Childhood Vaccination Coverage At 24 Months Held Steady, With Gaps

Key Takeaways:

• Most routine coverage at age 24 months among children born in 2021 and 2022 was similar to 2019 and 2020 levels, with declines reported for selected vaccines.
• Coverage varied by eligibility status, race and ethnicity, poverty status, urbanicity, and jurisdiction, showing uneven patterns across groups and locations.
• Authors presented the estimates through survey-based methods and described response and provider-data limitations alongside discussion-level measures linked to lower coverage.

National estimates came from the National Immunization Survey-Child, which compiles vaccination histories using information reported by vaccination providers (with parent/guardian consent). Comparisons were made at the same age benchmark, allowing birth-cohort differences to be described on a common timeline. Overall, the data suggested stability across much of the schedule with gaps in selected measures.

The authors reported modest declines in coverage for the Hib primary series, the HepB birth dose, ≥4 doses of pneumococcal conjugate vaccine, and rotavirus vaccination. The largest change involved receipt of 2 influenza doses by age 24 months, which fell from 61.0% in the earlier cohorts to 53.5% in the later cohorts. Coverage for several other routinely assessed vaccines remained comparatively steady rather than showing broad deterioration. In this comparison, departures from prior cohorts were concentrated in selected vaccines rather than across all childhood immunizations.

Children eligible for the Vaccines for Children program had lower coverage than children who were not eligible, researchers observed. For many vaccines, coverage was also lower among non-Hispanic Black or African American and Hispanic or Latino children than among non-Hispanic White children. Non-Hispanic Asian children had higher coverage for many vaccines, while children living in poverty and in more rural areas had lower coverage. The investigators described these patterns as persistent variation across demographic and access-related categories in the surveyed population.

Jurisdictional estimates varied widely, with the broadest spread reported for 2-dose influenza coverage (25.2% in Mississippi to 78.3% in Massachusetts). It describes a cellular telephone household survey linked to provider records, with weighting and analytic methods used to account for missing data and complex sampling. Authors also noted response and provider-data limits that could affect selection and completeness, and presented the estimates with acknowledged constraints.

In its public health practice discussion, the report notes that the Community Preventive Services Task Force recommends interventions to increase vaccination coverage, including standing orders for vaccination, immunization information systems, and vaccination programs in organized child care centers and WIC settings. The report also describes factors associated with higher uptake, such as strong provider recommendations, targeted messages from trusted sources, and increased participation in the Vaccines for Children program. These measures were presented as approaches named in the discussion around vaccination coverage at age 24 months, not as direct directives within the survey estimates.

Taken together, the findings depict mostly steady national coverage with persistent vaccine-specific, subgroup, and jurisdictional differences.