Various Pretesting Activities (see attached list)

Morbidity and Mortality Weekly Report
www.cdc.gov/mmwr

Weekly

September 5, 2008 / Vol. 57 / No. 35

National, State, and Local Area Vaccination Coverage Among
Children Aged 19–35 Months — United States, 2007
The National Immunization Survey (NIS) provides vaccination coverage estimates among children aged 19–35 months
for each of the 50 states and selected urban areas.* This report
describes the results of the 2007 NIS, which provided coverage estimates among children born during January 2004–July
2006. Healthy People 2010 established vaccination coverage
targets of 90% for each of the vaccines included in the combined 4:3:1:3:3:1† vaccine series and a target of 80% for the
combined series (1). Findings from the 2007 NIS indicated
that >90% coverage was achieved for most of the routinely
recommended vaccines (2). The majority of parents were vaccinating their children, with less than 1% of children receiving no vaccines by age 19–35 months. The coverage level for
the 4:3:1:3:3:1 series remained steady at 77.4%, compared
with 76.9% in 2006. Among states and local areas, substantial variability continued, with estimated vaccination coverage ranging from 63.1% to 91.3%. Coverage remained high
across all racial/ethnic groups and was not significantly different among racial/ethnic groups after adjusting for poverty status. However, for some vaccines, coverage remained lower
among children living below the poverty level compared with
children living at or above the poverty level. Maintaining high
* Fourteen local areas were sampled separately for the 2007 NIS. These included
six areas that receive federal immunization grant funds and are included in the
NIS sample every year (District of Columbia; Chicago, Illinois; New York,
New York; Philadelphia County, Pennsylvania; Bexar County, Texas; and
Houston, Texas); seven previously sampled areas (Alameda County, California;
Los Angeles County, California; San Bernardino County, California; MiamiDade County, Florida; Marion County, Indiana; Dallas County, Texas; and El
Paso County, Texas); and one area sampled for the first time (western
Washington). Local areas sampled in the NIS might change yearly as state
immunization programs target local assessments where they are most needed.
† >4 doses of diphtheria, tetanus toxoid, and any acellular pertussis vaccine, which
can include diphtheria and tetanus toxoid vaccine or diphtheria, tetanus toxoid,
and pertussis vaccine (DTaP); >3 doses of poliovirus vaccine; >1 dose of measles,
mumps, and rubella vaccine; >3 doses of Haemophilus influenzae type b vaccine;
>3 doses of hepatitis B vaccine; and >1 dose of varicella vaccine).

vaccination coverage and continued attention to reducing
current poverty disparities is needed to limit the spread -preventable diseases and ensure that children are protected.
To collect vaccination information on age-eligible children
(i.e., those aged 19–35 months), NIS uses a quarterly, randomdigit–dialing sample of telephone numbers for each survey
area. When respondents grant permission to contact providers, the telephone interview is followed by a mail survey of the
children’s vaccination providers to validate immunization
information. NIS methodology, including how the responses
are weighted to represent the population of children aged 19–
35 months, has been described previously (3). During 2007,
the household response rate (4) was 64.9%; a total of 17,017
children with provider-verified vaccination records were
included in this report, representing 68.6% of all children
with completed household interviews. Statistical analyses were
conducted using t-tests. Differences were considered statistically significant at p<0.05. A poverty status variable§ was added
to the logistic regression models to control for racial/ethnic
differences among children living at or above the poverty level
and children living below the poverty level. This report
describes coverage levels for vaccines that have been included
in the routine childhood vaccination schedule recommended
by the Advisory Committee on Immunization Practices (ACIP)
since 2000 or before (2).
§ Poverty status was based on 2006 U.S. Census poverty thresholds (available at

http://www.census.gov/hhes/www/poverty.html).
INSIDE

967 Laboratory Surveillance for Wild and Vaccine-Derived
Polioviruses — Worldwide, January 2007–June 2008
970 Notices to Readers
971 QuickStats

depar
tment of health and human ser
vices
department
services
Centers for Disease Control and Prevention

962

MMWR

The MMWR series of publications is published by the Coordinating
Center for Health Information and Service, Centers for Disease
Control and Prevention (CDC), U.S. Department of Health and
Human Services, Atlanta, GA 30333.
Suggested Citation: Centers for Disease Control and Prevention.
[Article title]. MMWR 2008;57:[inclusive page numbers].
Centers for Disease Control and Prevention
Julie L. Gerberding, MD, MPH
Director
Tanja Popovic, MD, PhD
Chief Science Officer
James W. Stephens, PhD
Associate Director for Science
Steven L. Solomon, MD
Director, Coordinating Center for Health Information and Service
Jay M. Bernhardt, PhD, MPH
Director, National Center for Health Marketing
Katherine L. Daniel, PhD
Deputy Director, National Center for Health Marketing
Editorial and Production Staff
Frederic E. Shaw, MD, JD
Editor, MMWR Series
Susan F. Davis, MD
(Acting) Assistant Editor, MMWR Series
Teresa F. Rutledge
Managing Editor, MMWR Series
Douglas W. Weatherwax
Lead Technical Writer-Editor
Donald G. Meadows, MA
Jude C. Rutledge
Writers-Editors
Peter M. Jenkins
(Acting) Lead Visual Information Specialist
Malbea A. LaPete
Stephen R. Spriggs
Visual Information Specialists
Kim L. Bright, MBA
Quang M. Doan, MBA
Erica R. Shaver
Information Technology Specialists
Editorial Board
William L. Roper, MD, MPH, Chapel Hill, NC, Chairman
Virginia A. Caine, MD, Indianapolis, IN
David W. Fleming, MD, Seattle, WA
William E. Halperin, MD, DrPH, MPH, Newark, NJ
Margaret A. Hamburg, MD, Washington, DC
King K. Holmes, MD, PhD, Seattle, WA
Deborah Holtzman, PhD, Atlanta, GA
John K. Iglehart, Bethesda, MD
Dennis G. Maki, MD, Madison, WI
Sue Mallonee, MPH, Oklahoma City, OK
Patricia Quinlisk, MD, MPH, Des Moines, IA
Patrick L. Remington, MD, MPH, Madison, WI
Barbara K. Rimer, DrPH, Chapel Hill, NC
John V. Rullan, MD, MPH, San Juan, PR
William Schaffner, MD, Nashville, TN
Anne Schuchat, MD, Atlanta, GA
Dixie E. Snider, MD, MPH, Atlanta, GA
John W. Ward, MD, Atlanta, GA

September 5, 2008

In 2007, national coverage with the 4:3:1:3:3:1 series was
77.4%; this coverage has been stable since 2004. Coverage
with the combined 4:3:1:3:3:1:4 vaccine series (i.e., the
4:3:1:3:3:1 series plus >4 doses of 7-valent pneumococcal conjugate vaccine [PCV7]) is being reported for the first time
and was 66.5%. National coverage was >90% for each of the
vaccines included in the 4:3:1:3:3:1 series except for >4 doses
of DTaP (84.5%); coverage with >3 doses of DTaP was 95.5%
(Table 1). Coverage with >1 dose of varicella vaccine (VAR)
reached 90% for the first time. VAR coverage among American Indian/Alaska Native (AI/AN)¶ children increased significantly, from 85.4% in 2006 to 94.9% in 2007. National
vaccination coverage estimates for PCV7 continued to increase,
from 86.9% in 2006 to 90.0% in 2007 for >3 doses and from
68.4% to 75.3% for >4 doses. Among AI/AN children, coverage with the fourth dose of PCV7 increased significantly,
from 62.7% to 80.4%.
Substantial differences were observed in vaccination coverage among states and local areas (Table 2). Estimated coverage for the 4:3:1:3:3:1 series ranged from 91.3% in Maryland
to 63.1% in Nevada. Among the 14 local areas included in
the 2007 NIS, coverage with the 4:3:1:3:3:1 series ranged from
82.2% in Philadelphia, Pennsylvania, to 69.6% in San Bernardino, California.
Vaccination coverage levels were higher among AI/ANs compared with whites for measles, mumps, and rubella (MMR)
vaccine, hepatitis B (HepB) vaccine, and VAR (Table 3). Coverage with the fourth dose of DTaP and the fourth dose of
PCV7 among black children was not significantly lower than
white children after controlling for poverty status. Vaccination coverage with the fourth dose of DTaP and the fourth
dose of PCV7 was lower among children living below the
poverty level compared with children living at or above the
poverty level, but this difference declined from 6.1% in 2006
to 4.8% in 2007 for >4 doses of DTaP and from 9.4% in
2006 to 3.5% in 2007 for >4 doses of PCV7. Vaccination
coverage levels were similar across all racial/ethnic groups for
the 4:3:1:3:3:1 series. Coverage differed for this series among
children living at or above the poverty level compared with
children living below the poverty level, but this difference
declined from 4.9% in 2006 to 3.2% in 2007. Coverage
between white and black children with the 4:3:1:3:3:1:4
series was not significantly different after controlling for
poverty status.
¶ For

this report, persons identified as white, black, Asian, or American Indian/
Alaska Native are all non-Hispanic. Persons identified as Hispanic might be of
any race.

Vol. 57 / No. 35

MMWR

963

TABLE 1. Estimated vaccination coverage among children aged 19–35 months, by selected vaccines and dosages — National
Immunization Survey, United States, 2003–2007
2004†

2003*
Vaccine

%

(95% CI††)

%

2005§

(95% CI)

%

(95% CI)

2006¶
%

(95% CI)

2007**
%

(95% CI)

DTP/DT/DTaP§§
≥3 doses
96.0
(±0.5)
95.9
(±0.5)
96.1
(±0.5)
95.8
(±0.5)
95.5
(±0.5)
≥4 doses
84.8
(±0.8)
85.5
(±0.8)
85.7
(±0.9)
85.2
(±0.9)
84.5
(±0.9)
Poliovirus
91.6
(±0.7)
91.6
(±0.7)
91.7
(±0.7)
92.8
(±0.6)
92.6
(±0.7)
93.0
(±0.6)
93.0
(±0.6)
91.5
(±0.7)
92.3
(±0.6)
92.3
(±0.7)
MMR¶¶ ≥1 dose
Hib*** ≥3 doses
93.9
(±0.6)
93.5
(±0.6)
93.9
(±0.6)
93.4
(±0.6)
92.6
(±0.7)
Hepatitis B ≥3 doses
92.4
(±0.6)
92.4
(±0.6)
92.9
(±0.6)
93.3
(±0.6)
92.7
(±0.7)
Varicella ≥1 dose
84.8
(±0.8)
87.5
(±0.7)
87.9
(±0.8)
89.2
(±0.7)
90.0
(±0.7)
†††
PCV7
≥3 doses
68.1
(±1.0)
73.2
(±1.0)
82.8
(±1.0)
86.9
(±0.8)
90.0
(±0.8)
≥4 doses
35.8
(±1.0)
43.4
(±1.1)
53.7
(±1.3)
68.4
(±1.1)
75.3
(±1.2)
Combined series
82.2
(±0.9)
83.5
(±0.9)
83.1
(±1.0)
83.1
(±0.9)
82.8
(±1.0)
4:3:1§§§
4:3:1:3¶¶¶
81.3
(±0.9)
82.5
(±0.9)
82.4
(±1.0)
82.1
(±1.0)
81.8
(±1.0)
****
4:3:1:3:3
79.4
(±0.9)
80.9
(±0.9)
80.8
(±1.0)
80.5
(±1.0)
80.1
(±1.0)
††††
4:3:1:3:3:1
72.5
(±1.0)
76.0
(±1.0)
76.1
(±1.1)
76.9
(±1.0)
77.4
(±1.1)
4:3:1:3:3:1:4§§§§
30.8
(±1.0)
38.4
(±1.1)
47.2
(±1.3)
60.1
(±1.2)
66.5
(±1.3)
Children who received no vaccinations
0.4
(±0.1)
0.4
(±0.2)
0.4
(±0.1)
0.4
(±0.1)
0.6
(±0.2)
* Born during January 2000–July 2002.
† Born during January 2001–July 2003.
§ Born during February 2002–July 2004.
¶ Born during January 2003–June 2005 (2006 estimates based on National Immunization Survey dataset, which was rereleased on February 25, 2008, after correcting for
Hispanic overcount in nine states).
** Born during January 2004–July 2006.
†† Confidence interval.
§§ Diphtheria, tetanus toxoids and pertussis vaccines, diphtheria and tetanus toxoids, and diphtheria, tetanus toxoids, and any acellular pertussis vaccine.
¶¶ Measles, mumps, and rubella vaccine.
*** Haemophilus influenzae type b (Hib) vaccine.
††† 7-valent pneumococcal conjugate vaccine (PCV7).
§§§ ≥4 doses of DTaP, ≥3 doses of poliovirus vaccine, and ≥1 dose of any measles-containing vaccine.
¶¶¶ 4:3:1 plus ≥3 doses of Hib vaccine.
**** 4:3:1:3 plus ≥3 doses of hepatitis B vaccine.
†††† 4:3:1:3:3 plus ≥1 dose of varicella vaccine.
§§§§ 4:3:1:3:3:1: plus ≥4 doses of PCV7.

Reported by: N Darling, MPH, M Kolasa, MPH, KG Wooten, MA,
Immunization Svcs Div, National Center for Immunization and
Respiratory Diseases, CDC.

Editorial Note: NIS is the only population-based, providerverified survey to provide national, state, and local area estimates of vaccination coverage among children aged 19–35
months. The results of the 2007 survey indicate that vaccination coverage for vaccines recommended routinely by ACIP
since 2000 and before (2) reached record high levels. Improvements in vaccination coverage for VAR meant that national
coverage estimates for all individual vaccines in the 4:3:1:3:3:1
series were >90%, except coverage with >4 doses of DTaP.
Coverage with >4 doses of PCV7 also was <90%. However,
3-dose coverage for both DTaP and PCV7 remained high.
Coverage with >4 doses of PCV7 increased significantly to
75.3% in 2007, a substantial increase since PCV7 was first
recommended in 2000 (5). However, coverage with >4 doses
of DTaP has not changed during the past 5 years. Increasing
coverage for the fourth dose of DTaP and the fourth dose of
PCV7 would improve national coverage for the 4:3:1:3:3:1
series and the 4:3:1:3:3:1:4 series, which will be used to monitor the Healthy People 2010 immunization objectives begin-

ning with 2009 NIS data. The vaccine shortage that ended in
September 2004 (6) might have reduced coverage with the
fourth dose of PCV7 among children in the 2007 NIS cohort
(i.e., those born during January 2004–July 2006). Use of
effective interventions, such as parent and provider reminder/
recall, reducing out-of-pocket costs, increasing access to vaccination, and multicomponent interventions that include education might further improve overall coverage in areas where
coverage is low (7). In addition, closing the coverage gap
between areas with the highest and lowest coverage remains a
priority. To achieve this, further collaborative efforts among
CDC, state immunization coordinators, immunization
programs, and other entities are essential.
Vaccination coverage among AI/AN children for VAR,
MMR vaccine, and the fourth dose of PCV7 increased significantly in 2007 compared with 2006; in 2007, coverage
levels among AI/AN children were higher for two of these
vaccines (VAR and MMR vaccine) compared with white children. Improved exchange of data between the Indian Health
Service information system and state immunization information systems and implementation of evidence-based strategies
such as reminder/recall at Indian Health Service and tribal

964

MMWR

September 5, 2008

TABLE 2. Estimated vaccination coverage for the 4:3:1:3:3:1* and 4:3:1:3:3:1:4† vaccination series and selected individual vaccines
among children aged 19–35 months, by state and selected local areas — National Immunization Survey, United States, 2007§
≥4 DTaP¶
State/Area

%

(95% CI¶¶)

≥1 MMR**
%

(95% CI)

≥1 VAR††
%

(95% CI)

≥4 PCV7§§
%

(95% CI)

4:3:1:3:3:1

4:3:1:3:3:1:4

%

%

(95% CI)

(95% CI)

United States
84.5
(±0.9)
92.3
(±0.7)
90.0 (±0.7)
75.3
(±1.2)
77.4
(±1.1)
66.5
(±1.3)
Alabama
85.4
(±5.2)
95.0
(±2.8)
92.0 (±4.5)
79.6
(±5.7)
78.2
(±6.3)
67.3
(±7.0)
Alaska
81.7
(±5.6)
89.7
(±4.1)
80.5 (±6.0)
80.9
(±6.0)
70.1
(±6.8)
64.4
(±7.3)
Arizona
85.4
(±5.7)
89.0
(±4.8)
86.0 (±5.4)
76.8
(±6.6)
75.2
(±6.7)
66.1
(±7.3)
Arkansas
78.8
(±5.8)
92.5
(±3.1)
89.2 (±4.2)
65.4
(±6.4)
72.3
(±6.2)
57.4
(±6.5)
California
84.9
(±4.0)
94.6
(±2.4)
93.2 (±2.6)
78.8
(±4.8)
77.1
(±4.7)
67.7
(±5.4)
Alameda County
83.1
(±5.4)
91.6
(±4.4)
89.6 (±4.5)
80.7
(±5.7)
76.3
(±5.8)
69.4
(±6.2)
Los Angeles County
84.0
(±5.3)
95.8
(±2.8)
93.9 (±3.3)
74.8
(±6.2)
78.0
(±5.9)
65.0
(±6.7)
San Bernardino County
74.8
(±6.2)
90.3
(±4.3)
89.8 (±4.4)
68.6
(±6.4)
69.6
(±6.5)
57.5
(±6.8)
Rest of state
86.4
(±5.8)
94.7
(±3.5)
93.5 (±3.8)
81.3
(±7.1)
77.4
(±7.0)
69.7
(±8.1)
Colorado
82.1
(±7.0)
91.2
(±4.5)
88.9 (±5.9)
70.7
(±8.7)
78.0
(±7.8)
64.3
(±9.1)
Connecticut
91.1
(±4.4)
95.3
(±2.8)
94.2 (±3.3)
88.8
(±4.9)
86.8
(±5.0)
81.2
(±5.9)
Delaware
86.9
(±4.5)
94.8
(±3.3)
92.1 (±3.8)
77.3
(±6.2)
80.3
(±5.7)
68.6
(±6.7)
District of Columbia
85.1
(±5.6)
95.2
(±3.3)
94.0 (±3.5)
77.5
(±6.2)
81.6
(±5.9)
71.0
(±6.7)
Florida
85.0
(±5.2)
92.3
(±4.1)
90.2 (±4.4)
66.1
(±6.7)
80.3
(±5.5)
61.8
(±6.8)
Miami-Dade County
86.0
(±5.0)
95.4
(±3.0)
90.8 (±4.5)
61.2
(±7.3)
76.1
(±6.3)
53.8
(±7.4)
Rest of state
84.9
(±6.0)
91.8
(±4.8)
90.1 (±5.1)
67.0
(±7.8)
81.0
(±6.4)
63.2
(±7.9)
Georgia
85.5
(±5.2)
91.4
(±4.2)
91.6 (±4.1)
75.5
(±6.7)
79.6
(±6.0)
65.9
(±7.2)
Hawaii
90.6
(±3.8)
93.8
(±3.7)
95.5 (±2.6)
80.7
(±5.8)
87.5
(±4.5)
77.4
(±6.1)
Idaho
77.2
(±6.3)
86.1
(±5.2)
75.5 (±6.4)
66.6
(±7.2)
65.6
(±7.2)
52.9
(±7.6)
Illinois
81.6
(±4.2)
93.1
(±2.7)
88.7 (±3.4)
76.0
(±4.5)
73.5
(±4.8)
65.8
(±5.0)
City of Chicago
78.2
(±6.4)
89.5
(±4.7)
88.8 (±4.2)
69.0
(±6.7)
71.0
(±6.7)
60.6
(±6.8)
Rest of state
82.7
(±5.2)
94.4
(±3.2)
88.7 (±4.4)
78.5
(±5.6)
74.4
(±6.0)
67.6
(±6.3)
Indiana
80.3
(±4.4)
90.4
(±3.3)
88.3 (±3.5)
70.4
(±5.2)
74.0
(±4.6)
61.8
(±5.3)
Marion County
80.8
(±5.2)
87.5
(±4.6)
86.0 (±4.6)
75.0
(±5.7)
71.4
(±5.9)
63.2
(±6.3)
Rest of state
80.2
(±5.2)
91.0
(±3.9)
88.8 (±4.2)
69.4
(±6.1)
74.5
(±5.4)
61.5
(±6.3)
Iowa
83.0
(±5.9)
93.0
(±3.8)
88.2 (±4.6)
72.3
(±6.6)
75.9
(±6.3)
64.2
(±6.9)
Kansas
87.0
(±4.9)
93.1
(±3.5)
88.7 (±4.1)
75.0
(±6.2)
76.0
(±6.0)
64.8
(±6.8)
Kentucky
85.2
(±5.8)
90.8
(±4.6)
87.9 (±5.1)
69.7
(±6.5)
78.2
(±6.2)
63.3
(±6.7)
Louisiana
80.1
(±5.9)
92.9
(±3.4)
91.5 (±3.7)
76.0
(±6.0)
77.0
(±6.1)
66.9
(±6.9)
Maine
86.7
(±5.4)
90.2
(±4.8)
85.5 (±5.3)
82.5
(±5.6)
72.9
(±6.9)
67.0
(±7.2)
Maryland
94.8
(±2.4)
97.1
(±2.0)
96.8 (±1.9)
84.4
(±5.9)
91.3
(±3.1)
79.9
(±6.2)
Massachusetts
90.0
(±5.0)
93.3
(±4.6)
87.4 (±5.6)
85.1
(±6.3)
77.9
(±7.3)
76.0
(±7.4)
Michigan
84.3
(±6.1)
89.5
(±5.3)
89.5 (±5.3)
71.1
(±7.4)
78.8
(±6.7)
66.9
(±7.5)
Minnesota
88.9
(±4.7)
94.9
(±2.8)
89.1 (±4.7)
82.1
(±6.2)
80.5
(±6.1)
72.8
(±6.9)
Mississippi
81.0
(±6.8)
87.2
(±5.8)
88.4 (±5.6)
65.8
(±7.8)
77.1
(±7.0)
61.2
(±7.9)
Missouri
80.6
(±6.5)
89.0
(±5.2)
89.4 (±5.0)
73.7
(±7.0)
76.1
(±6.9)
64.7
(±7.5)
Montana
79.1
(±5.8)
89.6
(±4.0)
78.5 (±5.8)
70.7
(±6.7)
65.3
(±6.9)
58.0
(±7.0)
Nebraska
87.8
(±5.3)
94.0
(±3.7)
93.8 (±3.8)
80.5
(±6.5)
82.9
(±6.0)
74.4
(±7.1)
Nevada
71.4
(±7.3)
86.3
(±4.9)
83.3 (±5.5)
61.7
(±7.5)
63.1
(±7.6)
50.7
(±7.5)
New Hampshire
94.4
(±3.5)
96.6
(±2.6)
95.2 (±3.1)
87.3
(±5.3)
90.6
(±4.3)
80.5
(±6.2)
New Jersey
85.3
(±5.9)
91.2
(±5.5)
92.5 (±4.8)
69.3
(±7.8)
80.5
(±6.4)
62.3
(±7.9)
New Mexico
81.6
(±7.0)
90.6
(±3.6)
88.8 (±3.9)
72.0
(±7.6)
76.0
(±7.2)
65.4
(±7.7)
New York
88.9
(±2.9)
93.6
(±2.1)
88.4 (±3.2)
75.1
(±4.5)
77.8
(±4.1)
65.2
(±4.9)
City of New York
84.7
(±4.5)
91.9
(±3.2)
89.0 (±3.9)
73.4
(±5.4)
76.3
(±5.3)
64.4
(±6.0)
Rest of state
92.8
(±3.8)
95.2
(±2.6)
87.8 (±5.1)
76.7
(±7.2)
79.1
(±6.3)
65.9
(±7.6)
North Carolina
85.8
(±5.0)
96.9
(±2.0)
93.3 (±4.1)
81.7
(±5.6)
77.3
(±6.5)
70.1
(±7.0)
North Dakota
85.5
(±4.9)
95.2
(±2.9)
91.5 (±3.8)
81.4
(±5.5)
77.2
(±5.7)
68.9
(±6.3)
Ohio
86.6
(±4.9)
90.7
(±3.7)
89.1 (±4.1)
74.7
(±6.0)
77.7
(±5.8)
64.5
(±6.5)
Oklahoma
82.7
(±6.0)
89.9
(±5.0)
89.7 (±5.0)
58.3
(±7.8)
78.5
(±6.3)
53.3
(±7.7)
Oregon
77.8
(±7.3)
88.9
(±5.3)
84.2 (±6.3)
70.1
(±7.5)
70.5
(±7.6)
62.7
(±7.8)
Pennsylvania
86.4
(±3.6)
93.8
(±2.5)
91.9 (±2.8)
79.1
(±4.4)
78.8
(±4.3)
68.3
(±4.9)
Philadelphia County
88.3
(±5.4)
92.2
(±4.5)
91.8 (±4.4)
81.2
(±6.5)
82.2
(±6.2)
73.0
(±7.3)
Rest of state
86.0
(±4.2)
94.1
(±2.8)
92.0 (±3.2)
78.8
(±5.1)
78.2
(±4.9)
67.5
(±5.7)
Rhode Island
84.9
(±6.1)
94.7
(±3.9)
92.1 (±4.1)
90.7
(±4.4)
75.0
(±7.0)
69.2
(±7.4)
South Carolina
84.2
(±4.5)
92.5
(±3.2)
91.5 (±3.3)
80.8
(±4.8)
79.5
(±5.0)
74.9
(±5.3)
South Dakota
88.7
(±4.5)
95.0
(±2.4)
85.3 (±5.2)
54.3
(±7.4)
76.9
(±6.1)
45.8
(±7.4)
* Includes ≥4 doses of diphtheria, tetanus toxoid, and any acellular pertussis vaccine (DTaP) (also can include diphtheria and tetanus toxoid vaccine or diphtheria, tetanus toxoid,
and pertussis vaccine); ≥3 doses of poliovirus vaccine; ≥1 dose of any measles-containing vaccine; ≥3 doses of Haemophilus influenzae type b vaccine; ≥3 doses of hepatitis B
vaccine; and ≥1 dose of varicella vaccine.
† 4:3:1:3:3:1 plus ≥4 doses of 7-valent pneumococcal conjugate vaccine (PCV7).
§ Children in the 2007 National Immunization Survey were born during January 2004–July 2006.
¶ ≥4 doses of DTaP.
** ≥1 dose of measles, mumps, and rubella vaccine.
†† ≥1 dose of varicella vaccine at or after child’s first birthday.
§§ ≥3 doses of PCV7.
¶¶ Confidence interval.

Vol. 57 / No. 35

MMWR

965

TABLE 2. (Continued) Estimated vaccination coverage for the 4:3:1:3:3:1* and 4:3:1:3:3:1:4† vaccination series and selected
individual vaccines among children aged 19–35 months, by state and selected local areas — National Immunization Survey,
United States, 2007§
≥4 DTaP¶

≥1 VAR††

≥1 MMR**

State/Area

%

(95% CI¶¶)

%

(95% CI)

Tennessee
Texas
Bexar County
City of Houston
Dallas County
El Paso County
Rest of state
Utah
Vermont
Virginia
Washington
Western Washington
Rest of state
West Virginia
Wisconsin
Wyoming

84.8
82.1
85.5
77.9
77.0
81.8
83.4
82.2
81.9
84.1
80.9
88.1
79.3
84.5
82.0
78.7

(±6.0)
(±3.5)
(±4.8)
(±5.6)
(±6.0)
(±5.7)
(±5.1)
(±5.3)
(±7.5)
(±4.8)
(±5.4)
(±4.8)
(±6.4)
(±4.9)
(±6.1)
(±6.1)

94.5
90.4
90.9
89.4
89.9
90.3
90.6
90.9
93.6
90.9
90.5
91.9
90.2
96.2
91.4
87.5

(±4.3)
(±2.6)
(±3.9)
(±3.8)
(±4.1)
(±4.8)
(±3.8)
(±4.0)
(±5.2)
(±3.8)
(±3.9)
(±3.9)
(±4.6)
(±2.1)
(±4.6)
(±5.2)

%
92.3
90.0
88.8
89.6
90.0
91.1
90.2
86.6
77.6
87.8
84.0
80.8
84.8
89.2
86.7
78.5

≥4 PCV7§§

4:3:1:3:3:1

(95% CI)

%

(95% CI)

%

(95% CI)

(±4.7)
(±2.6)
(±4.3)
(±3.8)
(±4.1)
(±4.7)
(±3.8)
(±4.8)
(±7.8)
(±4.5)
(±4.9)
(±5.9)
(±5.8)
(±3.8)
(±5.4)
(±6.3)

72.6
75.7
79.1
71.6
70.8
69.3
77.4
70.7
84.2
79.1
73.8
82.3
71.9
75.8
78.7
68.0

(±7.5)
(±4.0)
(±5.5)
(±5.9)
(±6.3)
(±6.9)
(±5.8)
(±6.4)
(±7.0)
(±5.1)
(±6.0)
(±5.8)
(±7.2)
(±5.7)
(±6.5)
(±6.7)

78.7
77.3
80.1
73.0
71.9
77.4
78.7
73.6
67.3
75.5
69.0
71.3
68.4
75.5
77.1
70.2

(±6.7)
(±3.8)
(±5.3)
(±5.7)
(±6.2)
(±6.2)
(±5.6)
(±6.1)
(±8.3)
(±5.7)
(±6.1)
(±6.7)
(±7.3)
(±5.6)
(±6.6)
(±6.8)

4:3:1:3:3:1:4
%

(95% CI)

64.3
68.5
74.0
64.1
61.0
63.1
70.4
61.4
62.7
67.9
64.6
66.8
64.1
64.9
69.6
58.7

(±7.7)
(±4.4)
(±5.8)
(±6.2)
(±6.8)
(±7.1)
(±6.4)
(±6.8)
(±8.5)
(±6.1)
(±6.2)
(±7.0)
(±7.4)
(±6.2)
(±7.2)
(±7.1)

TABLE 3. Estimated vaccination coverage among children aged 19–35 months, by selected vaccines and dosages, race/ethnicity,*
and poverty level† — National Immunization Survey, United States, 2007§
White
Vaccine

%

(95% CI¶)

Black
%

(95% CI)

Hispanic
%

(95% CI)

American
Indian/
Alaska Native
%

(95% CI)

Asian
%

(95% CI)

Below
poverty level
%

(95% CI)

At or above
poverty level
%

(95% CI)

DTaP**
≥3 doses
95.5 (±0.7)
93.9 (±1.8)
96.1 (±1.1)
97.3 (±2.9)
96.4 (±2.4)
94.1 (±1.2)
96.0
(±0.6)
≥4 doses
85.3 (±1.2)
82.3 (±2.7)
83.8 (±2.2)
86.4 (±7.1)
87.5 (±4.0)
81.1 (±2.1)
85.9
(±1.1)
Poliovirus
92.6 (±0.9)
91.1 (±2.1)
93.0 (±1.6)
94.8 (±5.5)
95.0 (±2.6)
91.9 (±1.3)
92.8
(±0.9)
MMR†† ≥1 dose
92.1 (±0.8)
91.5 (±2.0)
92.6 (±1.6)
96.2 (±3.2)
93.9 (±3.5)
91.3 (±1.4)
92.6
(±0.8)
Hib§§ ≥3 doses
92.9 (±0.9)
90.8 (±2.2)
93.5 (±1.4)
95.0 (±4.1)
91.0 (±3.4)
91.0 (±1.5)
93.1
(±0.8)
Hepatitis B ≥3 doses
92.5 (±0.9)
91.2 (±2.1)
93.6 (±1.6)
96.7 (±3.0)
93.8 (±2.9)
92.1 (±1.4)
92.9
(±0.9)
Varicella ≥1 dose
89.2 (±1.0)
89.8 (±2.2)
90.6 (±1.7)
94.9 (±3.5)
93.7 (±2.9)
89.2 (±1.6)
90.1
(±0.9)
PCV7¶¶
≥3 doses
89.8 (±0.9)
89.5 (±2.2)
91.0 (±1.7)
94.0 (±4.3)
86.8 (±4.7)
89.0 (±1.6)
90.3
(±0.9)
≥4 doses
76.6 (±1.4)
70.3 (±3.4)
75.4 (±2.6)
80.4 (±7.1)
75.0 (±5.9)
72.8 (±2.4)
76.3
(±1.4)
Combined series
4:3:1:3***
82.6 (±1.2)
79.5 (±2.9)
81.5 (±2.3)
85.3 (±7.2)
81.9 (±5.1)
78.8 (±2.2)
82.9
(±1.2)
4:3:1:3:3†††
81.0 (±1.3)
77.5 (±3.1)
79.8 (±2.4)
85.1 (±7.3)
80.7 (±5.2)
76.9 (±2.3)
81.4
(±1.2)
4:3:1:3:3:1§§§
77.5 (±1.3)
75.3 (±3.2)
78.0 (±2.5)
82.7 (±7.5)
79.4 (±5.3)
75.0 (±2.3)
78.2
(±1.3)
4:3:1:3:3:1:4¶¶¶
67.0 (±1.6)
62.0 (±3.6)
67.0 (±2.8)
74.6 (±8.4)
68.6 (±6.5)
64.7 (±2.7)
66.9
(±1.5)
* Persons identified as white, black, Asian, or American Indian/Alaska Native are all non-Hispanic. Persons identified as Hispanic might be of any race. Native Hawaiian or other
Pacific Islanders and multiple races were not included because of small sample sizes.
† Poverty status was based on 2006 U.S. Census poverty thresholds (available at http://www.census.gov/hhes/www/poverty.html).
§ Children in the 2007 National Immunization Survey were born during January 2004–July 2006.
¶ Confidence interval.
** Diphtheria, tetanus toxoid, and any acellular pertussis vaccine, which can include diphtheria and tetanus toxoid vaccine or diphtheria, tetanus toxoid, and pertussis vaccine.
†† Measles, mumps, and rubella vaccine.
§§ Haemophilus influenzae type b (Hib) vaccine.
¶¶ 7-valent pneumococcal conjugate vaccine (PCV7).
***≥4 doses of DTP/DT/DTaP, ≥3 doses of poliovirus vaccine, and ≥1 dose of any measles-containing vaccine, and ≥3 doses of Hib vaccine.
†††4:3:1:3 plus ≥3 doses of hepatitis B vaccine.
§§§4:3:1:3:3 plus ≥1 dose of varicella vaccine.
¶¶¶4:3:1:3:3:1 plus ≥4 doses of PCV7.

966

MMWR

facilities, might have contributed to these increases in vaccination coverage (A. Groom, CDC, personal communication,
August 2008). However, further monitoring is needed to
determine whether these levels will be sustained.
As in 2006, the results of the 2007 NIS indicate that differences in poverty status accounted for the observed differences
in coverage between white and black children for the fourth
dose of DTaP and fourth dose of PCV7. In 2007, these differences in coverage between children living at or above the poverty level compared with children living below the poverty level
were reduced by one percentage point for DTaP and by nearly
six percentage points for PCV7. Continued efforts are needed
to improve vaccination coverage among children of all racial
and ethnic groups living below the poverty level.
The 2007 NIS results confirm that the majority of parents
are vaccinating their children, with less than 1% of children
receiving no vaccines by age 19–35 months. Although vaccination coverage in this age group remains high, recent outbreaks of measles have occurred in certain communities (8).
Several factors might explain this apparent paradox. Despite
record high coverage with MMR vaccine, nearly 8% of children aged 19–35 months surveyed for the 2007 NIS remained
unvaccinated. Measles is highly contagious, and clustering of
unimmunized children within geographic areas can increase
risk for measles and other vaccine-preventable disease transmission. Clusters of unimmunized children might not be
detected by NIS methods and might not be visible in national
and state rates. Furthermore, any changes in vaccination
behaviors among parents of children born after July 2006
would not have been detected by the 2007 survey.
Increased attention to parental concerns about vaccine safety
has become apparent in recent years (9). The 2008 NIS is
collecting information on parental concerns about vaccine
safety to better assess parental attitudes and beliefs about vaccines. In addition, CDC and its partners are developing new
educational materials that can assist parents in making fully
informed decisions about immunizing their children.**
The findings in this report are subject to at least three limitations. First, NIS is a telephone survey, and statistical adjustments might not compensate fully for nonresponse and
households without landline telephones. Second, underestimates
of vaccination coverage might have resulted from the exclusive
use of provider-verified vaccination histories because completeness of these records is unknown. Finally, although national
** Additional information available at http://www.cdc.gov/vaccines.

September 5, 2008

coverage estimates are precise, annual estimates and trends for
state and local areas should be interpreted with caution because
of smaller sample sizes and wider confidence intervals.
Achieving and maintaining high vaccination coverage
levels is important to further reduce the burden of vaccinepreventable diseases and prevent a resurgence of measles and
other diseases that have been eliminated in the United States
(10). Although vaccination coverage estimates were at record
highs and above the Healthy People 2010 target for most of
the routinely recommended vaccines in 2007, ongoing efforts
through partnerships among national, state, local, private, and
public entities are needed to sustain these levels and ensure
that vaccination programs in the United States remain strong.
Acknowledgments

The findings in this report are based, in part, on contributions
by PJ Smith, PhD, Immunization Svcs Div, and BP Bell, MD,
Office of the Director, National Center for Immunization and
Respiratory Diseases, CDC.
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