Low vaccination levels of US preschool and school-age children. Retrospective assessments of vaccination coverage, 1991-1992

JAMA. 1994 Mar 16;271(11):833-9.


Objective: To obtain estimates on (1) the percentage of children who were up-to-date on the recommended childhood vaccination series, (2) the percentage of children who were age-appropriately immunized, and (3) coverage levels by individual vaccines.

Design: Vaccination levels were estimated by conducting retrospective immunization coverage surveys of the school health records of children entering kindergarten or first grade in the 1990-1991 or 1991-1992 school year. A multistage cluster survey design was used.

Setting: Survey sites were selected from among the 60 largest urban areas in the United States. One small city and one rural area were selected for comparison.

Results: By their second birthday, 11% to 58% (median, 44%) of the children were fully vaccinated. Stricter measurement criteria lowered coverage levels further. Completed series levels at school entry were 71% to 96% (median, 87%).

Conclusions: Vaccination levels at the second birthday were far below the goal for the year 2000. All health providers need to administer vaccines according to the recommended schedule.

MeSH terms

  • Child
  • Child, Preschool
  • Cluster Analysis
  • Diphtheria-Tetanus-Pertussis Vaccine / administration & dosage
  • Drug Combinations
  • Humans
  • Immunization Schedule
  • Measles Vaccine / administration & dosage
  • Measles-Mumps-Rubella Vaccine
  • Mumps Vaccine / administration & dosage
  • Poliovirus Vaccine, Oral / administration & dosage
  • Population Surveillance*
  • Retrospective Studies
  • Rubella Vaccine / administration & dosage
  • United States / epidemiology
  • Urban Population / statistics & numerical data
  • Vaccination / standards
  • Vaccination / statistics & numerical data*


  • Diphtheria-Tetanus-Pertussis Vaccine
  • Drug Combinations
  • Measles Vaccine
  • Measles-Mumps-Rubella Vaccine
  • Mumps Vaccine
  • Poliovirus Vaccine, Oral
  • Rubella Vaccine