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Vaccination coverage among children aged 19-35 months--United States, 2015.

Sustained high coverage with recommended vaccinations among children has kept many vaccine-preventable diseases at low levels in the United States (1). To assess coverage with vaccinations recommended for children by age 2 years in the United States (2), CDC analyzed data collected by the 2015 National Immunization Survey (NIS) for children aged 19-35 months (born January 2012-May 2014). Overall, coverage did not change during 2014-2015. Coverage in 2015 was highest for [greater than or equal to] 3 doses of poliovirus vaccine (93.7%), [greater than or equal to] 3 doses of hepatitis B vaccine (HepB) (92.6%), [greater than or equal to] 1 dose of measles, mumps, and rubella vaccine (MMR) (91.9%), and [greater than or equal to] 1 dose of varicella vaccine (91.8%). The data were also examined for potential vaccination coverage differences by race/ethnicity, poverty status, and urbanicity. Although disparities were noted for each of these factors, the most striking differences were seen for poverty status. Children living below the federal poverty level * had lower coverage with most of the vaccinations assessed compared with children living at or above the poverty level; the largest disparities were for rotavirus vaccine (66.8% versus 76.8%), [greater than or equal to] 4 doses of pneumococcal conjugate vaccine (PCV) (78.9% versus 87.2%), the full series of Haemophilus influenzae type b vaccine (Hib) (78.1% versus 85.5%), and [greater than or equal to] 4 doses of diphtheria, tetanus, and acellular pertussis vaccine (DTaP) (80.2% versus 87.1%). Although coverage was high in some groups, opportunities exist to continue to address disparities. Implementation of evidence-based interventions, including strategies to enhance access to vaccination services and systems strategies that can reduce missed opportunities, has the potential to increase vaccination coverage for children living below the poverty level and in rural areas (3).

NIS monitors vaccination coverage among children aged 19-35 months in the 50 states, the District of Columbia, selected local areas, and territories ([dagger]) using a random digit dialing (RDD) sample of landline and cellular telephone numbers. After identifying a household with at least one age-eligible child, a telephone interview is conducted to collect sociodemographic characteristics for all age-eligible children and request permission to contact the child's vaccination providers. If consent is given, a survey is mailed to each provider to request the child's vaccination history, including dates of receipt of vaccine doses. All coverage estimates are based on provider-reported vaccination histories. Details regarding NIS methodology and weighting have been described previously. ([section]) For 2015, national vaccination coverage estimates were based on a sample of 15,167 children with completed household interviews and adequate provider data. The Council of American Survey Research Organizations (CASRO) response rate was 34.9%. ([pagraprah]) Logistic regression was used to assess differences among racial/ethnic groups, controlling for poverty status, and to evaluate the potential interaction between poverty status and Metropolitan Statistical Area ** (MSA) status (a measure of urbanicity). Statistical comparisons were made using t-tests on weighted data, taking into account the complex survey design. P-values <0.05 were considered statistically significant.

National Vaccination Coverage

Nationally, coverage did not change during 2014-2015 for the vaccinations assessed, and the percentage of children who received no vaccinations remained <1% (Table 1). The Healthy People 2020 ([dagger][dagger]) target of 90% coverage was met for four vaccines: 1) [greater than or equal to] 3 doses of poliovirus vaccine (93.7%), 2) [greater than or equal to] 3 doses of HepB (92.6%), 3) [greater than or equal to] 1 dose of MMR (91.9%), and 4) [greater than or equal to] 1 dose of varicella vaccine (91.8%). Coverage remained below the target of 90% for [greater than or equal to] 4 doses of DTaP (84.6%); the full series of Hib (82.7%), and [greater than or equal to] 4 doses of PCV (84.1%); below the 85% target for [greater than or equal to] 2 doses of hepatitis A vaccine (HepA) (59.6%) and the HepB birth dose ([section][section]) (72.4%); and below the 80% target for rotavirus vaccination (73.2%) and the combined seven-vaccine series ([paragraph][paragraph]) (72.2%).

Vaccination Coverage by Race/Ethnicity, Poverty Level, and MSA Status

Compared with non-Hispanic white ([section][section]) *** (white) children, non-Hispanic black (black) children had lower coverage with the full series of Hib, [greater than or equal to] 4 doses of PCV, and the rotavirus series (Table 2). Coverage differences between black and white children were not statistically significant after adjustment for poverty status (data not shown). Black, Hispanic, non-Hispanic Asian, and non-Hispanic American Indian/Alaska Native children had higher coverage with the HepB birth dose than did white children. Among Asian children, coverage with [greater than or equal to] 4 doses of DTaP, [greater than or equal to] 3 doses of poliovirus vaccine, [greater than or equal to] 3 doses of HepB, the HepB birth dose, and [greater than or equal to] 2 doses of HepA was higher than that for white children.

Children living below the federal poverty level had lower coverage with nearly all vaccines compared with children living at or above the poverty level (Table 2). As in 2014, coverage with [greater than or equal to] 4 doses of DTaP, [greater than or equal to] 3 doses of poliovirus vaccine, [greater than or equal to] 1 dose of MMR, the primary and full series of Hib, [greater than or equal to] 4 doses of PCV, [greater than or equal to] doses of HepA, the rotavirus series and the combined seven-vaccine series was lower among children below the poverty level. The difference in coverage levels ranged from 2.6 to 10.0 percentage points; for five vaccines/doses ([greater than or equal to] 4 doses of DTaP, the full series of Hib, [greater than or equal to] 4 doses of PCV, [greater than or equal to] 2 doses of HepA, the rotavirus series) and the combined seven-vaccine series, the disparity exceeded 5.0 percentage points.

Coverage differed by MSA status for several vaccines in 2015 (Table 2). Children living in a non-MSA had lower coverage with [greater than or equal to] 3 doses of DTaP, [greater than or equal to] 3 doses of poliovirus vaccine, [greater than or equal to] 1 dose of varicella vaccine, [greater than or equal to] 4 doses of PCV, [greater than or equal to] 2 doses of HepA, and rotavirus vaccine than did children in an MSA central city. Logistic regression analyses did not identify any statistically significant interaction between poverty status and MSA status for any of the vaccines monitored by NIS. In all cases, poverty status remained independently associated with vaccination coverage after adjustment for MSA status.

Vaccination Coverage by Geographic Area

Vaccination coverage in 2015 varied considerably by geographic area (Table 3), differing across states by as much as 38.1 percentage points. Coverage with [greater than or equal to] 1 dose of MMR ranged from 83.4% (Virginia) to 97.5% (Connecticut). The lowest estimated coverage with [greater than or equal to] 4 doses of DTaP was 76.4% (Arkansas) and the highest was 92.0% (Maine). The largest discrepancy among states was for the HepB birth dose, with a low of 49.4% (Vermont) and a high of 87.5% (North Dakota). Coverage with [greater than or equal to] 2 doses of HepA varied widely, ranging from 41.2% (Mississippi) to 72.8% (Nebraska). The lowest state-specific estimate for rotavirus series coverage was 63.8% (Florida) and the highest 87.6% (Rhode Island). Coverage with the combined seven-vaccine series ranged from 64.4% (Virginia) to 80.6% (Connecticut).

Discussion

Nationally, coverage with vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) for children aged 19-35 months remains high and stable. The burden of most vaccine-preventable diseases is low in this population. Furthermore, Healthy People 2020 coverage targets continue to be met for poliovirus vaccine, MMR, HepB, and varicella vaccine. For other vaccines, coverage levels remained stable, and increased activities are needed to reach target coverage levels. Nationally, large disparities in coverage exist for children living below the poverty level compared with children living at or above the poverty level, with differences of 7-10 percentage points for [greater than or equal to] 4 doses of DTaP, Hib (full series), [greater than or equal to] 4 doses of PCV, and rotavirus vaccination. Disparities between racial/ethnic groups were observed, but these diminished in magnitude when poverty status and MSA were accounted for in the analysis.

The widespread, persistent and often sizeable vaccination coverage disparities between children living below poverty and children living at or above the poverty level have been observed for many vaccines monitored by NIS since at least 2009 and are concerning. Based on 2015 data, an estimated 32.9% (95% CI = 31.4%-34.4%) of U.S. children aged 19-35 months were living below the poverty level. The Vaccines for Children (VFC) program ([dagger][dagger][dagger]) has provided free vaccine to many uninsured, Medicaid-eligible and other children aged [less than or equal to] 18 years who would otherwise have less access to these important vaccines. The extent to which parents and guardians of children living in poverty are aware of the VFC program or face barriers to participation in it is not known. The Affordable Care Act (ACA) stipulates that ACIP-recommended vaccines be made available to insured children with no copayments or other cost-sharing requirements when administered by an in-network provider. Issues such as proximity to health care providers and clinics, transportation, and convenience of clinic hours also should be investigated and addressed, if needed. Breaks in insurance enrollment (especially Medicaid) are another complication faced by families living below the poverty level that might have a negative effect on their ability to access the medical care system in general (4).

Widespread geographic variation in coverage levels was evident in the ranges of coverage estimates by state and local area, as well as differences by MSA status. Children in more rural (non-MSA) areas had lower coverage with DTaP, poliovirus vaccine, varicella vaccine, PCV, HepA, and rotavirus vaccine than did more urban (MSA central city) children. This also could reflect issues of access and proximity to vaccination providers, including those who administer VFC vaccines.

Evidence-based interventions such as those recommended in The Guide to Community Preventive Services (3) can contribute to addressing the poverty and urbanicity gaps in vaccination coverage. Enhancing access to vaccination services might include conducting home vaccination visits, holding extended office/ clinic hours during the week or on weekends, and establishing vaccination programs in organized child care centers and in settings where the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is administered.

Overall, MMR coverage remained within the 92%-95% range generally considered adequate for herd immunity for all three diseases (5); however, coverage levels of <90% were observed in several states and local areas as well as in the U.S. Virgin Islands. In the era of VFC, the number of cases of measles has dropped substantially, to only 49 in the United States in 2016 (through July 30) (6). Despite high coverage, outbreaks continue to occur, demonstrating that pockets of susceptibility to this highly contagious disease remain. Reductions in rotavirus-related morbidity have been observed in the United States after vaccine introduction, and indirect (herd) effects of vaccination might have contributed to the decline (7). Additional activities are needed to increase rotavirus coverage as demonstrated by the relatively low overall coverage, large disparity by poverty, and state variation in vaccination rates. Increased rotavirus vaccination coverage is needed to decrease further the overall prevalence of rotavirus gastroenteritis.

The findings in this report are subject to at least three limitations, each of which could lead to bias in estimates of vaccination coverage (8). First, response rates were low. Second, the telephone sample frame did not cover the entire target population. Bias from incomplete sample frame and nonresponse may remain after weighting adjustments. Finally, ascertainment of the vaccination status may be incomplete. A total survey error model, including potential underascertainment of vaccinations reported by providers, indicated that some NIS estimates might be too low by about five percentage points (9). However, a recent analysis demonstrated no evidence of substantial change in bias in NIS during the period 1995-2013 (10).

NIS continues to provide valuable national and state level data. In addition, it is important that states continue to obtain local level coverage data useful for identifying pockets of under-vaccinated children. This analysis documents high overall coverage and, importantly, lower coverage in rural and poorer populations. Continued surveillance is needed to monitor coverage, locate pockets of susceptibility, and evaluate the impact of interventions designed to ensure that all children remain adequately protected against vaccine-preventable diseases. More widespread implementation of evidence-based interventions is needed to bring about continued improvement in vaccination coverage among infants and young children in the United States. Financial barriers to vaccine purchase itself are addressed for children living below the poverty level by the VFC program and vaccine-related stipulations in the ACA. Improved access might be achieved through establishment of vaccination programs in child care centers and in WIC settings. Systems-based interventions, such as patient reminder and recall systems, provider reminders, establishment of standing orders for vaccination, and further development of immunization information systems might be useful in improving vaccination coverage among all young children in the United States.

Summary

What is already known about this topic?

Vaccination has resulted in substantial reductions in morbidity and mortality from childhood diseases in the United States. As new vaccines, such as varicella, pneumococcal conjugate, and rotavirus have been recommended by the Advisory Committee on Immunization Practices, the National Immunization Survey (NIS) has been able to provide important information on vaccine coverage among U.S. children aged 19-35 months and on progress toward meeting coverage targets.

What is added by this report?

The 2015 NIS data reveal no significant changes in overall coverage relative to the previous year. More than 90% of children were up to date on vaccination against polio; hepatitis B; measles, mumps, and rubella; and varicella. However, children living below the poverty level continued to have lower coverage with rotavirus vaccine; pneumococcal conjugate vaccine; Haemophilus influenzae type b vaccine; and diphtheria, tetanus, and acellular pertussis vaccine. In addition, children living in more rural areas had lower coverage with diphtheria, tetanus, and acellular pertussis vaccine; poliovirus vaccine; varicella vaccine; pneumococcal conjugate vaccine, hepatitis A vaccine; and rotavirus vaccine.

What are the implications for public health practice?

CDC will continue to work with state immunization programs through ongoing site visits, teleconferences, and structured interviews to identify reasons for the observed disparities in vaccination coverage by poverty status and to implement effective strategies to eliminate them. Effort is needed to ensure full participation in the Vaccines for Children (VFC) program for eligible children who could benefit from it. Supporting the continued development of state and local immunization information systems to monitor vaccination coverage can help identify areas of undervaccination that might not be easily detected by the national monitoring program. Identifying areas of need and responding with evidence-based interventions will allow continued progress in protecting young children against vaccine-preventable diseases.

References

(1.) Whitney CG, Zhou F, Singleton J, Schuchat A. Benefits from immunization during the vaccines for children program era-United States, 1994-2013. MMWR Morb Mortal Wkly Rep 2014;63:352-5.

(2.) Robinson CL; Advisory Committee on Immunization Practices (ACIP), ACIP Child/Adolescent Immunization Work Group. Advisory Committee on Immunization Practices Recommended Immunization Schedules for Persons Aged 0 Through 18 Years--United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:86-7. http://dx.doi. org/10.15585/mmwr.mm6504a4

(3.) Community Preventive Services Task Force. The Guide to Community Preventive Services: increasing appropriate vaccination. Atlanta, GA: US Department of Health and Human Services, Community Preventive Services Task Force; 2016. http://www.thecommunityguide.org/ vaccines/index.html

(4.) Smith PJ, Stevenson J, Chu SY. Associations between childhood vaccination coverage, insurance type, and breaks in health insurance coverage. Pediatrics 2006;117:1972-8.http://dx.doi.org/10.1542/ peds.2005-2414

(5.) Bednarczyk RA, Orenstein WA, Omer SB. Estimating the number of measles-susceptible children and adolescents in the United States using data from the National Immunization Survey-Teen (NIS-Teen). Am J Epidemiol 2016;184:148-56. http://dx.doi.org/10.1093/aje/kwv320

(6.) CDC. Notifiable diseases and mortality tables. MMWR Morb Mortal Wkly Rep 2016;65:ND-38.

(7.) Pollard SL, Malpica-Llanos T, Friberg IK, Fischer-Walker C, Ashraf S, Walker N. Estimating the herd immunity effect of rotavirus vaccine. Vaccine 2015;33:3795-800. http://dx.doi.org/10.1016/j.vaccine.2015.06.064

(8.) Hill HA, Elam-Evans LD, Yankey D, Singleton JA, Kolasa M. National, state, and selected local area vaccination coverage among children aged 19-35 months--United States, 2014. MMWR Morb Mortal Wkly Rep 2015;64:889-96. http://dx.doi.org/10.15585/mmwr.mm6433a1

(9.) Wolter K, Pineau V, Skalland B, et al. Total survey error assessment for socio-demographic subgroups in the 2012 U.S. National Immunization Survey. In: Biemer P, De Leeuw E, Edwards B, Kreuter F, Lyberg L, Tucker C, and West B, eds. Total survey error in practice. Hoboken, NJ: John Wiley & Sons, Inc. In press 2016.

(10.) Yankey D, Hill HA, Elam-Evans LD, et al. Estimating change in telephone survey bias in an era of declining response rates and transition to wireless telephones--evidence from the National Immunization Survey (NIS), 1995-2013. Presented at the 2015 American Association for Public Opinion Research (AAPOR) 70 th Annual Conference, Hollywood, FL; May 14-17, 2015.

* Poverty level uses income and family size to categorize households into those 1) at or above the poverty level, and 2) below the poverty level. Poverty level was based on 2014 U.S. Census poverty thresholds (http://www.census.gov/ hhes/www/poverty/data/threshold).

([dagger]) The local areas sampled separately for the 2015 NIS included areas that receive federal Section 317 immunization funds and are included in the NIS sample every year (Chicago, Illinois; New York, New York; Philadelphia County, Pennsylvania; Bexar County, Texas; and Houston, Texas) and two additional sample areas (El Paso County, Texas and Hidalgo County, Texas). The 2015 NIS was also conducted in Guam, Puerto Rico, and the U.S. Virgin Islands; these three territories were excluded from national coverage estimates.

([section]) Further details regarding the statistical methodology of NIS are available in the NIS User's Guide 2014, which can be downloaded at http://www.cdc. gov/nchs/nis/data_files.htm.

([paragraph]) The CASRO household response rate, calculated as the product of the resolution rate (percentage of the total telephone numbers called that were classified as nonworking, nonresidential, or residential), screening completion rate (percentage of known households that were successfully screened for the presence of age-eligible children), and the interview completion rate (percentage of households with one or more age-eligible children that completed the household survey) (http://www.casro.org). The CASRO response rate is equivalent to the American Association for Public Opinion Research (AAPOR) type 3 response rate (http://www.aapor.org/AAPOR_ Main/media/publications/Standard-Definitions20169theditionfinal.pdf). The 15,167 children with adequate provider data in the 2015 NIS represent 56.2% of children with completed household interviews.

** Metropolitan Statistical Areas have at least one urbanized area of 50,000 or more population, plus adjacent territory that has a high degree of social and economic integration with the core as measured by commuting ties. The Office of Management and Budget published the Standards for Delineating Metropolitan Statistical Areas in 2010; current definitions are based on an update published in February of 2013 (https://www.whitehouse.gov/sites/ default/files/omb/bulletins/2015/15-01.pdf).

([dagger]dagger]) https://www.healthypeople.gov/2020/topics-objectives/topic/ immunization-and-infectious-diseases.

([section][section]) The Healthy People 2020 target for the birth dose (0-3 days) of HepB is 85%, measured by annual birth cohort. For the three most recent completed birth cohorts examined by NIS, coverage with the birth dose of HepB was 71.8% for children born in 2010, 73.2% for children born in 2011, and 73.3% for children born in 2012.

([paragraph][paragraph]) The combined seven-vaccine series (4:3:1:3*:3:1:4) includes [greater than or equal to] 4 doses of DTaP/ diphtheria and tetanus toxoids vaccine/diphtheria, tetanus toxoids, and pertussis vaccine; [greater than or equal to] 3 doses of poliovirus vaccine; [greater than or equal to] 1 dose of measles-containing vaccine; [greater than or equal to] 3 or [greater than or equal to] 4 doses of Hib (depending upon product type of vaccine); [greater than or equal to] 3 doses of HepB; [greater than or equal to] 1 dose of varicella vaccine; and [greater than or equal to] 4 doses of PCV.

*** Child's race/ethnicity was reported by his/her parent or guardian. Children categorized in this report as white, black, American Indian/Alaska native, Asian, native Hawaiian/other Pacific Islander, or multiracial were identified as non-Hispanic by the parent or guardian. Children identified as multiracial had more than one race category identified. Persons identified as Hispanic might be of any race.

([dagger][dagger][dagger]) http://www.cdc.gov/vaccines/programs/vfc/index.html.

Holly A. Hill, MD, PhD [1]; Laurie D. Elam-Evans, PhD [1]; David Yankey, MS, MPH [1]; James A. Singleton, PhD [1]; Vance Dietz, MD [1]

[1] Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC.

Corresponding author: Holly A. Hill, hhill@cdc.gov, 404-639-8044.
TABLE 1. Estimated vaccination coverage among children aged 19-35
months, by selected vaccines and doses--National Immunization Survey,
United States, 2011-2015 *

                                                         2011

Vaccine/Dose                                          % (95% CI)

DTaP ([dagger])
[greater than or equal to] 3 doses              95.5 ([+ or -] 0.5)
[greater than or equal to] 4 doses              84.6 ([+ or -] 1.0)
Poliovirus ([greater than or equal to] 3        93.9 ([+ or -] 0.6)
  doses)
MMR ([greater than or equal to] 1 dose)         91.6 ([+ or -] 0.8)

Hib ([section])
Primary series                                  94.2 ([+ or -] 0.6) **
Full series                                     80.4 ([+ or -] 1.1) **

HepB
[greater than or equal to] 3 doses              91.1 ([+ or -] 0.7)
Birth dose ([paragraph])                        68.6 ([+ or -] 1.3) **
Varicella ([greater than or equal to] 1 dose)   90.8 ([+ or -] 0.7)

PCV
[greater than or equal to] 3 doses              93.6 ([+ or -] 0.6) **
[greater than or equal to] 4 doses              84.4 ([+ or -] 1.0)

HepA
[greater than or equal to] 1 dose               81.2 ([+ or -] 1.0) **
[greater than or equal to] 2 doses              52.2 ([+ or -] 1.4) **
Rotavirus ([dagger][dagger])                    67.3 ([+ or -] 1.3) **
Combined series ([section][section])            68.5 ([+ or -] 1.3) **
No vaccinations                                  0.8 ([+ or -] 0.2)

                                                         2012

Vaccine/Dose                                          % (95% CI)

DTaP ([dagger])
[greater than or equal to] 3 doses              94.3 ([+ or -] 0.7) **
[greater than or equal to] 4 doses              82.5 ([+ or -] 1.2) **
Poliovirus ([greater than or equal to] 3        92.8 ([+ or -] 0.7) **
  doses)
MMR ([greater than or equal to] 1 dose)         90.8 ([+ or -] 0.8)

Hib ([section])
Primary series                                  93.3 ([+ or -] 0.7)
Full series                                     80.9 ([+ or -] 1.2)

HepB
[greater than or equal to] 3 doses              89.7 ([+ or -] 0.9) **
Birth dose ([paragraph])                        71.6 ([+ or -] 1.4) **
Varicella ([greater than or equal to] 1 dose)   90.2 ([+ or -] 0.8)

PCV
[greater than or equal to] 3 doses              92.3 ([+ or -] 0.8) **
[greater than or equal to] 4 doses              81.9 ([+ or -] 1.1) **

HepA
[greater than or equal to] 1 dose               81.5 ([+ or -] 1.1)
[greater than or equal to] 2 doses              53.0 ([+ or -] 1.5)
Rotavirus ([dagger][dagger])                    68.6 ([+ or -] 1.4)
Combined series ([section][section])            68.4 ([+ or -] 1.4)
No vaccinations                                  0.8 ([+ or -] 0.1)

                                                         2013

Vaccine/Dose                                          % (95% CI)

DTaP ([dagger])
[greater than or equal to] 3 doses              94.1 ([+ or -] 0.9)
[greater than or equal to] 4 doses              83.1 ([+ or -] 1.3)
Poliovirus ([greater than or equal to] 3        92.7 ([+ or -] 1.0)
  doses)
MMR ([greater than or equal to] 1 dose)         91.9 ([+ or -] 0.9)

Hib ([section])
Primary series                                  93.7 ([+ or -] 0.9)
Full series                                     82.0 ([+ or -] 1.3)

HepB
[greater than or equal to] 3 doses              90.8 ([+ or -] 1.0)
Birth dose ([paragraph])                        74.2 ([+ or -] 1.4) **
Varicella ([greater than or equal to] 1 dose)   91.2 ([+ or -] 0.9)

PCV
[greater than or equal to] 3 doses              92.4 ([+ or -] 1.0)
[greater than or equal to] 4 doses              82.0 ([+ or -] 1.3)

HepA
[greater than or equal to] 1 dose               83.1 ([+ or -] 1.2) **
[greater than or equal to] 2 doses              54.7 ([+ or -] 1.6)
Rotavirus ([dagger][dagger])                    72.6 ([+ or -] 1.5) **
Combined series ([section][section])            70.4 ([+ or -] 1.5)
No vaccinations                                  0.7 ([+ or -] 0.3)

                                                         2014

Vaccine/Dose                                          % (95% CI)

DTaP ([dagger])
[greater than or equal to] 3 doses              94.7 ([+ or -] 0.7)
[greater than or equal to] 4 doses              84.2 ([+ or -] 1.2)
Poliovirus ([greater than or equal to] 3        93.3 ([+ or -] 0.8)
  doses)
MMR ([greater than or equal to] 1 dose)         91.5 ([+ or -] 0.9)

Hib ([section])
Primary series                                  93.3 ([+ or -] 0.8)
Full series                                     82.0 ([+ or -] 1.3)

HepB
[greater than or equal to] 3 doses              91.6 ([+ or -] 0.9)
Birth dose ([paragraph])                        72.4 ([+ or -] 1.5)
Varicella ([greater than or equal to] 1 dose)   91.0 ([+ or -] 0.9)

PCV
[greater than or equal to] 3 doses              92.6 ([+ or -] 0.8)
[greater than or equal to] 4 doses              82.9 ([+ or -] 1.3)

HepA
[greater than or equal to] 1 dose               85.1 ([+ or -] 1.1) **
[greater than or equal to] 2 doses              57.5 ([+ or -] 1.6) **
Rotavirus ([dagger][dagger])                    71.7 ([+ or -] 1.6)
Combined series ([section][section])            71.6 ([+ or -] 1.5)
No vaccinations                                  0.8 ([+ or -] 0.2)

                                                         2015

Vaccine/Dose                                          % (95% CI)

DTaP ([dagger])
[greater than or equal to] 3 doses               95.0 ([+ or -] 0.6)
[greater than or equal to] 4 doses               84.6 ([+ or -] 1.1)
Poliovirus ([greater than or equal to] 3         93.7 ([+ or -] 0.6)
  doses)
MMR ([greater than or equal to] 1 dose)          91.9 ([+ or -] 0.8)

Hib ([section])
Primary series                                   94.3 ([+ or -] 0.6)
Full series                                      82.7 ([+ or -] 1.1)

HepB
[greater than or equal to] 3 doses               92.6 ([+ or -] 0.7)
Birth dose ([paragraph])                         72.4 ([+ or -] 1.4)
Varicella ([greater than or equal to] 1 dose)    91.8 ([+ or -] 0.8)

PCV
[greater than or equal to] 3 doses               93.3 ([+ or -] 0.7)
[greater than or equal to] 4 doses               84.1 ([+ or -] 1.1)

HepA
[greater than or equal to] 1 dose                85.8 ([+ or -] 1.1)
[greater than or equal to] 2 doses               59.6 ([+ or -] 1.5)
Rotavirus ([dagger][dagger])                     73.2 ([+ or -] 1.4)
Combined series ([section][section])             72.2 ([+ or -] 1.4)
No vaccinations                                   0.8 ([+ or -] 0.2)

Abbreviations: CI = confidence interval; DTaP = diphtheria, tetanus
toxoids, and acellular pertussis vaccine; HepA = hepatitis A vaccine;
HepB = hepatitis B vaccine; Hib = Haemophilus influenzae type b
vaccine; MMR = measles, mumps, and rubella vaccine; PCV =
pneumococcal conjugate vaccine.

* For 2011, children born January 2008-May 2010; for 2012, children
born January 2009-May 2011; for 2013, children born January 2010-May
2012; for 2014, children born January 2011-May 2013; and for 2015,
children born January 2012-May 2014.

([dagger]) Includes children who might have been vaccinated with
diphtheria and tetanus toxoids vaccine, or diphtheria, tetanus
toxoids, and pertussis vaccine.

([section]) Hib Primary series: receipt of [greater than or equal to]
2 or [greater than or equal to] 3 doses, depending on product type
received. Full series: receipt of [greater than or equal to] 3 or
[greater than or equal to] 4 doses, depending on product type
received (primary series and booster dose).

([paragraph]) One dose HepB administered between birth and age 3
days.

** Statistically significant (p<0.05) change in coverage compared
with previous year.

([dagger][dagger]) Rotavirus vaccine includes [greater than or equal
to] 2 or [greater than or equal to] 3 doses, depending on the product
type received ([greater than or equal to] 2 doses for Rotarix [RV1]
and [greater than or equal to] 3 doses for RotaTeq [RV5]).

([section][section]) The combined seven-vaccine series (4:3:1:3 *
:3:1:4) includes [greater than or equal to] 4 doses of DTaP, [greater
than or equal to] 3 doses of poliovirus vaccine, [greater than or
equal to] 1 dose of measles-containing vaccine, full series of Hib (3
or 4 doses, depending on product type), [greater than or equal to] 3
doses of hepatitis B vaccine, [greater than or equal to] 1 dose of
varicella vaccine, and [greater than or equal to] 4 doses of PCV.

TABLE 2. Estimated vaccination coverage among children aged 19-35
months, by selected vaccines and doses, race/ethnicity, * poverty
level, ([dagger]) and Metropolitan Statistical Area (MSA) status
([section])--National Immunization Survey, United States, 201511

                               Race/ethnicity

                                   White,
                                non-Hispanic
                                 (Referent)

Vaccine/Dose                     % (95% CI)

DTaP **
[greater than or equal       94.8 ([+ or -] 0.8)
  to] 3 doses
[greater than or equal       85.2 ([+ or -] 1.5)
  to] 4 doses
Poliovirus ([greater than    93.1 ([+ or -] 0.9)
  or equal to] 3 doses)
MMR ([greater than or        91.8 ([+ or -] 1.1)
  equal to] 1 dose)

Hib ([paragraph]
  [paragraph])
[greater than or equal       93.3 ([+ or -] 0.9)
  to] 3 doses
Primary series               94.4 ([+ or -] 0.8)
Full series                  83.0 ([+ or -] 1.5)

HepB
[greater than or equal       92.0 ([+ or -] 1.1)
  to] 3 doses
Birth dose ***               68.2 ([+ or -] 1.8)
Varicella ([greater than     91.2 ([+ or -] 1.1)
  or equal to] 1 dose)

PCV
[greater than or equal       93.2 ([+ or -] 1.0)
  to] 3 doses
[greater than or equal       85.0 ([+ or -] 1.5)
  to] 4 doses
HepA ([greater than or       58.7 ([+ or -] 1.9)
  equal to] 2 doses)
Rotavirus ([dagger]          74.6 ([+ or -] 1.7)
  [dagger][dagger])
Combined series              72.7 ([+ or -] 1.8)
  ([section][section]
  [section])

                                         Race/ethnicity

                                             Black,
                                          non-Hispanic

Vaccine/Dose                               % (95% CI)

DTaP **
[greater than or equal       94.3 ([+ or -] 1.6)
  to] 3 doses
[greater than or equal       82.0 ([+ or -] 2.9)
  to] 4 doses
Poliovirus ([greater than    93.3 ([+ or -] 1.7)
  or equal to] 3 doses)
MMR ([greater than or        90.7 ([+ or -] 2.3)
  equal to] 1 dose)

Hib ([paragraph]
  [paragraph])
[greater than or equal       92.1 ([+ or -] 2.0)
  to] 3 doses
Primary series               93.3 ([+ or -] 1.8)
Full series                  78.9 ([+ or -] 3.1) ([dagger][dagger])

HepB
[greater than or equal       93.3 ([+ or -] 1.8)
  to] 3 doses
Birth dose ***               74.2 ([+ or -] 3.6) ([dagger][dagger])
Varicella ([greater than     91.8 ([+ or -] 2.1)
  or equal to] 1 dose)

PCV
[greater than or equal       92.5 ([+ or -] 1.9)
  to] 3 doses
[greater than or equal       81.4 ([+ or -] 2.9) ([dagger][dagger])
  to] 4 doses
HepA ([greater than or       59.3 ([+ or -] 3.9)
  equal to] 2 doses)
Rotavirus ([dagger]          69.7 ([+ or -] 3.6) ([dagger][dagger])
  [dagger][dagger])
Combined series              69.1 ([+ or -] 3.6)
  ([section][section]
  [section])

                                         Race/ethnicity

                                            Hispanic

Vaccine/Dose                               % (95% CI)

DTaP **
[greater than or equal       95.5 ([+ or -] 1.2)
  to] 3 doses
[greater than or equal       84.5 ([+ or -] 2.6)
  to] 4 doses
Poliovirus ([greater than    94.5 ([+ or -] 1.3)
  or equal to] 3 doses)
MMR ([greater than or        92.3 ([+ or -] 1.8)
  equal to] 1 dose)

Hib ([paragraph]
  [paragraph])
[greater than or equal       94.0 ([+ or -] 1.4)
  to] 3 doses
Primary series               95.1 ([+ or -] 1.3)
Full series                  83.0 ([+ or -] 2.6)

HepB
[greater than or equal       93.2 ([+ or -] 1.5)
  to] 3 doses
Birth dose ***               77.8 ([+ or -] 3.2) ([dagger][dagger])
Varicella ([greater than     92.7 ([+ or -] 1.8)
  or equal to] 1 dose)

PCV
[greater than or equal       94.4 ([+ or -] 1.6)
  to] 3 doses
[greater than or equal       84.0 ([+ or -] 2.5)
  to] 4 doses
HepA ([greater than or       60.9 ([+ or -] 3.5)
  equal to] 2 doses)
Rotavirus ([dagger]          72.9 ([+ or -] 3.2)
  [dagger][dagger])
Combined series              71.7 ([+ or -] 3.2)
  ([section][section]
  [section])

                                         Race/ethnicity

                                            American
                                             Indian/
                                          Alaska Native

Vaccine/Dose                               % (95% CI)

DTaP **
[greater than or equal       92.3 ([+ or -] 4.7)
  to] 3 doses
[greater than or equal       79.6 ([+ or -] 7.6)
  to] 4 doses
Poliovirus ([greater than    91.8 ([+ or -] 4.7)
  or equal to] 3 doses)
MMR ([greater than or        88.5 ([+ or -] 6.1)
  equal to] 1 dose)

Hib ([paragraph]
  [paragraph])
[greater than or equal       88.2 ([+ or -] 5.7)
  to] 3 doses
Primary series               89.8 ([+ or -] 5.6)
Full series                  81.4 ([+ or -] 7.3)

HepB
[greater than or equal       92.4 ([+ or -] 4.9)
  to] 3 doses
Birth dose ***               80.7 ([+ or -] 8.4) ([dagger][dagger])
Varicella ([greater than     87.8 ([+ or -] 6.0)
  or equal to] 1 dose)

PCV
[greater than or equal       89.7 ([+ or -] 5.4)
  to] 3 doses
[greater than or equal       77.1 ([+ or -] 7.9)
  to] 4 doses
HepA ([greater than or       61.3 ([+ or -] 9.5)
  equal to] 2 doses)
Rotavirus ([dagger]          -- ([section][section])
  [dagger][dagger])
Combined series              68.2 ([+ or -] 9.0)
  ([section][section]
  [section])

                                         Race/ethnicity

                                              Asian

Vaccine/Dose                               % (95% CI)

DTaP **
[greater than or equal       97.3 ([+ or -] 1.6) ([dagger][dagger])
  to] 3 doses
[greater than or equal       90.0 ([+ or -] 3.5) ([dagger][dagger])
  to] 4 doses
Poliovirus ([greater than    96.9 ([+ or -] 1.7) ([dagger][dagger])
  or equal to] 3 doses)
MMR ([greater than or        92.5 ([+ or -] 3.4)
  equal to] 1 dose)

Hib ([paragraph]
  [paragraph])
[greater than or equal       93.7 ([+ or -] 2.7)
  to] 3 doses
Primary series               94.8 ([+ or -] 2.2)
Full series                  87.0 ([+ or -] 3.9)

HepB
[greater than or equal       95.5 ([+ or -] 2.3) ([dagger][dagger])
  to] 3 doses
Birth dose ***               76.7 ([+ or -] 5.5) ([dagger][dagger])
Varicella ([greater than     93.4 ([+ or -] 2.9)
  or equal to] 1 dose)

PCV
[greater than or equal       92.4 ([+ or -] 2.9)
  to] 3 doses
[greater than or equal       85.0 ([+ or -] 4.1)
  to] 4 doses
HepA ([greater than or       67.8 ([+ or -] 6.2) ([dagger][dagger])
  equal to] 2 doses)
Rotavirus ([dagger]          75.6 ([+ or -] 5.4)
  [dagger][dagger])
Combined series              77.9 ([+ or -] 4.9)
  ([section][section]
  [section])

                                  Race/ethnicity

                                      Native
                                    Hawaiian or
                                   other Pacific
                                     Islander

Vaccine/Dose                        % (95% CI)

DTaP **
[greater than or equal       92.2 ([+ or -] 6.6)
  to] 3 doses
[greater than or equal       -- ([section][section])
  to] 4 doses
Poliovirus ([greater than    92.8 ([+ or -] 6.4)
  or equal to] 3 doses)
MMR ([greater than or        92.0 ([+ or -] 6.6)
  equal to] 1 dose)

Hib ([paragraph]
  [paragraph])
[greater than or equal       91.8 ([+ or -] 6.8)
  to] 3 doses
Primary series               92.8 ([+ or -] 6.4)
Full series                  -- ([section][section])

HepB
[greater than or equal       94.1 ([+ or -] 5.5)
  to] 3 doses
Birth dose ***               -- ([section][section])
Varicella ([greater than     91.8 ([+ or -] 6.8)
  or equal to] 1 dose)

PCV
[greater than or equal       90.6 ([+ or -] 7.5)
  to] 3 doses
[greater than or equal       -- ([section][section])
  to] 4 doses
HepA ([greater than or       -- ([section][section])
  equal to] 2 doses)
Rotavirus ([dagger]          -- ([section][section])
  [dagger][dagger])
Combined series              -- ([section][section])
  ([section][section]
  [section])

                               Race/ethnicity         Poverty level

                                                       At or above
                                                         poverty
                                 Multiracial           (Referent)

Vaccine/Dose                     % (95% CI)            % (95% CI)

DTaP **
[greater than or equal       93.6 ([+ or -] 2.7)   96.0 ([+ or -] 0.6)
  to] 3 doses
[greater than or equal       82.5 ([+ or -] 3.8)   87.1 ([+ or -] 1.3)
  to] 4 doses
Poliovirus ([greater than    92.4 ([+ or -] 2.8)   94.6 ([+ or -] 0.7)
  or equal to] 3 doses)
MMR ([greater than or        93.0 ([+ or -] 2.3)   92.9 ([+ or -] 0.9)
  equal to] 1 dose)

Hib ([paragraph]
  [paragraph])
[greater than or equal       92.0 ([+ or -] 2.8)   94.7 ([+ or -] 0.7)
  to] 3 doses
Primary series               93.1 ([+ or -] 2.7)   95.6 ([+ or -] 0.7)
Full series                  82.4 ([+ or -] 3.7)   85.5 ([+ or -] 1.3)

HepB
[greater than or equal       91.4 ([+ or -] 3.6)   92.7 ([+ or -] 1.0)
  to] 3 doses
Birth dose ***               72.8 ([+ or -] 4.9)   70.2 ([+ or -] 1.6)
Varicella ([greater than     92.1 ([+ or -] 2.5)   92.5 ([+ or -] 0.9)
  or equal to] 1 dose)

PCV
[greater than or equal       92.5 ([+ or -] 2.8)   94.6 ([+ or -] 0.8)
  to] 3 doses
[greater than or equal       83.7 ([+ or -] 3.6)   87.2 ([+ or -] 1.2)
  to] 4 doses
HepA ([greater than or       54.1 ([+ or -] 5.3)   61.7 ([+ or -] 1.7)
  equal to] 2 doses)
Rotavirus ([dagger]          70.6 ([+ or -] 5.2)   76.8 ([+ or -] 1.6)
  [dagger][dagger])
Combined series              73.7 ([+ or -] 4.6)   74.7 ([+ or -] 1.6)
  ([section][section]
  [section])

                                          Poverty level

                                              Below
                                             poverty

Vaccine/Dose                               % (95% CI)

DTaP **
[greater than or equal       93.1 ([+ or -] 1.2) ([dagger][dagger])
  to] 3 doses
[greater than or equal       80.2 ([+ or -] 2.2) ([dagger][dagger])
  to] 4 doses
Poliovirus ([greater than    91.8 ([+ or -] 1.4) ([dagger][dagger])
  or equal to] 3 doses)
MMR ([greater than or        90.3 ([+ or -] 1.6) ([dagger][dagger])
  equal to] 1 dose)

Hib ([paragraph]
  [paragraph])
[greater than or equal       90.5 ([+ or -] 1.4) ([dagger][dagger])
  to] 3 doses
Primary series               91.9 ([+ or -] 1.3) ([dagger][dagger])
Full series                  78.1 ([+ or -] 2.2) ([dagger][dagger])

HepB
[greater than or equal       92.5 ([+ or -] 1.3)
  to] 3 doses
Birth dose ***               76.3 ([+ or -] 2.5) ([dagger][dagger])
Varicella ([greater than     90.6 ([+ or -] 1.6)
  or equal to] 1 dose)

PCV
[greater than or equal       91.2 ([+ or -] 1.4) ([dagger][dagger])
  to] 3 doses
[greater than or equal       78.9 ([+ or -] 2.2) ([dagger][dagger])
  to] 4 doses
HepA ([greater than or       56.0 ([+ or -] 2.8) ([dagger][dagger])
  equal to] 2 doses)
Rotavirus ([dagger]          66.8 ([+ or -] 2.7) ([dagger][dagger])
  [dagger][dagger])
Combined series              68.7 ([+ or -] 2.5) ([dagger][dagger])
  ([section][section]
  [section])

                                            MSA status

                                    MSA,                  MSA,
                                central city              non-
                                 (Referent)           central city

Vaccine/Dose                     % (95% CI)            % (95% CI)

DTaP **
[greater than or equal       95.3 ([+ or -] 0.8)   95.0 ([+ or -] 0.9)
  to] 3 doses
[greater than or equal       85.4 ([+ or -] 1.5)   84.3 ([+ or -] 1.9)
  to] 4 doses
Poliovirus ([greater than    93.9 ([+ or -] 1.0)   94.0 ([+ or -] 1.0)
  or equal to] 3 doses)
MMR ([greater than or        92.4 ([+ or -] 1.2)   91.7 ([+ or -] 1.3)
  equal to] 1 dose)

Hib ([paragraph]
  [paragraph])
[greater than or equal       93.6 ([+ or -] 1.0)   93.3 ([+ or -] 1.1)
  to] 3 doses
Primary series               94.6 ([+ or -] 0.9)   94.3 ([+ or -] 1.0)
Full series                  82.3 ([+ or -] 1.6)   83.6 ([+ or -] 1.8)

HepB
[greater than or equal       92.9 ([+ or -] 1.1)   92.5 ([+ or -] 1.2)
  to] 3 doses
Birth dose ***               72.1 ([+ or -] 2.1)   71.7 ([+ or -] 2.2)
Varicella ([greater than     92.5 ([+ or -] 1.2)   91.5 ([+ or -] 1.2)
  or equal to] 1 dose)

PCV
[greater than or equal       93.1 ([+ or -] 1.1)   93.9 ([+ or -] 1.0)
  to] 3 doses
[greater than or equal       83.9 ([+ or -] 1.6)   85.5 ([+ or -] 1.7)
  to] 4 doses
HepA ([greater than or       60.5 ([+ or -] 2.2)   59.6 ([+ or -] 2.4)
  equal to] 2 doses)
Rotavirus ([dagger]          72.7 ([+ or -] 2.1)   75.1 ([+ or -] 2.1)
  [dagger][dagger])
Combined series              72.5 ([+ or -] 2.0)   72.5 ([+ or -] 2.3)
  ([section][section]
  [section])

                                           MSA status

                                             Non-MSA

Vaccine/Dose                               % (95% CI)

DTaP **
[greater than or equal       93.5 ([+ or -] 1.5) ([dagger][dagger])
  to] 3 doses
[greater than or equal       82.7 ([+ or -] 2.4)
  to] 4 doses
Poliovirus ([greater than    91.7 ([+ or -] 1.8) ([dagger][dagger])
  or equal to] 3 doses)
MMR ([greater than or        90.7 ([+ or -] 1.8)
  equal to] 1 dose)

Hib ([paragraph]
  [paragraph])
[greater than or equal       91.8 ([+ or -] 1.6)
  to] 3 doses
Primary series               93.2 ([+ or -] 1.5)
Full series                  80.9 ([+ or -] 2.4)

HepB
[greater than or equal       92.1 ([+ or -] 1.6)
  to] 3 doses
Birth dose ***               75.6 ([+ or -] 2.8) ([dagger][dagger])
Varicella ([greater than     89.9 ([+ or -] 1.9) ([dagger][dagger])
  or equal to] 1 dose)

PCV
[greater than or equal       91.8 ([+ or -] 1.7)
  to] 3 doses
[greater than or equal       80.4 ([+ or -] 2.5) ([dagger][dagger])
  to] 4 doses
HepA ([greater than or       55.7 ([+ or -] 3.2) ([dagger][dagger])
  equal to] 2 doses)
Rotavirus ([dagger]          68.6 ([+ or -] 3.0) ([dagger][dagger])
  [dagger][dagger])
Combined series              70.2 ([+ or -] 2.9)
  ([section][section]
  [section])

Abbreviations: CI = confidence interval; DTaP = diphtheria, tetanus
toxoids, and acellular pertussis vaccine; HepA = hepatitis A vaccine;
HepB = hepatitis B vaccine; Hib = Haemophilus influenzae type b
vaccine; MMR = measles, mumps, and rubella vaccine; PCV =
pneumococcal conjugate vaccine.

* Children's race/ethnicity was reported by parent or guardian.
Children identified in this report as white, black, Asian, American
Indian/Alaska Native, Native Hawaiian or other Pacific Islander, or
multiracial were reported by the parent or guardian as non-Hispanic.
Children identified as multiracial had more than one race category
selected. Children identified as Hispanic might be of any race.

([dagger]) Children were classified as below poverty if their total
family income was less than the poverty threshold specified for the
applicable family size and number of children aged <18 years.
Children with total family income at or above the poverty threshold
specified for the applicable family size and number of children aged
<18 years were classified as at or above poverty. A total of 492
children with adequate provider data and missing data on income were
excluded from the analysis. Poverty thresholds reflect yearly changes
in the Consumer Price Index (http://www.census.gov/hhes/www/
poverty.html).

([section]) Metropolitan Statistical Area as defined by the US Office
of Management and Budget https://www.whitehouse.gov/sites/default/
files/omb/bulletins/2015/15-01.pdf).

([paragraph]) Children in the 2015 National Immunization Survey were
born January 2012-May 2014.

** Includes children who might have been vaccinated with diphtheria
and tetanus toxoids vaccine, or diphtheria, tetanus toxoids, and
pertussis vaccine.

([dagger][dagger]) Statistically significant (p<0.05) difference from
referent group.

([section][section]) Estimate not available because the unweighted
sample size for the denominator was <30, or 95% CI half-width/
estimate >0.588, or 95% CI half-width was >10.

([paragraph][paragraph]) Hib primary series: receipt of [greater than
or equal to] 2 or [greater than or equal to] 3 doses, depending on
product type received; full series: primary series and booster dose
includes receipt of [greater than or equal to] 3 or [greater than or
equal to] 4 doses, depending on product type received.

*** One dose HepB administered from birth through age 3 days.

([dagger][dagger][dagger]) Includes [greater than or equal to] 2 or
[greater than or equal to] 3 doses, depending on product type
received ([greater than or equal to] 2 doses for Rotarix [RV1], or
[greater than or equal to] 3 doses for RotaTeq [RV5]).

([section][section][section]) The combined seven-vaccine series
(4:3:1:3 *:3:1:4) includes [greater than or equal to] 4 doses of
DTaP, [greater than or equal to] 3 doses of poliovirus vaccine,
[greater than or equal to] 1 dose of measles-containing vaccine, full
series of Hib ([greater than or equal to] 3 or [greater than or equal
to] 4 doses, depending on type), [greater than or equal to] 3 doses
of HepB, [greater than or equal to] 1 dose of varicella vaccine, and
[greater than or equal to] 4 doses of PCV.

TABLE 3. Estimated vaccination coverage with selected individual
vaccines and a combined vaccine series * among children aged 19-35
months, overall and by U.S. Department of Health and Human Services
(HHS) region and state and local area--National Immunization Survey,
United States, 2015 ([dagger])

                                   Vaccine/Vaccine series

                           MMR ([greater than or equal to] 1 dose)

local area                               % (95% CI)

U.S. overall              91.9 ([+ or -] 0.8)
HHS Region I              94.1 ([+ or -] 2.1)
Connecticut               97.5 ([+ or -] 2.4)
Maine                     96.0 ([+ or -] 3.1)
Massachusetts             91.8 ([+ or -] 4.0)
New Hampshire             93.4 ([+ or -] 3.9)
Rhode Island              94.5 ([+ or -] 3.2)
Vermont                   95.5 ([+ or -] 2.7)
HHS Region II             92.6 ([+ or -] 2.2)
New Jersey                92.8 ([+ or -] 4.4)
New York                  92.5 ([+ or -] 2.6)
  City of New York        94.1 ([+ or -] 2.9)
  Rest of state (NY)      90.9 ([+ or -] 4.3)
HHS Region III            89.6 ([+ or -] 2.5)
Delaware                  97.2 ([+ or -] 2.6) ([section][section])
District of Columbia      92.4 ([+ or -] 3.8)
Maryland                  95.4 ([+ or -] 2.5)
Pennsylvania              90.9 ([+ or -] 3.7)
  Philadelphia            93.2 ([+ or -] 3.5)
  Rest of state (PA)      90.5 ([+ or -] 4.4)
Virginia                  83.4 ([+ or -] 6.7)
West Virginia             86.7 ([+ or -] 5.7)
HHS Region IV             91.3 ([+ or -] 1.9)
Alabama                   95.2 ([+ or -] 3.5)
Florida                   90.4 ([+ or -] 5.0)
Georgia                   90.5 ([+ or -] 4.7)
Kentucky                  91.6 ([+ or -] 4.1)
Mississippi               89.8 ([+ or -] 5.3)
North Carolina            94.3 ([+ or -] 3.3)
South Carolina            88.5 ([+ or -] 5.1)
Tennessee                 90.2 ([+ or -] 4.0) ([dagger][dagger])
HHS Region V              90.9 ([+ or -] 1.8)
Illinois                  91.6 ([+ or -] 2.8)
  City of Chicago         90.5 ([+ or -] 4.7)
  Rest of state (IL)      91.9 ([+ or -] 3.4)
Indiana                   92.0 ([+ or -] 4.4)
Michigan                  90.6 ([+ or -] 4.5)
Minnesota                 92.6 ([+ or -] 3.6)
Ohio                      88.1 ([+ or -] 5.6) ([dagger][dagger])
Wisconsin                 92.4 ([+ or -] 4.3)
HHS Region VI             92.3 ([+ or -] 1.8)
Arkansas                  90.2 ([+ or -] 5.0)
Louisiana                 92.6 ([+ or -] 4.3)
New Mexico                89.7 ([+ or -] 5.3)
Oklahoma                  92.6 ([+ or -] 5.1)
Texas                     92.5 ([+ or -] 2.4)
  Bexar County            89.2 ([+ or -] 5.0)
  City of Houston         92.8 ([+ or -] 3.9)
  El Paso County          90.6 ([+ or -] 4.5)
  Hidalgo County          86.9 ([+ or -] 5.2)
    ([paragraph]
    [paragraph])
  Rest of state (TX)      93.3 ([+ or -] 3.1)
    ([paragraph]
    [paragraph])
HHS Region VII            93.2 ([+ or -] 2.1)
Iowa                      95.5 ([+ or -] 2.4)
Kansas                    92.3 ([+ or -] 4.1)
Missouri                  91.6 ([+ or -] 4.3)
Nebraska                  95.6 ([+ or -] 3.0)
HHS Region VIII           91.8 ([+ or -] 2.3)
Colorado                  93.6 ([+ or -] 3.6)
Montana                   91.7 ([+ or -] 3.7)
North Dakota              92.8 ([+ or -] 3.8)
South Dakota              91.4 ([+ or -] 4.8)
Utah                      89.2 ([+ or -] 5.2)
Wyoming                   93.5 ([+ or -] 3.5)
HHS Region IX             92.6 ([+ or -] 3.1)
Arizona                   90.6 ([+ or -] 4.1)
California                92.8 ([+ or -] 3.9)
Hawaii                    94.7 ([+ or -] 3.3)
Nevada                    93.7 ([+ or -] 3.7)
HHS Region X              94.1 ([+ or -] 1.8) ([section][section])
Alaska                    89.7 ([+ or -] 4.0)
Idaho                     91.2 ([+ or -] 4.0)
Oregon                    94.1 ([+ or -] 3.7) ([section][section])
Washington                95.3 ([+ or -] 2.6) ([section][section])
Range                     (83.4-97.5)

Territory
Guam ***                  91.7 ([+ or -] 3.6)
Puerto Rico ***           91.4 ([+ or -] 3.9)
U.S. Virgin Islands ***   77.2 ([+ or -] 5.5)

                                   Vaccine/Vaccine series

                              DTaP ([greater than or equal to]
                                    4 doses) ([section])

local area                               % (95% CI)

U.S. overall              84.6 ([+ or -] 1.1)
HHS Region I              88.9 ([+ or -] 2.7)
Connecticut               90.8 ([+ or -] 4.5)
Maine                     92.0 ([+ or -] 5.0)
Massachusetts             87.2 ([+ or -] 5.1)
New Hampshire             88.4 ([+ or -] 5.4)
Rhode Island              90.5 ([+ or -] 4.1)
Vermont                   89.2 ([+ or -] 4.2)
HHS Region II             88.1 ([+ or -] 2.7)
New Jersey                89.8 ([+ or -] 4.8)
New York                  87.4 ([+ or -] 3.3)
  City of New York        85.5 ([+ or -] 5.0)
  Rest of state (NY)      89.2 ([+ or -] 4.3)
HHS Region III            85.5 ([+ or -] 2.7)
Delaware                  89.9 ([+ or -] 4.5)
District of Columbia      86.1 ([+ or -] 5.0)
Maryland                  87.6 ([+ or -] 4.5)
Pennsylvania              88.7 ([+ or -] 3.8)
  Philadelphia            87.2 ([+ or -] 4.5)
  Rest of state (PA)      88.9 ([+ or -] 4.4)
Virginia                  80.6 ([+ or -] 7.0)
West Virginia             78.6 ([+ or -] 6.8)
HHS Region IV             83.3 ([+ or -] 2.3)
Alabama                   82.2 ([+ or -] 6.4)
Florida                   86.0 ([+ or -] 5.2)
Georgia                   82.3 ([+ or -] 6.0)
Kentucky                  87.0 ([+ or -] 4.8)
Mississippi               79.6 ([+ or -] 7.0)
North Carolina            83.9 ([+ or -] 5.8)
South Carolina            77.5 ([+ or -] 7.0)
Tennessee                 81.2 ([+ or -] 6.5)
HHS Region V              84.2 ([+ or -] 2.3)
Illinois                  85.0 ([+ or -] 3.8)
  City of Chicago         86.2 ([+ or -] 5.9)
  Rest of state (IL)      84.6 ([+ or -] 4.6)
Indiana                   85.3 ([+ or -] 5.7)
Michigan                  84.9 ([+ or -] 5.5)
Minnesota                 85.4 ([+ or -] 5.0)
Ohio                      80.9 ([+ or -] 6.8)
Wisconsin                 85.2 ([+ or -] 5.7)
HHS Region VI             82.4 ([+ or -] 2.7)
Arkansas                  76.4 ([+ or -] 6.9)
Louisiana                 84.4 ([+ or -] 5.7)
New Mexico                84.8 ([+ or -] 6.0)
Oklahoma                  85.7 ([+ or -] 6.3)
Texas                     82.1 ([+ or -] 3.6)
  Bexar County            80.1 ([+ or -] 6.1)
  City of Houston         80.5 ([+ or -] 6.5)
  El Paso County          82.8 ([+ or -] 6.1)
  Hidalgo County          82.4 ([+ or -] 5.8)
    ([paragraph]
    [paragraph])
  Rest of state (TX)      82.5 ([+ or -] 4.8)
    ([paragraph]
    [paragraph])
HHS Region VII            85.5 ([+ or -] 3.0)
Iowa                      88.9 ([+ or -] 4.0)
Kansas                    86.8 ([+ or -] 4.7)
Missouri                  82.6 ([+ or -] 6.3)
Nebraska                  86.9 ([+ or -] 5.0)
HHS Region VIII           83.8 ([+ or -] 2.9)
Colorado                  86.1 ([+ or -] 5.0)
Montana                   78.6 ([+ or -] 6.5)
North Dakota              85.7 ([+ or -] 5.1)
South Dakota              83.1 ([+ or -] 6.0)
Utah                      82.0 ([+ or -] 5.8)
Wyoming                   83.2 ([+ or -] 6.1)
HHS Region IX             84.9 ([+ or -] 4.6)
Arizona                   83.7 ([+ or -] 5.8)
California                85.2 ([+ or -] 5.7)
Hawaii                    83.2 ([+ or -] 5.4)
Nevada                    84.7 ([+ or -] 5.7)
HHS Region X              85.6 ([+ or -] 3.1)
Alaska                    79.7 ([+ or -] 5.2)
Idaho                     81.0 ([+ or -] 5.9)
Oregon                    85.8 ([+ or -] 5.7)
Washington                87.3 ([+ or -] 4.7)
Range                     (76.4-92.0)

Territory
Guam ***                  73.3 ([+ or -] 6.1)
Puerto Rico ***           82.0 ([+ or -] 5.8)
U.S. Virgin Islands ***   65.8 ([+ or -] 6.3)

                                   Vaccine/Vaccine series

                              Hep B (birth dose) ([paragraph])

local area                               % (95% CI)

U.S. overall              72.4 ([+ or -] 1.4)
HHS Region I              76.3 ([+ or -] 3.3)
Connecticut               81.8 ([+ or -] 6.2)
Maine                     68.7 ([+ or -] 7.7)
Massachusetts             78.4 ([+ or -] 5.8)
New Hampshire             72.0 ([+ or -] 7.0)
Rhode Island              73.2 ([+ or -] 6.4)
Vermont                   49.4 ([+ or -] 6.7)
HHS Region II             60.6 ([+ or -] 4.0)
New Jersey                63.9 ([+ or -] 7.2)
New York                  59.0 ([+ or -] 4.7)
  City of New York        53.4 ([+ or -] 6.8)
  Rest of state (NY)      64.6 ([+ or -] 6.6)
HHS Region III            72.5 ([+ or -] 3.6) ([dagger][dagger])
Delaware                  76.0 ([+ or -] 6.7)
District of Columbia      72.7 ([+ or -] 5.8)
Maryland                  79.0 ([+ or -] 6.6)
Pennsylvania              73.2 ([+ or -] 6.0)
  Philadelphia            77.3 ([+ or -] 6.1)
  Rest of state (PA)      72.5 ([+ or -] 7.0)
Virginia                  67.3 ([+ or -] 8.1)
West Virginia             68.3 ([+ or -] 7.4)
HHS Region IV             70.9 ([+ or -] 2.9)
Alabama                   83.2 ([+ or -] 5.4)
Florida                   56.9 ([+ or -] 7.6)
Georgia                   80.5 ([+ or -] 5.7)
Kentucky                  75.3 ([+ or -] 6.7)
Mississippi               77.0 ([+ or -] 7.3)
North Carolina            81.3 ([+ or -] 6.0)
South Carolina            68.9 ([+ or -] 7.0)
Tennessee                 64.7 ([+ or -] 7.9) ([dagger][dagger])
HHS Region V              75.2 ([+ or -] 2.5)
Illinois                  71.2 ([+ or -] 4.6)
  City of Chicago         82.9 ([+ or -] 5.9)
  Rest of state (IL)      67.2 ([+ or -] 5.8)
Indiana                   80.0 ([+ or -] 6.3)
Michigan                  80.0 ([+ or -] 5.9)
Minnesota                 67.8 ([+ or -] 6.5)
Ohio                      77.9 ([+ or -] 6.5)
Wisconsin                 73.1 ([+ or -] 6.6)
HHS Region VI             76.5 ([+ or -] 2.9)
Arkansas                  80.6 ([+ or -] 6.2)
Louisiana                 75.3 ([+ or -] 7.1)
New Mexico                67.8 ([+ or -] 7.5)
Oklahoma                  80.4 ([+ or -] 5.9)
Texas                     76.4 ([+ or -] 3.9)
  Bexar County            72.5 ([+ or -] 6.7)
  City of Houston         82.6 ([+ or -] 5.7)
  El Paso County          76.5 ([+ or -] 7.0)
  Hidalgo County          89.5 ([+ or -] 4.8)
    ([paragraph]
    [paragraph])
  Rest of state (TX)      74.9 ([+ or -] 5.2)
    ([paragraph]
    [paragraph])
HHS Region VII            77.2 ([+ or -] 3.6)
Iowa                      78.2 ([+ or -] 5.3)
Kansas                    83.3 ([+ or -] 5.4)
Missouri                  75.0 ([+ or -] 7.4)
Nebraska                  72.5 ([+ or -] 6.8)
HHS Region VIII           75.8 ([+ or -] 3.4)
Colorado                  73.1 ([+ or -] 6.4)
Montana                   73.8 ([+ or -] 6.5)
North Dakota              87.5 ([+ or -] 4.7)
South Dakota              71.4 ([+ or -] 7.3)
Utah                      79.6 ([+ or -] 6.0)
Wyoming                   67.2 ([+ or -] 7.3)
HHS Region IX             70.9 ([+ or -] 5.8)
Arizona                   78.0 ([+ or -] 6.0)
California                69.1 ([+ or -] 7.4)
Hawaii                    75.5 ([+ or -] 6.3)
Nevada                    77.7 ([+ or -] 6.8)
HHS Region X              71.0 ([+ or -] 3.9)
Alaska                    65.7 ([+ or -] 6.1) ([section][section])
Idaho                     69.8 ([+ or -] 6.9)
Oregon                    72.5 ([+ or -] 7.0) ([section][section])
Washington                71.2 ([+ or -] 6.2)
Range                     (49.4-87.5)

Territory
Guam ***                  82.3 ([+ or -] 5.0)
Puerto Rico ***           72.7 ([+ or -] 7.6)
U.S. Virgin Islands ***   79.4 ([+ or -] 5.3)

                                   Vaccine/Vaccine series

                              HepA ([greater than or equal to]
                                          2 doses)

local area                               % (95% CI)

U.S. overall              59.6 ([+ or -] 1.5)
HHS Region I              65.4 ([+ or -] 3.9)
Connecticut               72.0 ([+ or -] 7.3)
Maine                     53.8 ([+ or -] 8.3)
Massachusetts             65.7 ([+ or -] 6.9)
New Hampshire             60.2 ([+ or -] 7.7)
Rhode Island              65.1 ([+ or -] 6.9)
Vermont                   57.1 ([+ or -] 6.7)
HHS Region II             53.4 ([+ or -] 4.1)
New Jersey                58.3 ([+ or -] 7.4)
New York                  51.2 ([+ or -] 5.0)
  City of New York        47.8 ([+ or -] 6.9)
  Rest of state (NY)      54.6 ([+ or -] 7.2)
HHS Region III            61.5 ([+ or -] 3.8)
Delaware                  67.6 ([+ or -] 7.3)
District of Columbia      67.9 ([+ or -] 6.5)
Maryland                  63.0 ([+ or -] 7.2)
Pennsylvania              64.6 ([+ or -] 6.3)
  Philadelphia            65.4 ([+ or -] 6.9)
  Rest of state (PA)      64.4 ([+ or -] 7.4)
Virginia                  54.1 ([+ or -] 8.3)
West Virginia             65.7 ([+ or -] 7.7) ([section][section])
HHS Region IV             55.8 ([+ or -] 3.1)
Alabama                   57.6 ([+ or -] 7.6)
Florida                   54.6 ([+ or -] 7.5)
Georgia                   62.0 ([+ or -] 7.6)
Kentucky                  48.3 ([+ or -] 7.3)
Mississippi               41.2 ([+ or -] 8.1)
North Carolina            56.2 ([+ or -] 7.5)
South Carolina            54.5 ([+ or -] 7.6)
Tennessee                 59.5 ([+ or -] 8.0)
HHS Region V              59.9 ([+ or -] 3.0)
Illinois                  57.9 ([+ or -] 4.9)
  City of Chicago         62.7 ([+ or -] 8.0)
  Rest of state (IL)      56.3 ([+ or -] 6.0)
Indiana                   65.3 ([+ or -] 7.4) ([section][section])
Michigan                  64.1 ([+ or -] 7.2) ([section][section])
Minnesota                 65.4 ([+ or -] 6.6)
Ohio                      53.1 ([+ or -] 8.2)
Wisconsin                 58.6 ([+ or -] 7.5)
HHS Region VI             63.9 ([+ or -] 3.2) ([section][section])
Arkansas                  54.2 ([+ or -] 8.0)
Louisiana                 59.0 ([+ or -] 8.0)
New Mexico                62.7 ([+ or -] 7.9)
Oklahoma                  71.6 ([+ or -] 7.4) ([section][section])
Texas                     64.6 ([+ or -] 4.3)
  Bexar County            64.2 ([+ or -] 7.3)
  City of Houston         64.5 ([+ or -] 7.6)
  El Paso County          73.5 ([+ or -] 6.7) ([section][section])
  Hidalgo County          64.1 ([+ or -] 6.7)
    ([paragraph]
    [paragraph])
  Rest of state (TX)      64.2 ([+ or -] 5.7)
    ([paragraph]
    [paragraph])
HHS Region VII            63.5 ([+ or -] 4.0) ([section][section])
Iowa                      64.7 ([+ or -] 6.5)
Kansas                    67.9 ([+ or -] 6.8)
Missouri                  57.2 ([+ or -] 7.9) ([section][section])
Nebraska                  72.8 ([+ or -] 6.5)
HHS Region VIII           57.8 ([+ or -] 4.0)
Colorado                  59.7 ([+ or -] 7.3)
Montana                   43.9 ([+ or -] 7.3)
North Dakota              66.3 ([+ or -] 6.9)
South Dakota              53.0 ([+ or -] 7.8)
Utah                      59.8 ([+ or -] 7.6)
Wyoming                   45.8 ([+ or -] 7.8) ([section][section])
HHS Region IX             60.3 ([+ or -] 6.2)
Arizona                   58.6 ([+ or -] 7.4)
California                60.8 ([+ or -] 7.8)
Hawaii                    51.4 ([+ or -] 7.0)
Nevada                    61.9 ([+ or -] 7.5)
HHS Region X              58.8 ([+ or -] 4.4)
Alaska                    56.5 ([+ or -] 6.5)
Idaho                     58.8 ([+ or -] 7.3)
Oregon                    61.8 ([+ or -] 8.0)
Washington                57.5 ([+ or -] 7.0)
Range                     (41.2-72.8)

Territory
Guam ***                  49.4 ([+ or -] 6.9)
Puerto Rico ***           50.7 ([+ or -] 8.1)
U.S. Virgin Islands ***   36.8 ([+ or -] 6.5)

                                   Vaccine/Vaccine series

                                        Rotavirus **

local area                               % (95% CI)

U.S. overall              73.2 ([+ or -] 1.4)
HHS Region I              80.7 ([+ or -] 3.2)
Connecticut               77.9 ([+ or -] 6.7)
Maine                     71.1 ([+ or -] 7.7)
Massachusetts             83.5 ([+ or -] 5.4)
New Hampshire             80.9 ([+ or -] 6.2)
Rhode Island              87.6 ([+ or -] 4.9)
Vermont                   72.7 ([+ or -] 6.2)
HHS Region II             73.7 ([+ or -] 3.8) ([section][section])
New Jersey                75.2 ([+ or -] 6.8)
New York                  73.0 ([+ or -] 4.5)
  City of New York        71.1 ([+ or -] 6.4)
  Rest of state (NY)      75.0 ([+ or -] 6.4)
HHS Region III            72.7 ([+ or -] 3.6)
Delaware                  81.5 ([+ or -] 6.1)
District of Columbia      73.0 ([+ or -] 6.2)
Maryland                  76.8 ([+ or -] 6.4)
Pennsylvania              74.3 ([+ or -] 5.9)
  Philadelphia            71.5 ([+ or -] 6.4)
  Rest of state (PA)      74.9 ([+ or -] 6.9)
Virginia                  67.1 ([+ or -] 8.3)
West Virginia             69.6 ([+ or -] 7.5)
HHS Region IV             69.8 ([+ or -] 3.0)
Alabama                   76.2 ([+ or -] 6.9)
Florida                   63.8 ([+ or -] 7.5)
Georgia                   73.8 ([+ or -] 7.0)
Kentucky                  65.3 ([+ or -] 7.1)
Mississippi               65.9 ([+ or -] 8.0)
North Carolina            75.9 ([+ or -] 6.7) ([dagger][dagger])
South Carolina            69.8 ([+ or -] 7.1)
Tennessee                 70.9 ([+ or -] 7.6)
HHS Region V              73.2 ([+ or -] 2.8)
Illinois                  75.4 ([+ or -] 4.5)
  City of Chicago         78.3 ([+ or -] 6.8) ([section][section])
  Rest of state (IL)      74.4 ([+ or -] 5.5)
Indiana                   72.6 ([+ or -] 7.2)
Michigan                  65.5 ([+ or -] 7.7)
Minnesota                 82.6 ([+ or -] 5.4)
Ohio                      71.8 ([+ or -] 7.6)
Wisconsin                 75.3 ([+ or -] 6.7)
HHS Region VI             73.5 ([+ or -] 2.9)
Arkansas                  68.2 ([+ or -] 7.4)
Louisiana                 67.7 ([+ or -] 7.6)
New Mexico                73.8 ([+ or -] 6.9)
Oklahoma                  67.2 ([+ or -] 8.3)
Texas                     75.7 ([+ or -] 3.9) ([section][section])
  Bexar County            70.7 ([+ or -] 7.0)
  City of Houston         74.8 ([+ or -] 6.8)
  El Paso County          73.4 ([+ or -] 7.1)
  Hidalgo County          73.1 ([+ or -] 6.4)
    ([paragraph]
    [paragraph])
  Rest of state (TX)      76.6 ([+ or -] 5.1)
    ([paragraph]
    [paragraph])
HHS Region VII            75.7 ([+ or -] 3.6)
Iowa                      75.1 ([+ or -] 5.9)
Kansas                    77.0 ([+ or -] 6.3)
Missouri                  76.1 ([+ or -] 7.0)
Nebraska                  73.0 ([+ or -] 6.4)
HHS Region VIII           74.9 ([+ or -] 3.6)
Colorado                  75.9 ([+ or -] 6.5)
Montana                   67.3 ([+ or -] 7.0)
North Dakota              79.8 ([+ or -] 6.2)
South Dakota              73.4 ([+ or -] 7.0)
Utah                      74.5 ([+ or -] 6.7)
Wyoming                   76.4 ([+ or -] 6.6)
HHS Region IX             74.1 ([+ or -] 5.6)
Arizona                   75.1 ([+ or -] 6.6)
California                74.6 ([+ or -] 7.1)
Hawaii                    72.5 ([+ or -] 6.4)
Nevada                    65.5 ([+ or -] 7.6)
HHS Region X              73.4 ([+ or -] 4.0)
Alaska                    72.0 ([+ or -] 5.9)
Idaho                     74.5 ([+ or -] 6.6)
Oregon                    72.9 ([+ or -] 7.3)
Washington                73.6 ([+ or -] 6.3)
Range                     (63.8-87.6)

Territory
Guam ***                  40.6 ([+ or -] 6.5)
Puerto Rico ***           64.9 ([+ or -] 7.6)
U.S. Virgin Islands ***   43.3 ([+ or -] 6.9)

                                   Vaccine/Vaccine series

                                          Combined
                                       vaccine series

local area                               % (95% CI)

U.S. overall              72.2 ([+ or -] 1.4)
HHS Region I              77.8 ([+ or -] 3.3)
Connecticut               80.6 ([+ or -] 6.0)
Maine                     71.8 ([+ or -] 7.9) ([dagger][dagger])
Massachusetts             78.5 ([+ or -] 6.0)
New Hampshire             74.1 ([+ or -] 7.1)
Rhode Island              77.2 ([+ or -] 6.0)
Vermont                   75.6 ([+ or -] 5.9)
HHS Region II             73.4 ([+ or -] 3.7)
New Jersey                76.5 ([+ or -] 6.5)
New York                  71.9 ([+ or -] 4.4)
  City of New York        68.2 ([+ or -] 6.5)
  Rest of state (NY)      75.7 ([+ or -] 6.1)
HHS Region III            71.0 ([+ or -] 3.6)
Delaware                  79.3 ([+ or -] 6.1)
District of Columbia      76.3 ([+ or -] 6.0)
Maryland                  76.8 ([+ or -] 5.9)
Pennsylvania              72.8 ([+ or -] 5.8)
  Philadelphia            76.1 ([+ or -] 6.0)
  Rest of state (PA)      72.2 ([+ or -] 6.8)
Virginia                  64.4 ([+ or -] 8.3)
West Virginia             64.9 ([+ or -] 7.8)
HHS Region IV             71.2 ([+ or -] 2.9)
Alabama                   70.6 ([+ or -] 7.1)
Florida                   66.6 ([+ or -] 7.2)
Georgia                   75.6 ([+ or -] 6.7)
Kentucky                  73.0 ([+ or -] 6.5)
Mississippi               70.6 ([+ or -] 7.5)
North Carolina            76.4 ([+ or -] 6.5)
South Carolina            68.2 ([+ or -] 7.3)
Tennessee                 70.1 ([+ or -] 7.5)
HHS Region V              70.2 ([+ or -] 2.8)
Illinois                  70.8 ([+ or -] 4.7)
  City of Chicago         72.8 ([+ or -] 7.3)
  Rest of state (IL)      70.1 ([+ or -] 5.8)
Indiana                   74.7 ([+ or -] 7.0)
Michigan                  67.6 ([+ or -] 7.3)
Minnesota                 73.2 ([+ or -] 6.4)
Ohio                      68.3 ([+ or -] 7.9)
Wisconsin                 68.8 ([+ or -] 7.1)
HHS Region VI             71.2 ([+ or -] 3.1)
Arkansas                  66.6 ([+ or -] 7.5)
Louisiana                 70.8 ([+ or -] 7.6)
New Mexico                70.1 ([+ or -] 7.9)
Oklahoma                  75.4 ([+ or -] 7.3)
Texas                     71.2 ([+ or -] 4.2) ([section][section])
  Bexar County            67.5 ([+ or -] 7.1)
  City of Houston         70.5 ([+ or -] 7.3)
  El Paso County          71.6 ([+ or -] 7.1)
  Hidalgo County          71.6 ([+ or -] 6.5)
    ([paragraph]
    [paragraph])
  Rest of state (TX)      71.6 ([+ or -] 5.6)
    ([paragraph]
    [paragraph])
HHS Region VII            73.8 ([+ or -] 3.7)
Iowa                      77.9 ([+ or -] 5.5)
Kansas                    75.2 ([+ or -] 6.3)
Missouri                  71.0 ([+ or -] 7.4)
Nebraska                  73.8 ([+ or -] 6.3)
HHS Region VIII           72.7 ([+ or -] 3.6)
Colorado                  75.4 ([+ or -] 6.2)
Montana                   68.1 ([+ or -] 7.1)
North Dakota              80.2 ([+ or -] 5.7)
South Dakota              75.6 ([+ or -] 6.8)
Utah                      68.1 ([+ or -] 7.3)
Wyoming                   73.3 ([+ or -] 7.1)
HHS Region IX             74.4 ([+ or -] 5.5)
Arizona                   72.3 ([+ or -] 6.7)
California                75.0 ([+ or -] 6.9)
Hawaii                    73.8 ([+ or -] 6.3)
Nevada                    71.3 ([+ or -] 7.0)
HHS Region X              73.0 ([+ or -] 3.9)
Alaska                    66.3 ([+ or -] 6.2)
Idaho                     71.6 ([+ or -] 6.8)
Oregon                    67.4 ([+ or -] 7.8)
Washington                77.1 ([+ or -] 5.7)
Range                     (64.4-80.6)

Territory
Guam ***                  52.9 ([+ or -] 7.0)
Puerto Rico ***           61.0 ([+ or -] 8.1)
U.S. Virgin Islands ***   50.7 ([+ or -] 6.7)

Abbreviations: CI = confidence interval; DTaP = diphtheria, tetanus
toxoids and acellular pertussis vaccine; HepA = hepatitis A vaccine;
HepB = hepatitis B vaccine; Hib = Haemophilus influenzae type b
vaccine; MMR = measles, mumps, and rubella vaccine; PCV =
pneumococcal conjugate vaccine.

* The combined seven-vaccine series (4:3:1:3 *:3:1:4) includes
[greater than or equal to] 4 doses of DTaP, [greater than or equal
to] 3 doses of poliovirus vaccine, [greater than or equal to] 1
doses of measles-containing vaccine, full series of Hib vaccine
([greater than or equal to] 3 or [greater than or equal to] 4 doses,
depending on product type), [greater than or equal to] 3 doses of
HepB, [greater than or equal to] 1 dose of varicella vaccine, and
[greater than or equal to] 4 doses of PCV.

([dagger]) Children in the 2015 National Immunization Survey were
born January 2012-May 2014.

([section]) Includes children who might have been vaccinated with
diphtheria and tetanus toxoids vaccine, or diphtheria, tetanus
toxoids and pertussis vaccine ([paragraph]) One dose HepB
administered from birth through age 3 days.

** Either [greater than or equal to] 2 or [greater than or equal to]
3 doses of rotavirus vaccine, depending on product type received
([greater than or equal to] 2 doses for Rotarix [RV1] or [greater
than or equal to] 3 doses for RotaTeq [RV5]). ([dagger][dagger])
Statistically significant decrease in coverage compared to 2014
(p<0.05).

([section][section]) Statistically significant increase in coverage
compared to 2014 (p<0.05).

([paragraph][paragraph]) No comparison was made to coverage in 2014;
Hidalgo County was not sampled in 2014 and "rest of state" is not
comparable between the two years.

*** Children from Guam (n=467), Puerto Rico (n=617), and the U.S.
Virgin Islands (n=580) were excluded from the national estimates.
Guam and U.S. Virgin Islands were not sampled in 2014.
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Article Details
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Author:Hill, Holly A.; Elam-Evans, Laurie D.; Yankey, David; Singleton, James A.; Dietz, Vance
Publication:Morbidity and Mortality Weekly Report
Article Type:Survey
Date:Oct 7, 2016
Words:10938
Previous Article:Vaccination coverage among children in kindergarten--United States, 2015-16 school year.
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