How many kids are completely unvaccinated?

November 29, 2018
Rachael Zimlich, RN, BSN

Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.

Volume 36, Issue 1

Overall vaccination rates in children are good, but there is a small pocket of children who are completely unvaccinated, and this number is rising.

Although rates of recommended vaccinations for children have remained stable overall, the number of children receiving no vaccines at all has quadrupled from previous years.

According to a new report from the Centers for Disease Control and Prevention (CDC), this small but increasing group of children aged younger than 2 years that have not received any immunizations is concerning officials.

“These reports show that most US parents are protecting their children from vaccine-preventable diseases by making sure they are getting recommended vaccines,” says CDC spokesperson Ian Branam, MA, “but we are seeing an increase in the number of children younger than 2 years of age who receive no vaccines. This increase means that there are about 100,000 children under 2 years old that are not protected against potentially serious vaccine-preventable diseases.”

According to the report, published in the Morbidity and Mortality Weekly Report (MMWR), 1.3% of children born in 2015 had not received any vaccinations by the 2017 National Immunization Survey-Child (NIS-Child).1 This figure indicates an upward trend in children in the 19-month to 35-month age group going without vaccinations, up from 0.9% in 2011 and 0.3% in 2001.

The CDC’s Advisory Committee on Immunization Practices (ACIP) recommends vaccinations against 14 diseases by age 24 months, and the CDC says it is working to understand the reason for the upward tick in missed opportunities for vaccination in this age group.

“While the percent of US children who receive no vaccines is still very low, the CDC is doing more work to understand factors contributing to this increase and how to address them,” Branam says. “Parental choice may play some role, but the CDC’s data suggest that many of these parents do want to vaccinate their children, but they may not be able to get vaccines for them. They may face hurdles, like not having a healthcare professional nearby, not having time to get their children to a doctor, and/or thinking they cannot afford vaccines.”

What the data show

Coverage for most vaccines remains stable overall, according to the report, with more than 90% of children aged 19 to 35 months receiving 3 or more doses of the poliovirus vaccine; 1 or more doses of the measles/mumps/rubella vaccine (MMR); 3 or more doses of the hepatitis B vaccine (HepB); and 1 or more doses of the varicella vaccine.

Vaccine coverage was generally lower for most recommended vaccines among children who are uninsured or uninsured by Medicaid when compared with children with private health insurance, according to the report. Specifically, 17.2% of unvaccinated children were uninsured compared with 2.8% of all children. Vaccination rates also were lower in rural areas, the report notes. Researchers also discovered disparities for vaccines that required a booster dose in the second year of life, including diphtheria/tetanus/acellular pertussis (DTaP), Haemophilus influenzae type b (Hib), and pneumococcal conjugate vaccine (PCV).

“While the total number of uninsured children in the survey was small, they were overly represented in the unvaccinated group. Among children surveyed in 2017, 7.1% of uninsured children received no vaccines, compared with 0.8% and 1.0% of children with private insurance and Medicaid, respectively. Uninsured children are eligible to receive vaccines free of charge through the Vaccines for Children program, but there may be additional hurdles for uninsured children to access vaccines,” Branam says. “The CDC is doing research to better understand and address potential barriers for uninsured children to access vaccines. Reducing barriers to vaccination is a priority of the US immunization program.”

Branam says that whereas overall compliance with recommended vaccines is still good, the report is a reminder to pediatricians to continually educate parents and share resources for vaccination with them.

“We hope this report is a reminder to healthcare professionals to make a strong vaccine recommendation to their patients at every visit and make sure parents understand how important it is for their children to get all their recommended vaccinations on time,” Branam says. “The Vaccines for Children program helps reduce financial hurdles parents face when trying to get their children vaccinated and protected from vaccine-preventable diseases. We encourage healthcare professionals to ensure their patients are aware of the Vaccines for Children program if they need help paying for vaccines.”

Branam says pediatricians are also encouraged to continue to communicate the importance of vaccinations with parents, and says the CDC offers educational materials to help.

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