Vaccinating young children is one of the most effective and cost-effective ways to prevent illness and death. When the data for this report were collected in 2024, U.S. recommendations included routine vaccines and a monoclonal antibody protecting children against 16 potentially dangerous infections by age 2.
For about 30 years, CDC's National Immunization Survey-Child (NIS-Child) has tracked coverage. Households with children 19–35 months old are reached by cellphone; with consent, the children's vaccination providers are asked for full records. This report covers 27,392 children born in 2021–2022, compared with those born in 2019–2020.
Holding steady — mostly
| Vaccine, by age 24 months | Coverage (born 2021–2022) |
|---|---|
| ≥3 doses of polio vaccine | 92.1% |
| ≥3 doses of hepatitis B | 91.6% |
| ≥1 dose of MMR (measles, mumps, rubella) | 90.8% |
| ≥1 dose of varicella (chickenpox) | 90.0% |
| ≥4 doses of DTaP | 80.7% |
| ≥2 doses of flu vaccine | 53.5% |
| ≥2 doses of hepatitis A | 46.8% |
| No vaccines at all | 1.2% |
Polio, hepatitis B, MMR and varicella have stayed at or near 90% for years.
What slipped
Five vaccines declined compared with children born in 2019–2020:
| Vaccine | Drop (percentage points) |
|---|---|
| ≥2 doses of flu vaccine | 7.4 (61.0% → 53.5%) |
| Hepatitis B birth dose | 1.8 |
| Rotavirus | 1.7 |
| ≥4 doses of pneumococcal conjugate vaccine | 1.5 |
| Hib primary series | 1.0 |
Healthy People 2030
| Target | Goal | Achieved |
|---|---|---|
| ≥1 dose of MMR | ≥90.8% | 90.8% — met |
| No vaccines | ≤1.3% | 1.2% — met |
| ≥4 doses of DTaP | ≥90.0% | 80.7% — not met |
Gaps between groups
- Vaccines for Children (VFC) — the program that gives vaccines to eligible children whatever their family can pay: coverage was lower for every vaccine among VFC-eligible children, by 2.5 (hepatitis B) to 22.4 (flu) percentage points.
- Poverty: coverage with every vaccine was lower for children below the poverty line, by 3.5 to 18.1 (rotavirus) points.
- Race and ethnicity: compared with White children, coverage with most vaccines was lower among Black children, and several — including rotavirus (10.1 points) and pneumococcal (8.9) — lower among Hispanic children. Asian children had higher coverage for about half the vaccines, and fewer had no vaccines (0.6% vs 1.4%).
- Where they live: coverage with most vaccines was lower outside metropolitan areas than in their principal cities.
- By state: two-dose flu coverage ranged from 25.2% (Mississippi) to 78.3% (Massachusetts), and fell in 30 of 56 states and local areas.
Why the declines matter
The hepatitis B birth dose has fallen for three birth cohorts in a row, after rising 10.6 points from 2014 to 2019. Given within 24 hours of birth under the schedule these children followed, it's a universal safeguard:
- for babies of mothers who test positive for hepatitis B surface antigen, the birth dose plus hepatitis B immune globulin is the first line of defense. Without it, about 90% of such babies develop chronic infection, and about 25% of them eventually die of liver disease;
- 12%–16% of pregnant women in the U.S. — even with insurance and prenatal care — aren't tested for hepatitis B;
- babies can also be infected by family or community members before finishing the three-dose series.
Flu vaccination dropped during the COVID-19 pandemic and hasn't recovered. In one study, 30.9% of children aged 6 months–17 years had a parent hesitant about flu vaccine. Common reasons: not believing the child would get very sick (48.2%), worry about safety and side effects (43.3%), and doubt that it works well (37.0%). Yet the 2024–25 flu season had the highest cumulative hospitalization rate since 2010–11, and 280 children died of flu — the most in any non-pandemic season since reporting began in 2004 — 89% of them not fully vaccinated.
Outbreaks are already happening. In 2025, the U.S. reported 2,144 confirmed measles cases — the most since measles was declared eliminated in 2000 — and 93% were in people unvaccinated or of unknown status. Preliminary pertussis cases in 2024 exceeded those of 2019. Vaccines have saved an estimated $2.7 trillion in societal costs.
What works
The Community Preventive Services Task Force recommends:
- standing orders for vaccination;
- immunization information systems;
- vaccination programs in child care centers and in Special Supplemental Nutrition Program for Women, Infants, and Children settings.
Strong recommendations from providers, targeted messages from trusted sources and more VFC participation also help. Because national and state figures can hide local gaps, health departments are urged to mine their immunization information systems for places that need attention.
Limits
- Only 22%–27% of households responded in 2020–2024, and provider records were adequate for about half — weighting may not remove all bias.
- Households without cellphones are missed (though 98% of U.S. adults have one).
- Records may be incomplete; past checks suggest coverage can be underestimated by up to 9 points for some vaccines.
Sources
Based on Hill HA, Yankey D, Elam-Evans LD, et al., "Vaccination Coverage by Age 24 Months Among Children Born in 2021 and 2022 — National Immunization Survey-Child, United States, 2022–2024," MMWR volume 75, number 11, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The report's discussion puts two-dose flu coverage at 51.8% while its results give 53.5%, so only the result is used; and it gives the 30 of 56 areas where flu coverage fell as 54.6%, which that count is not, so only the count is given.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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