Vaccination Coverage Estimates for Selected Counties: Achievement of Healthy People 2010 Goals and Association with Indices of Access to Care, Economic Conditions, and Demographic Composition

James A. Singleton

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Vaccine Coverage and Hesitancy Healthcare Policy and Management Child and Adolescent Health

Abstract

OBJECTIVES: We provided vaccination coverage estimates for 181 counties; evaluated the extent to which Healthy People 2010 (HP 2010) vaccination coverage objectives were achieved; and examined how variations in those estimates depend on access to care and economic conditions. METHODS: We analyzed data for 24,031 children aged 19 to 35 months sampled from the 2004 and 2005 National Immunization Survey. RESULTS: Children living in the 181 counties represented 49% of all the 19- to 35-month-old children living in the U.S. None of the 181 counties had coverage for the polio, measles-mumps-rubella, Haemophilus influenzae type B, and hepatitis B vaccines that was significantly lower than the HP 2010 objective of 90% coverage. However, as many as 30.4% of the counties did not achieve the HP 2010 objective for diphtheria, tetanus toxoids, and acellular pertussis or diphtheria and tetanus toxoids and pertussis (DtaP/DTP), and as many as 6.6% did not achieve the goal for varicella (VAR). If children who received three doses of DTaP/DTP had received a final fourth dose, and if all children had received one dose of VAR, all of the 181 counties would have achieved the HP 2010 vaccination coverage target of 80% for the entire 4:3:1:3:3:1 vaccination series. Factors found to be associated with low county-level vaccination coverage rates were correlates of poverty, and factors found to be associated with high county-level vaccination coverage rates were correlates of access to pediatric services. CONCLUSIONS: HP 2010 vaccination coverage goals for all 181 counties can be achieved by improving vaccination coverage for only two vaccines. Those goals may be achieved most efficiently by targeting interventions in counties where indices of poverty are high or where access to pediatric services is low.

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References

1994General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP)2008Current Population Reports, P60-235, Income, Poverty, and Health Insurance Coverage in the United States: 2007 2004Children Who Have Received No Vaccines: Who Are They and Where Do They Live?2001Overview of the sampling design and statistical methods used in the National Immunization Survey21Address 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) 639-8828.22The full text of this article is available via AJPM Online at www.elsevier.com/locate/ajpmonline.2004Income, Poverty, and Health Insurance Coverage in the United States: 2003 2000Practice article. National immunization survey: the methodology of a vaccination surveillance system 2005The Association Between Having a Medical Home and Vaccination Coverage Among Children Eligible for the Vaccines for Children Program 1989Measles Outbreak Among Unvaccinated Preschool-Aged Children: Opportunities Missed by Health Care Providers to Administer Measles Vaccine

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