County-Level Trends in Vaccination Coverage Among Children 19–35
Months — United States, 1995–2008With the exception of the hepatitis A vaccine (for which estimates of county-level vaccination coverage were available for only one biennial period), significant increases in county-level estimated vaccination coverage occurred for all the individual vaccines and vaccine series from the earliest and latest biennial periods for which estimates were available. County-level increases for individual vaccines ranged from 3.6% for measles, mumps, and rubella (MMR) to 71.4% for varicella vaccine. The percentage of counties with significant increases in county-level vaccination coverage rates was greater for the more recently recommended vaccines, varicella and pneumococcal conjugate vaccine (PCV7), and for the vaccine series that included varicella vaccine and PCV7. However, significant increases in estimated county-level vaccination coverage rates occurred in a moderate number of counties for individual vaccines that were recommended before 1995. The Healthy People 2010vaccination coverage objective of 90% for individual vaccines was achieved for a majority of the 193 selected counties during the 2007–2008 biennial period for the recommended number of doses for polio, MMR, Haemophilus influenzae type B (Hib), hepatitis B, and varicella vaccines. For most vaccines and vaccine series, higher levels of county-level vaccination coverage correlated with a higher number of pediatricians per capita, a higher number of people living in group quarters per capita, higher per capita income, a higher number of Hispanics per capita, and having a service-dependent economy. Lower levels of county-level vaccination coverage correlated with higher number of persons in poverty per capita, a higher percentage of black children among children aged <5 years, higher levels of housing stress, a higher number of pediatric intensive care beds per capita, and designation as a nonmetropolitan county with an economy dependent on recreation activities.