Toddler Vaccination in the U.S.: Children Born in 2016 and 2017

Immunization has been called a global health success story, estimated to prevent 2–3 million deaths a year worldwide. In the United States, the Advisory Committee on Immunization Practices recommends vaccines against 14 potentially serious illnesses by age 24 months. CDC tracks how many children get them through the National Immunization Survey-Child (NIS-Child).

How the survey works

Parents and guardians of children aged 19–35 months are reached by random-digit-dialed phone survey and asked to name every provider who vaccinated their child; with consent, those providers are mailed a request for the child's vaccination record. Combining the 2017–2019 surveys gave 25,970 children born in 2016 and 2017 with enough provider data. (In 2019, 21.1% of households responded, and 49.4% of completed interviews had adequate provider records.) The results were compared with children born in 2014–2015.

National coverage by age 2

Only 1.2% had received no vaccines at all by age 2.

The gaps

Insurance mattered most. Coverage for every vaccine except the hepatitis B birth dose was lower for uninsured children and those on Medicaid than for privately insured children.

Smaller gaps appeared by poverty (for nearly every vaccine), and less consistently by race and ethnicity and urban or rural area. States differed widely, above all for flu: from 38.9% in Florida to 81.7% in Massachusetts.

Coverage with 2 or more flu vaccine doses by age 24 months, by state. CDC

Why flu matters

Children aged 6–59 months are at higher risk of severe flu and of needing care for it. Most are recommended 3 doses by age 2, depending on birth month, so the share fully vaccinated is lower than the 2-dose figure here. With influenza and SARS-CoV-2 likely to circulate together in fall and winter 2020–21, raising flu vaccination was especially urgent: together they could strain the health system.

What can help

• Vaccines for Children (VFC) provides recommended vaccines free to children 18 and under who are Medicaid-eligible, uninsured, American Indian or Alaska Native, or underinsured — but parents may not know about it or struggle to reach a provider. Better awareness and help finding providers could close gaps.
• Lower income is also linked to more vaccine hesitancy; CDC's Vaccinate with Confidence framework aims to protect communities, empower families and stop myths.
• COVID-19 disrupted routine care, including vaccination, as stay-at-home orders spread in spring 2020. Providers should tell families how vaccination can be done safely, remind parents of shots due or overdue, give every recommended vaccine at each visit, and pay special attention to flu vaccination in fall and winter.

Limits

1. The low response rate, and missing households without phones or with only landlines, could bias results.
2. Coverage may be underestimated when parents can't name all providers or providers don't return records — by as much as 9 points for the combined series.
3. Flu estimates here may differ from CDC's season-by-season estimates.

Sources

Based on Hill HA, Yankey D, Elam-Evans LD, Singleton JA, Pingali SC, Santibanez TA, "Vaccination Coverage by Age 24 Months Among Children Born in 2016 and 2017 — National Immunization Survey-Child, United States, 2017–2019," MMWR Morbidity and Mortality Weekly Report volume 69, number 42, Centers for Disease Control and Prevention; a work of the United States government in the public domain.