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The immunisation schedule protects against **14 potentially serious illnesses
by age 24 months**, and the headline for 2017 is that it is working: coverage
remained high and stable, above 90% for
≥3 doses of polio vaccine · ≥1 dose of MMR · ≥3 doses of hepatitis B
· ≥1 dose of varicella
Beneath that, one figure moved.
Zero doses
| Birth year | Received no vaccine doses by 24 months |
|---|---|
| 2011 | 0.9% |
| 2015 | 1.3% |
Still low. But it grew by roughly half in four birth cohorts, and it is
qualitatively different from the rest of the data. A child missing one vaccine
has a gap; a child with none has not entered the system at all — and those
children are not evenly spread, so a national 1.3% can be a great deal higher
in one community.
Where coverage is lower
Two consistent gaps, across most vaccines:
- Uninsured children, and those insured by Medicaid, compared with
privately insured children - Children living outside metropolitan statistical areas, compared with
those in the principal cities of one
Both are about reaching a provider rather than about vaccines. Which is why
the three proposed remedies are all logistical:
- Greater awareness and use of the Vaccines for Children programme, which
already covers uninsured and Medicaid-eligible children — the entitlement
exists and is under-used - Eliminating missed opportunities to vaccinate during visits that are
already happening for something else - Minimising interruptions in health insurance coverage — because a lapse
at the wrong month is a missed dose
The survey's own caveat
The National Immunization Survey-Child is a **random-digit-dialled telephone
survey**, and its estimates come from provider-reported records, not from
what parents remember: interviewers ask permission to contact every provider,
who returns an immunisation history.
That makes the data good and the sample hard-won:
| Response rate to the telephone interview | 26.1% |
| Households with adequate provider-reported data | 53.9% |
| Final sample | 15,333 children |
A quarter answer the phone, and about half of those yield usable records.
Weighting is what carries it to a national estimate, and **no change in survey
accuracy was detected between 2016 and 2017** — the check that keeps a
year-on-year comparison honest.
Source: Centers for Disease Control and Prevention, MMWR.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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