The underserved suffer from
undervaccination

Specific SDOH impact vaccination rates for children up to age 24 months.5

Before the pandemic, persistent disparities were observed in routine vaccination coverage by health insurance status, race and ethnicity, and poverty status.5 These gaps in recommended vaccinations remained steady or worsened during the COVID-19 pandemic.7,12,13,14,15

According to the January 2023 CDC Morbidity and Mortality Weekly Report, for children born during 2018 to 2019, coverage by 24 months with most childhood vaccines was lower among those who were uninsured, Black, Hispanic, or living below the federal poverty level compared to those who were privately insured, White, or living at or above the poverty level.5,7,a


Estimated vaccination coverage in infants and children born during 2018-2019 who received the combined 7-vaccination series by age 24 months according to the CDC Child National Immunization Survey, 2019-2021 Report5,a:

Health Insurance Status5,b

Health Insurance Status of Pediatric Patients Who Received Vaccinations

Race/Ethnicity7,c

Race and Ethnicity of Pediatric Patients That Received Vaccinations

Poverty Status7

Poverty Status of Pediatric Patients With Vaccination Coverage

Fewer disparities were found by MSA7,d:


Coverage by age 24 months among children born during 2018-2019 for the combined 7-vaccine series:

70.2% (68.5 – 71.9) – MSA Principal City (N=12,876)

71.4% (69.6 – 73.1) – MSA Nonprincipal City (N=11,860)

64.2% (61.2 – 67.2) – Non-MSA (N=4,862)

Wide variations also occurred in vaccination coverage by state7


Largest disparity for ≥ 2 doses of influenza vaccine, by age 24 months among children born during 2018-2019e with estimates ranging from:

39.7% (33.3 – 46.9) – Alabama (N=372)

– TO –

84.0% (78.9 – 88.4) – Rhode Island (N=374)


aCDC conducts the NIS-Child annually as a random-digit-dialed mobile telephone survey of parents or guardians of children ages 19–35 months. Interviewers collect sociodemographic information and then request consent to contact the child’s vaccination providers. When consent is obtained, a survey is mailed to each provider requesting the child’s vaccination information. A synthesized, comprehensive vaccination history is created to estimate vaccination coverage.The combined 7-vaccine series includes DTaP, poliovirus, and other vaccines for preventable diseases.

bChildren’s health insurance status was reported by parent or guardian. “Other insurance” includes the Children’s Health Insurance Program, military insurance, coverage via the Indian Health Service, and any other type of health insurance not mentioned elsewhere.

cChildren’s race/ethnicity was reported by the parent or guardian. Children identified in this report as White, Black, Asian, AI/AN, NHPI, or multiple races were reported by the parent or guardian as non-Hispanic. Children identified as being of multiple races had more than one race category selected. Children identified as Hispanic might be of any race.

dMSA status was determined based on household-reported county of residence and grouped into three categories: MSA principal city, MSA nonprincipal city, and non-MSA. MSA and principal city were as defined by the U.S. Census Bureau (https://www.census.gov/programs-surveys/metro-micro.html). Non-MSA areas included urban populations not located within an MSA, as well as completely rural areas.

eDoses must be at least 24 days apart (4 weeks with a 4-day grace period); doses could have been received during two influenza seasons.

AI, American Indian; AN, Alaska Native; DTaP, Diphtheria, tetanus, and pertussis; MSA, Metropolitan Statistical Area; NHPI, Native Hawaiian or other Pacific Islander.

See how your state measures up.

Are you a health care professional in a rural community?

“A strong recommendation from a health care provider is the single most important factor in determining whether or not someone gets vaccinated.”16

Understanding the impact of SDOH on adolescents in your community and taking appropriate action can help you work toward closing the vaccination gap in your practice.

3 simple but important steps:

  • Make an effective vaccination recommendation for all appropriate adolescents.17
  • Understand that parents may have concerns and be prepared to address their questions.17
  • Ensure consistent messaging among everyone in your practice about the importance of vaccines.17
ref5

Reference

  1. Hill HA, Chen M, Elam-Evans LD, Yankey D, Singleton JA. Vaccination Coverage by age 24 months among children born during 2018-2019 – National Immunization Survey-Child, United States, 2019-2021. MMWR Morb Mortal Wkly Rep. 2023;72(2):33-38. doi:10.15585/mmwr.mm7202a3
ref7

Reference

  1. Hill HA, Chen M, Elam-Evans LD, Yankey D, Singleton JA. Vaccination coverage by age 24 months among children born in 2018 and 2019 – national immunization survey-child, United States, 2019-2021. Supplemental Tables 1-3. MMWR Morb Mortal Wkly Rep. 2023;72(2):33-38. doi:10.15585/mmwr.mm7202a3
ref8

Reference

  1. Social determinants of health at CDC. Centers for Disease Control and Prevention. Last reviewed December 8, 2022. Accessed February 26, 2023. https://www.cdc.gov/about/sdoh/index.html
ref12

Reference

  1. Hill HA, Yankey D, Elam-Evans LD, Singleton JA, Sterrett N. Vaccination coverage by age 24 months among children born in 2017 and 2018 – national immunization survey-child, United States, 2018-2020. Supplemental Tables 1-3. MMWR Morb Mortal Wkly Rep. 2021;70(41):1435-1440. doi:10.15585/mmwr.mm7041a1
ref13

Reference

  1. Murthy BP, Zell E, Kirtland K, et al. Impact of the COVID-19 pandemic on administration of selected routine childhood and adolescent vaccinations — 10 U.S. jurisdictions, March-September 2020. MMWR Morb Mortal Wkly Rep. 2021;70(23):840-845. doi:10.15585/mmwr.mm7023a2
ref14

Reference

  1. Schweiberger K, Patel SY, Mehrotra A, Ray KN. Trends in pediatric primary care visits during the coronavirus disease of 2019 pandemic. Acad Pediatr. 2021;21(8):1426-1433. doi:10.1016/j.acap.2021.04.031
ref15

Reference

  1. Gillen EM, Donthi S, Sobel, E, Fix A, Finkel M, Frazier L. Vaccination rates among Medicaid adolescents declined during pandemic. Avalere. August 18, 2021. Accessed May 23, 2023. http://avalere.com/insights/vaccination-rates- among-medicaid-adolescents-declined-during-pandemic
ref16

Reference

  1. Educate the parent and patient. Centers for Disease Control and Prevention. Last reviewed May 7, 2019. Accessed February 26, 2023. https://www.cdc.gov/vaccines/hcp/admin/educating-patients.html
ref17

Reference

  1. Vaccination in rural communities. Centers for Disease Control and Prevention. Last reviewed March 23, 2022. Accessed July 13, 2023. https://www.cdc.gov/ ruralhealth/vaccines/index.html
ref19

Reference

  1. Flu vaccination coverage, United States, 2021-22 Influenza Season. Centers for Disease Control and Prevention. Last reviewed October 18, 2022. Accessed January 19, 2023. https://www.cdc.gov/flu/fluvaxview/coverage-2022estimates.htm
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