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America's Children in Brief: Key National Indicators of Well-Being, 2016


Vaccination can prevent or lessen the severity of vaccine-preventable diseases and is regarded as one of the greatest public health achievements in the United States in the 20th century.31 For children ages 19–35 months, receipt of the combined seven-vaccine series (4:3:1:3*:3:1:4) is used to evaluate the proportion of children meeting the current vaccination guidelines. Data on vaccination coverage are used to identify groups at risk of vaccine-preventable diseases and to evaluate the effectiveness of programs designed to increase coverage. Black, non-Hispanic children generally have had lower vaccination coverage relative to their White, non-Hispanic counterparts; poverty status accounts for much of this difference in vaccination coverage.32

Figure 10: Percentage of children ages 19–35 months vaccinated with combined seven-vaccine series by race and Hispanic origin, 2009–2014
Percentage of children ages 19–35 months vaccinated with combined seven-vaccine series by race and Hispanic origin, 2009–2014

NOTE: The 4:3:1:3*:3:1:4 combined series consists of four doses (or more) of diphtheria, tetanus toxoids, and pertussis (DTP) vaccines, diphtheria and tetanus toxoids (DT), or diphtheria, tetanus toxoids, and any acellular pertussis (DTaP) vaccines; three doses (or more) of poliovirus vaccines; one dose (or more) of any measles-containing vaccine; the full series of Haemophilus influenzae type b (Hib) vaccine (three or four doses, depending on product type); three doses (or more) of hepatitis B vaccines; one dose (or more) of varicella vaccine; and four doses (or more) of pneumococcal conjugate vaccine (PCV). The recommended immunization schedule for children is available at Estimating coverage estimates for this series began in 2009. The 2009 series estimates were affected by a temporary Hib vaccine shortage and the resulting interim Advisory Committee on Immunization Practices (ACIP) recommendation to defer the Hib booster dose for healthy children during December 2007 to June 2009, a time when most children ages 19–35 months in the 2009 National Immunization Survey would have received the Hib booster dose. Persons of Hispanic origin may be of any race. Data on race and Hispanic origin are collected separately and combined for reporting according to 1997 Office of Management and Budget Standards for Data on Race and Ethnicity.

SOURCE: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases and National Center for Health Statistics, National Immunization Survey.

  • In 2014, vaccination coverage for the combined seven-vaccine series (4:3:1:3*:3:1:4) was higher for Hispanic (74 percent) and White, non-Hispanic children (73 percent) than for Black, non-Hispanic children (65 percent) ages 19–35 months.
  • Between 2009 and 2014, vaccination coverage among children ages 19–35 months receiving the combined vaccine series increased for White, non-Hispanic (from 45 to 73 percent); Black, non-Hispanic (from 40 to 65 percent); and Hispanic (from 46 to 74 percent) children.
  • During that same period, the percentage of White, non-Hispanic children ages 19–35 months receiving the combined vaccine series was higher than the percentage of Black, non-Hispanic children, except for 2010, when coverage did not differ. Vaccination coverage for the combined series between White, non-Hispanic and Hispanic children was not significantly different.

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31 U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (1999). Ten great public health achievements—United States, 1900–1999. Morbidity and Mortality Weekly Report, 48(12), 241–243. Retrieved from

32 Hill, H. A., Elam-Evans, L. D., Yankey, D., Singleton, J. A., & Kolasa, M. (2015). National, state, and selected local area vaccination coverage among children aged 19–35 months—United States, 2014. Morbidity and Mortality Weekly Report, 64(33), 889–896. Retrieved from