or more of the recommended doses of vaccine. NIS enables identification of differences in coverage levels among states and urban areas and development of area-specific interventions (3). States and urban areas that did not meet the 1995 interim goals will need to intensify efforts to meet the 1995 and 1996 goals. Strategies for improving coverage include avoiding missed opportunities for vaccinations by increasing health care providers' awareness of the need to check the vaccination status of children evaluated for other reasons (8,9) and linking vaccination to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (10). CDC and other public health agencies will continue to use NIS to monitor and target efforts to improve vaccination coverage levels. References
* For this reporting period, included children born during August 1991- November 1993 (median: age 27 months). ** Four doses of DTP, three doses of poliovirus vaccine, one dose of MMR, and three doses of Hib.
*** The overlap of three quarters between the current reporting
period and
the previous reporting period requires a special procedure for
calculating
the standard error of the difference. Taking the overlap into
account leads
to a smaller standard error than if the reporting periods were
regarded as
independent.
Table 1. Vaccination coverage levels among children aged 19-35 months, by selected
vaccines -- National Immunization Survey (NIS), United States, July 1994-June 1995
==============================================================================================
National Immunization Survey
--------------------------------------------------
April 1994 - July 1994- April 1995-
March 1995 June 1995 June 1995 +
1995 1996 --------------- -------------- --------------
Vaccine/Dose Goal Goal % (95% CI *) % (95% CI) % (95% CI)
-------------------------------------------------------------------------------------------
DTP/DT &
>=3 Doses 87% 90% 94 (+/-0.6%) 94 (+/-0.5%) 95 (+/-0.8%)
>=4 Doses -- -- 77 (+/-1.0%) 78 (+/-1.0%) 78 (+/-1.3%)
Poliovirus
>=3 Doses 85% 90% 84 (+/-0.9%) 86 (+/-0.8%) 88 (+/-1.1%)
Hib @
>=3 Doses 85% 90% 90 (+/-0.7%) 91 (+/-0.7%) 92 (+/-0.9%)
MMR **
>=1 Dose 90% 90% 89 (+/-0.8%) 89 (+/-0.7%) 89 (+/-1.0%)
Hepatitis B
>=3 Doses 50% 70% 42 (+/-1.2%) 51 (+/-1.1%) 62 (+/-1.5%)
19-24 Months -- -- 58 (+/-1.4%) 64 (+/-1.3%) 70 (+/-2.4%)
25-30 Months -- -- 41 (+/-1.4%) 51 (+/-1.3%) 67 (+/-2.5%)
31-35 Months -- -- 24 (+/-1.3%) 34 (+/-1.3%) 49 (+/-2.6%)
Combined Series
4 DTP/3 Polio/1 MMR ++ -- -- 75 (+/-1.0%) 75 (+/-1.0%) 76 (+/-1.4%)
4 DTP/3 Polio/1 MMR/ -- -- 72 (+/-1.1%) 73 (+/-1.0%) 75 (+/-1.4%)
3 Hib &&
-------------------------------------------------------------------------------------------
* Confidence interval.
+ For this reporting period, included children born during May 1992-November 1993.
& Diphtheria and tetanus toxoids and pertussis vaccine/Diphtheria and tetanus toxoids.
@ Haemophilus influenzae type b vaccine.
** Measles-mumps-rubella vaccine.
++ Four doses of DTP/DT, three doses of poliovirus vaccine, and one dose of MMR.
&& Four doses of DTP/DT, three doses of poliovirus vaccine, one dose of MMR, and three doses
of Hib.
==============================================================================================
Return to top. Table_2 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
TABLE 2. Estimated vaccination coverage levels with the 4:3:1 series * and the 4:3:1:3
series +, by coverage level and state -- National Immunization Survey, United States,
July 1994-June 1995
=============================================================================================================
4:3:1 Series coverage º 4:3:1:3 Series coverage
Coverage Level/ --------------------- º Coverage level/ -----------------------
State % (95% CI &) º State % (95% CI)
-------------------------------------------+-----------------------------------------------
>=85% º >=85%
Connecticut @ 86 (+/-4.7%) º New Hampshire 85 (+/-4.3%)
Massachusetts @ 85 (+/-4.0%) º Vermont 87 (+/-3.8%)
New Hampshire @ 87 (+/-4.0%) º 75%-84%
Vermont ** 88 (+/-3.7%) º Alabama 76 (+/-4.7%)
75%-84% º Connecticut 84 (+/-5.0%)
Alabama ++ 77 (+/-4.7%) º Delaware 77 (+/-5.7%)
Delaware @ 79 (+/-5.5%) º Florida 78 (+/-4.7%)
Florida @ 78 (+/-4.7%) º Hawaii 78 (+/-5.7%)
Georgia @ 75 (+/-5.1%) º Iowa 81 (+/-4.5%)
Hawaii @ 82 (+/-5.3%) º Kansas 75 (+/-5.0%)
Illinois ++ 75 (+/-4.4%) º Kentucky 83 (+/-4.8%)
Iowa++ 82 (+/-4.4%) º Maine 82 (+/-4.5%)
Kansas++ 78 (+/-4.8%) º Massachusetts 83 (+/-4.2%)
Kentucky ** 84 (+/-4.7%) º Minnesota 78 (+/-5.2%)
Maine ** 84 (+/-4.3%) º Mississippi 81 (+/-5.0%)
Maryland @ 78 (+/-4.6%) º New York 77 (+/-4.2%)
Minnesota ** 79 (+/-5.2%) º North Carolina 79 (+/-5.2%)
Mississippi ** 82 (+/-4.9%) º North Dakota 81 (+/-4.4%)
New Jersey @ 76 (+/-5.0%) º Ohio 75 (+/-4.2%)
New Mexico ++ 75 (+/-5.8%) º Pennsylvania 77 (+/-4.5%)
New York @ 78 (+/-4.1%) º Rhode Island 82 (+/-4.8%)
North Carolina ** 82 (+/-5.0%) º South Carolina 80 (+/-5.1%)
North Dakota ++ 82 (+/-4.3%) º South Dakota 78 (+/-5.2%)
Ohio ++ 77 (+/-4.2%) º Virginia 78 (+/-5.4%)
Pennsylvania @ 80 (+/-4.2%) º Wisconsin 75 (+/-4.0%)
Rhode Island @ 83 (+/-4.7%) º Wyoming 77 (+/-5.2%)
South Carolina @ 81 (+/-5.0%) º 65%-74%
South Dakota ++ 79 (+/-5.1%) º Alaska 68 (+/-6.1%)
Virginia ** 79 (+/-5.4%) º Arizona 71 (+/-4.3%)
Washington ++ 75 (+/-4.2%) º Arkansas 68 (+/-5.8%)
Wisconsin ** 78 (+/-3.9%) º California 69 (+/-4.4%)
Wyoming ** 79 (+/-5.1%) º Colorado 70 (+/-5.8%)
65%-74% º Georgia 74 (+/-5.2%)
Alaska && 72 (+/-6.0%) º Idaho 67 (+/-6.0%)
Arizona ++ 74 (+/-4.2%) º Illinois 72 (+/-4.5%)
Arkansas ++ 71 (+/-5.8%) º Indiana 71 (+/-5.1%)
California && 72 (+/-4.3%) º Louisiana 70 (+/-5.4%)
Colorado ++ 74 (+/-5.6%) º Maryland 74 (+/-4.8%)
Idaho ++ 68 (+/-6.0%) º Missouri 70 (+/-6.0%)
Indiana ++ 73 (+/-5.0%) º Montana 68 (+/-5.9%)
Louisiana && 72 (+/-5.3%) º Nebraska 71 (+/-5.4%)
Missouri ++ 71 (+/-6.0%) º New Jersey 73 (+/-5.2%)
Montana ++ 70 (+/-5.8%) º New Mexico 71 (+/-6.0%)
Nebraska ++ 73 (+/-5.3%) º Oklahoma 69 (+/-6.5%)
Nevada && 66 (+/-6.1%) º Oregon 68 (+/-5.9%)
Oklahoma ++ 72 (+/-6.4%) º Tennessee 72 (+/-4.0%)
Oregon && 71 (+/-5.8%) º Texas 69 (+/-3.7%)
Tennessee && 73 (+/-4.0%) º Utah 69 (+/-4.4%)
Texas ++ 71 (+/-3.6%) º Washington 73 (+/-4.3%)
Utah ++ 72 (+/-4.3%) º West Virginia 67 (+/-6.2%)
West Virginia ++ 68 (+/-6.2%) º <65%
<65% º Michigan 61 (+/-5.3%)
Michigan ++ 64 (+/-5.2%) º Nevada 64 (+/-6.1%)
º
Total 75 (+/-1.0%) º Total 73 (+/-1.0%)
-------------------------------------------+-----------------------------------------------
* Four doses of diphtheria and tetanus toxoids and pertussis vaccine/diphtheria and tetanus toxoids
(DTP/DT), three doses of poliovirus vaccine, and one dose of measles-mumps-rubella vaccine (MMR).
+ Four doses of DTP/DT, three doses of poliovirus vaccine, and one dose of MMR, and three doses of
Haemophilus influenzae type b vaccine (Hib).
& Confidence interval.
@ Met the 1995 Childhood Immunization Initiative (CII) goals for three or more doses of DTP, three or more
doses of poliovirus, one or more dose of MMR, three or more doses of Hib, and three or more doses
doses of hepatitis B vaccine.
** Met the 1995 CII goals for three or more doses of DTP, three or more doses of poliovirus, one or more
dose of MMR, three or more doses of Hib, but not for three or more doses of hepatitis B vaccine.
++ Did not meet the 1995 CII goals for at least one of three or more doses of DTP, three or more doses of
poliovirus, one or more dose of MMR, or three or more doses of Hib, or the 1995 goal for three or more
doses of hepatitis B vaccine.
&& Did not meet the 1995 CII goals for at least one of three or more doses of DTP, three or more doses of
poliovirus, one or more dose of MMR, or three or more doses of Hib, but did meet the 1995 goal for
three or more doses of hepatitis B vaccine.
=============================================================================================================
Return to top. Table_3 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
TABLE 3. Estimated vaccination coverage levels with the 4:3:1 series * and the 4:3:1:3
series +, by coverage level and selected urban area -- National Immunization Survey,
United States, July 1994-June 1995
=================================================================================================
4:3:1 Series º 4:3:1:3 Series
coverage º coverage
Coverage level/ --------------- º Coverage level/ --------------
Area % (95% CI &) º Area % (95% CI)
------------------------------------------------+----------------------------------------------
>=85% º >=85%
Boston @ 86 (+/-5.1%) º Boston 86 (+/-5.1%)
75%-84% º 75%-84%
Baltimore ** 79 (+/-6.0%) º Cuyahoga Co., Ohio 76 (+/-5.9%)
Cuyahoga Co., Ohio ** 79 (+/-5.7%) º El Paso Co., Tex. 80 (+/-4.7%)
Dade Co., Fla. ++ 76 (+/-5.3%) º Fulton/Dekalb Co., Ga. 75 (+/-6.5%)
El Paso Co., Tex. @ 81 (+/-4.6%) º Jefferson Co., Ala. 79 (+/-5.7%)
Fulton/Dekalb Co., Ga. @ 78 (+/-6.3%) º King Co., Wash. 77 (+/-5.2%)
Jefferson Co., Ala. ** 80 (+/-5.6%) º Marion Co., Ind. 77 (+/-5.9%)
King Co., Wash. @ 80 (+/-4.9%) º New York City 76 (+/-6.2%)
Maricopa Co., Ariz. && 75 (+/-5.8%) º Santa Clara Co., Calif. 77 (+/-5.8%)
Marion Co., Ind. ++ 78 (+/-5.8%) º 65%-74%
Milwaukee Co., Wis. ** 76 (+/-5.8%) º Baltimore 74 (+/-6.5%)
New York City @ 78 (+/-6.1%) º Chicago 65 (+/-7.4%)
San Diego Co., Calif. @ 76 (+/-5.5%) º Dallas Co., Tex. 67 (+/-6.6%)
Santa Clara Co., Calif. @ 81 (+/-5.3%) º Dade Co., Fla. 74 (+/-6.4%)
Shelby Co., Tenn. @ 76 (+/-6.4%) º Davidson Co., Tenn. 67 (+/-6.2%)
65%-74% º Duval Co., Fla. 70 (+/-6.0%)
Bexar Co., Tex. && 68 (+/-6.4%) º Franklin Co., Ohio 71 (+/-6.5%)
Chicago && 69 (+/-7.2%) º Los Angeles Co., Calif. 66 (+/-7.1%)
Dallas Co., Tex. ++ 67 (+/-6.6%) º Maricopa Co., Ariz. 71 (+/-6.0%)
Davidson Co., Tenn. ++ 69 (+/-6.1%) º Milwaukee Co., Wis. 73 (+/-6.0%)
District of Columbia && 68 (+/-6.7%) º Philadelphia Co., Pa. 67 (+/-7.5%)
Duval Co., Fla. ++ 73 (+/-6.4%) º San Diego Co., Calif. 74 (+/-5.6%)
Franklin Co., Ohio && 72 (+/-6.4%) º Shelby Co., Tenn. 74 (+/-6.4%)
Los Angeles Co. Calif. @ 68 (+/-7.0%) º <65%
Orleans Parish, La. ++ 66 (+/-7.4%) º Bexar Co., Tex. 63 (+/-6.5%)
Philadelphia Co., Pa. ++ 69 (+/-7.4%) º Detroit 51 (+/-7.7%)
<65% º District of Columbia 62 (+/-6.9%)
Detroit && 55 (+/-7.9%) º Houston 62 (+/-7.7%)
Houston && 64 (+/-7.7%) º Newark, N.J. 57 (+/-9.1%)
Newark, N.J. && 60 (+/-9.0%) º Orleans Parish, La. 64 (+/-7.5%)
------------------------------------------------+----------------------------------------------
* Four doses of diphtheria and tetanus toxoids and pertussis vaccine/diphtheria and tetanus
toxoids (DTP/DT), three doses of poliovirus vaccine, and one dose of measles-mumps-
rubella vaccine (MMR).
+ Four doses of DTP/DT, three doses of poliovirus vaccine, one dose of MMR, and three doses
of Haemophilus influenzae type b vaccine (Hib).
& Confidence interval.
@ Met the 1995 Childhood Immunization Initiative (CII) goals for three or more doses of DTP,
three or more doses of poliovirus, one or more dose of MMR, three or more doses of Hib,
and three or more doses of hepatitis B vaccine.
** Met the 1995 CII goals for three or more doses of DTP, three or more doses of poliovirus,
one or more dose of MMR, three or more doses of Hib, but not for three or more doses of
hepatitis B vaccine.
++ Did not meet the 1995 CII goals for at least one of three or more doses of DTP, three or
more doses of poliovirus, one or more dose of MMR, or three or more doses of Hib, but
did meet the 1995 goal for three or more doses of hepatitis B vaccine.
&& Did not meet the 1995 CII goals for at least one of three or more doses of DTP, three or
more doses of poliovirus, one or more dose of MMR, or three or more doses of Hib, or the
1995 goal for three or more doses of hepatitis B vaccine.
=================================================================================================
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