Progress in Timely Vaccination Coverage Among Children Living in Low-Income Households

Neha Jain · John F. Stevenson · Nancy Männikkö · Noelle‐Angelique Molinari

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Vaccine Coverage and Hesitancy Child and Adolescent Health Immune responses and vaccinations

Abstract

OBJECTIVE: To evaluate progress in timely vaccination coverage associated with low-income households. DESIGN: The US National Immunization Survey. PARTICIPANTS: Children aged 19 to 35 months living in low-income households who were sampled between 1995 and 2007 (N = 232 318). Low-income households had an annual income that was 133% or less of the federal poverty level, and high-income households had an annual income of 400% or more of the federal poverty level. MAIN OUTCOME MEASURES: Administration of 4 or more doses of diphtheria, tetanus, pertussis (DTaP-DTP) vaccine; 3 or more doses of polio; 1 or more doses of measles, mumps, rubella (MMR); 3 or more doses of Haemophilus influenzae type b (Hib); 3 or more doses of hepatitis B; and 1 or more doses of varicella vaccines by age 19 months as reported by the children's vaccination providers. Progress in timely coverage was evaluated by tracking changes between consecutive annual birth cohorts born between 1994 and 2004. RESULTS: Among low-income children, timely vaccination coverage increased significantly between consecutive birth cohorts by an estimated 0.5% for DTaP-DTP, 0.3% for polio, 0.6% for MMR, 1.2% for hepatitis B, and 5.3% for varicella vaccines but did not change significantly for the Hib vaccine. Disparities in timely coverage for low- vs high-income children declined significantly between consecutive birth cohorts by an estimated -0.3% for MMR, -0.3% for hepatitis B, and -0.5% for varicella vaccines, did not change significantly for the polio vaccine, and increased significantly by 0.4% for the DTaP-DTP vaccine. CONCLUSIONS: Disparities in vaccination coverage associated with low household income persist. Further progress in timely vaccination may be achieved by improving health care providers' reminder/recall systems, implementing educational interventions that address barriers to vaccination, and increasing parents' awareness of the Vaccines for Children Program.

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2000Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults11The names and affiliations of the Task Force members are listed on page v of this supplement and at http://www.thecommunityguide.org22Some of this material was published previously in: Shefer A, Briss P, Rodewald L, et al. Improving immunization coverage rates: an evidence-based review of the literature. Epidemiol Rev 1999;20:96–142.2005Timeliness of Childhood Vaccinations in the United States 1991The Measles Epidemic 2002Timeliness of Childhood Immunizations 2006Assessment of Delay in Age-appropriate Vaccination Using Survival Analysis 1989Measles Outbreak Among Unvaccinated Preschool-Aged Children: Opportunities Missed by Health Care Providers to Administer Measles Vaccine 2001U.S. children living in and near poverty22Address reprint requests to: Centers for Disease Control and Prevention, National Immunization Program Resource Center, 1600 Clifton Road NE, Mailstop E-34, Atlanta, Georgia 30333. Fax: (404) 639-8828.1992Causes of Low Preschool Immunization Coverage in the United States

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