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Comparative Study
. 2020 Sep/Oct;135(5):640-649.
doi: 10.1177/0033354920944867. Epub 2020 Aug 12.

Trends in Childhood Influenza Vaccination Coverage, United States, 2012-2019

Tammy A Santibanez  1 , Anup Srivastav  1   2 , Yusheng Zhai  1   2 , James A Singleton  1
Affiliations
Comparative Study

Trends in Childhood Influenza Vaccination Coverage, United States, 2012-2019

Tammy A Santibanez et al. Public Health Rep. 2020 Sep/Oct.

Abstract

Objective: The objective was to compare estimates of childhood influenza vaccination across 7 consecutive influenza seasons based on 2 survey systems.

Methods: We analyzed data from the National Health Interview Survey (NHIS) and the National Immunization Survey-Flu (NIS-Flu) using Kaplan-Meier survival analysis to estimate receipt, based on parental report, of at least 1 dose of influenza vaccine among children aged 6 months to 17 years.

Results: We found no significant increasing trend in influenza vaccination coverage among children overall from 2012 to 2018 based on the NHIS or from 2012 to 2019 based on the NIS-Flu. We found 4 seasons with a significant increase in influenza vaccination coverage compared with the previous season (2012-2013 [NHIS, NIS-Flu], 2013-2014 [NIS-Flu], 2017-2018 [NHIS], and 2018-2019 [NIS-Flu]). As of the 2018-2019 season, based on NIS-Flu, influenza vaccination coverage was only 62.6%. Children with health conditions that put them at increased risk for complications from influenza had higher influenza vaccination coverage than children without these health conditions for all the seasons studied except 2014-2015. For all seasons studied, influenza vaccination coverage estimates for children were higher based on NIS-Flu data compared with NHIS data. Trends across seasons and differences in vaccination coverage between age groups were similar between the 2 surveys.

Conclusions: Influenza vaccination coverage among children appears to have plateaued. Only about half of the children in the United States were vaccinated against influenza. Improvements in measurement of influenza vaccination and development and review of strategies to increase childhood influenza vaccination coverage are needed.

Keywords: child; immunization; influenza; questionnaires; surveys; vaccination.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Influenza vaccination coverage (at least 1 dose) among children aged 6 months to 17 years, by influenza season and risk status, National Health Interview Survey (NHIS), United States, 2012-2018. Estimates were obtained by using Kaplan-Meier survival analysis. Based on Advisory Committee on Immunization Practices recommendations and the questions available in NHIS, high risk was defined as parental report of 1 or more of the following: ever being told by a physician that the child had cystic fibrosis, sickle cell anemia, diabetes, congenital heart disease, other heart conditions, cerebral palsy, muscular dystrophy, and seizures; or reporting an asthma episode or attack in the past 12 months. Error bars indicate 95% CIs. Asterisks represent significant differences (P < .05) based on comparison of high-risk with non–high-risk estimate.
Figure 2
Figure 2
Influenza vaccination coverage (at least 1 dose) among children aged 6 months to 17 years, by influenza season and age group, National Health Interview Survey (NHIS), 2012-2018, and National Immunization Survey–Flu (NIS-Flu), 2012-2019, United States. Estimates were obtained by using Kaplan-Meier survival analysis methods. Age group determined by age of child as of November 1 of the influenza season examined. Error bars indicate 95% CIs.
Figure 3
Figure 3
Influenza vaccination coverage (at least 1 dose) among children aged 6 months to 17 years, by influenza season and racial/ethnic group, National Health Interview Survey (NHIS), 2012-2018, and National Immunization Survey–Flu (NIS-Flu), 2012-2019, United States. Estimates obtained by using Kaplan-Meier survival analysis.
Figure 4
Figure 4
Percentage-point difference between parental-reported estimates of influenza vaccination coverage (at least 1 dose) among children aged 6 months to 17 years, by influenza season, age group, and race/ethnicity, in National Health Interview Survey (NHIS), 2012-2018, and National Immunization Survey–Flu (NIS-Flu), 2012-2019, United States. Differences were calculated as NIS-Flu estimate minus NHIS estimate for each year; significant differences, indicated by the dark gray bars, were determined by t tests; P < .05 was considered significant.
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