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2 tables omitted
The National Immunization Survey (NIS) provides vaccination coverage
estimates for children aged 19-35 months for each of the 50 states and 28
selected urban areas.* This report summarizes results from the 2004 NIS,†
which indicated nationwide increases in coverage with at least 1 dose of varicella
vaccine (VAR), pneumococcal conjugate vaccine (PCV), and the 4:3:1,‡
4:3:1:3:3,§ and 4:3:1:3:3:1∥ vaccine series. These levels represent
an important accomplishment by exceeding for the first time the Healthy People 2010 goal of ≥80% coverage for the 4:3:1:3:3 vaccine
To collect vaccination data for age-eligible children, NIS uses a quarterly
random-digit–dialing sample of telephone numbers for each of the 78
survey areas. NIS methodology, including the weighting of responses to represent
the entire population of children aged 19-35 months, has been described previously.1 During 2004, health-care provider vaccination records were obtained
for 21,998 children. The overall survey response rate for eligible households
National coverage estimates increased from 2003 to 2004 for two of the
more recently implemented vaccines, VAR and PCV. Coverage estimates for all
other vaccines were not substantially different from 2003 to 2004. For the
combined vaccine series 4:3:1, 4:3:1:3:3, and 4:3:1:3:3:1, national coverage
increased from 2003 to 2004.
However, as in previous years, estimated vaccination coverage levels
still varied substantially among states. Estimated coverage with the 4:3:1:3:3
series ranged from 89.1% in Massachusetts to 68.4% in Nevada. Coverage also
ranged substantially among the 28 urban areas. The highest estimated coverage
among the urban areas for the 4:3:1:3:3 series was 89.7% for Davidson County,
Tennessee, and the lowest was 64.8% for El Paso County, Texas.
N Darling, MPH, T Santibanez, PhD, J Santoli, MD, Immunization Svcs
Div, National Immunization Program, CDC.
The findings in this report indicate that, for the first time, vaccination
coverage (80.9%) for the 4:3:1:3:3 series exceeded the Healthy People 2010 goal (objective 14-24a)2 to increase
to at least 80% the proportion of children aged 19-35 months who receive all
vaccines recommended for universal administration for at least 5 years. Beginning
with next year’s report on the 2005 NIS, the series measure 4:3:1:3:3:1
(76.0% in 2004) will be used to evaluate progress toward the Healthy People 2010 goal because, beginning with the survey cohort,
varicella vaccination will have been recommended for universal administration
for 5 years.
The vaccination coverage levels described in this report are notable
given shortages in the supplies of several vaccines during 2001-2004. For
example, DTaP shortages persisted for more than 1 year, beginning in March
2001 and resolving by July 2002. Shortages for PCV also began in mid-year
2001 and ended in May 2003, only to become short again in early 2004; the
PCV shortage ended in September 2004.3-5 Because vaccine supply
shortages are likely to reoccur,6,7 as evidenced by the shortages
of influenza vaccine during both the 2003-04 and 2004-05 influenza seasons,8,9 strategies to manage vaccine supply and continued monitoring of
the effects of shortages on coverage are needed.
The findings in this report are subject to at least three limitations.
First, NIS is a telephone survey; although NIS results are weighted to make
them representative of all children aged 19-35 months, these statistical adjustments
might not fully represent all the complexities of the survey (e.g., accounting
for nonresponse and households without telephones). Second, NIS uses provider-verified
vaccination histories and assumes that coverage among children whose providers
did not respond is similar to that among children whose providers did respond;
thus, incomplete reporting might have resulted in underestimates of coverage.
Third, although national estimates are precise,10 estimates for
states and urban areas should be interpreted with caution because of wider
NIS is routinely used to monitor vaccination status among preschool-aged
children; however, NIS could be expanded for measuring vaccination coverage
among other age groups and for newer vaccines as they become licensed and
recommended. In a 2004 pilot study, NIS was used to estimate vaccination coverage
among adolescents; analysis of these data is ongoing. In 2003 and 2004, another
expansion of NIS, the National Adult Immunization Survey (NAIS), was used
to assess influenza and pneumococcal polysaccharide vaccination coverage and
reasons for nonvaccination among adults aged ≥50 years. In 2004, NIS began
measuring influenza vaccination coverage among children aged 6-23 months.
Several vaccines are newly recommended for various age groups (e.g., meningococcal
conjugate [MCV4] and tetanus, diphtheria, and acellular pertussis [Tdap] vaccines)
with several others likely to be licensed in the near future (e.g., measles-mumps-rubella-varicella
[MMRV], rotavirus, human papillomavirus [HPV], and zoster vaccines). These
developments underscore the importance of survey systems such as NIS in monitoring
new vaccine implementation, which in turn can provide valuable information
for enhancing vaccine uptake.
REFERENCES: 10 available
*Jefferson County, Alabama; Maricopa County, Arizona; Los Angeles, San
Diego, and Santa Clara counties, California; District of Columbia; Miami-Dade
and Duval counties, Florida; Fulton/Dekalb counties, Georgia; Chicago, Illinois;
Marion County, Indiana; Orleans Parish, Louisiana; Baltimore, Maryland; Boston,
Massachusetts; Detroit, Michigan; Newark, New Jersey; New York, New York;
Cuyahoga and Franklin counties, Ohio; Philadelphia County, Pennsylvania; Davidson
and Shelby counties, Tennessee; Bexar, Dallas, and El Paso counties, and Houston,
Texas; King County, Washington; and Milwaukee County, Wisconsin.
†During the 2004 reporting period, NIS included children born
during February 2001–June 2003.
‡≥4 doses of diphtheria, tetanus toxoids and pertussis vaccines,
diphtheria and tetanus toxoids, and diphtheria, tetanus toxoids and any acellular
pertussis vaccine (DTP/DT/DTaP); ≥3 doses of poliovirus vaccine; and ≥1
dose of any measles-containing vaccine.
§4:3:1 plus ≥3 doses of Haemophilus influenzae type b (Hib) vaccine and ≥3 doses of hepatitis B vaccine.
∥4:3:1:3:3 plus ≥1 dose of VAR.
National, State, and Urban Area Vaccination Coverage Among Children
Aged 19-35 Months—United States, 2004. JAMA. 2005;294(12):1485–1486. doi:10.1001/jama.294.12.1485
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