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IntroductionKey FindingsNational InsightsOverviewAccess to Health CareImmunizationsChronic Disease PreventionInequity InsightsAccess to Health Care: Dedicated Health Care ProviderImmunizations: Pneumococcal VaccinationChronic Disease Prevention: Colorectal Cancer ScreeningState Insights: OverallState Insights: Access to Health CareState Insights: ImmunizationsState Insights: Chronic Disease PreventionAppendix 1Appendix 2Footnotes
Background
Vaccines are among the most cost-effective clinical preventive services and one of the best tools for preventing infectious diseases. Vaccinations have led to a 95% decrease in vaccine-preventable diseases (VPDs) over the last 50 years, [xv] and yet VPDs remain a major cause of US morbidity and mortality with thousands of cases of illness and deaths each year. [xvi], [xvii]
Current immunization recommendations target 14 VPDs in children and 17 across an individual’s lifespan. Immunizations prevent diseases, save lives, and save billions of dollars in health care costs. [xviii] For individuals born in 2009, the US childhood immunization program is estimated to prevent 42,000 premature deaths and 20 million cases of disease with direct cost savings of $13.5 billion. [xix]
Vaccines can provide community immunity, also known as herd immunity, to populations with high vaccination coverage. Community immunity protects people not eligible for certain vaccines including infants, pregnant women, and immunocompromised individuals. Communities with pockets of unvaccinated or under-vaccinated individuals are at increased risk for disease outbreaks.
FIGURE 4 - Immunizations National Goals
HP2020 has set national objectives regarding immunizations including the following four goals:
Findings
Immunizations were examined through four measures: Immunizations—Children, Immunizations—Adolescents, Influenza Vaccination—Adults, and Pneumococcal Vaccination—Adults 65+ (Table 3). Nationally, Tdap coverage exceeds the HP2020 goal and MCV4 coverage falls just short of the target, indicating a missed opportunity for HPV vaccination.
Looking across prevention categories, the largest geographic variation is in immunizations, with wide ranges between the states with highest and lowest vaccination coverage. State laws differ on vaccination requirements and medical or philosophical exemptions for school children. Studies have shown that exemptions tend to cluster geographically. [xx]
Looking at each immunization measure individually:
- Nationally, 71.6% of children aged 19 to 35 months are up to date with recommended childhood immunizations. This varies from 84.7% in Maine to 63.4% in West Virginia.
- HPV coverage for females aged 13 to 17 years is 39.7% nationally; it varies from 54.0% in North Carolina to 20.1% in Tennessee. HPV vaccination coverage for males aged 13 to 17 years is 21.6% nationally; it varies from 42.9% in Rhode Island to 9.0% in Alabama.
- MCV4 coverage for adolescents aged 13 to 17 years is 79.3% nationally; it varies from 95.2% in Pennsylvania to 46.0% in Mississippi.
Doctor injecting male patient in hospital
- Tdap coverage is 87.6% nationally; it varies from 94.8% in Connecticut to 70.8% in Mississippi.
- National influenza vaccination coverage for adults is 40.4% and ranges from 50.2% in South Dakota to 31.7% in Florida.
- National pneumococcal vaccination coverage for adults aged 65 years and older is 69.5%. This ranges from 75.6% in Oregon to 61.9% in New Jersey.
Figure 5 shows the national average as a diamond and how each state performs (blue dots) on immunizations examined in this report. Immunization coverage varies by vaccine type. The majority of states are clustered around the national average for childhood immunizations and adult influenza and pneumococcal vaccinations, revealing less variation between states compared with HPV and MCV4 vaccinations.
Figure 5: Immunizations: National Average and Range of State Values
Table 3: Measures: Immunizations
Footnotes
xv Shefer A, Briss P, Rodewald L, Bernier L, Strikas R, Yusuf H, et al. Improving immunization coverage rates: an evidence-based review of the literature. Epidemiol Rev. 1999;21(1):96-142.
xvi Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/E/reported-cases.pdf. 2015. Accessed January 28, 2016.
xvii Centers for Disease Control and Prevention. Estimates of Deaths Associated with Seasonal Influenza—United States, 1976–2007. MMWR. 2010;59:1057-1062.
xviii Centers for Disease Control and Prevention. Benefits from Immunization During the Vaccines for Children Program Era — United States, 1994-2013. MMWR. 2014;63(16):352-355.
xix Zhou F, Shefer A, Wenger J, Messonnier M, Wang LY, Lopez A, et al. Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009. Pediatrics. 2014;133(4):577-585