A growing number of U.S. children are not receiving all of their recommended vaccinations, according to two CDC reports released Friday.
Overall, CDC researchers found vaccinations rates among U.S. children ages 19 to 35 months and those in kindergarten remained high, but both the share of unvaccinated infants and the share of kindergarten-aged children with vaccine exemptions rose slightly.
Share of children under 24 months without vaccinations rises slightly
The first report examined vaccination rates at the national, state, and local levels among U.S. children ages 19 to 35 months using data from the 2017 National Immunization Survey-Child. The Advisory Committee on Immunization Practices recommends children receive vaccinations against 14 potentially serious illnesses by age 24 months.
CDC researchers found the percentage of children who had not received a single vaccine dose by 24 months rose slightly from 2011 to 2015. According to the report, the percentage of unvaccinated 24 month-olds increased from 0.9% for children born in 2011 to 1.3% for children born in 2015. Amanda Cohn, a pediatrician and CDC's senior adviser for vaccines, said assuming a similar proportion of children in 2016 had not received recommended vaccinations by age 24 months, approximately 100,000 children currently have not received recommended vaccines.
The report found vaccination rates for children ages 19 to 35 months were lower in rural areas when compared with non-rural areas. The researchers wrote, "The shortage of health care providers, especially pediatricians, might partially explain the lower coverage among children living in rural area."
The researchers also found children ages 19 to 35 months who were enrolled in Medicaid had lower vaccination rates than those enrolled in private health insurance. The researchers wrote, "Vaccination coverage differences by insurance status are concerning," because uninsured children and children with Medicaid are eligible for free vaccinations under the federally funded Vaccines for Children Program (VFC). They continued, "Collaboration with state immunization programs, eliminating missed immunization opportunities, and minimizing interruptions in insurance coverage are important to understand and address coverage disparities among children eligible for [VFC] and those in rural areas."
Share of kindergarten children with vaccination exemptions grows slightly
The second report summarized data from state and local immunization programs on vaccination and exemption rates for U.S. children in kindergarten.
CDC researchers found a small percentage of children entering kindergarten in 2017 had vaccination exemptions, but that percentage increased slightly from 2% for the 2016-2017 school year to 2.2% for the 2017-2018 school year. The researchers noted that "this was the third consecutive school year that a slight increase was observed."
The report did not provide a breakdown of the exemptions, but data from states show a majority of the exemptions are nonmedical, the Post reports. The researchers wrote, "Reasons for the increase cannot be determined from the data reported to CDC, but could include the ease of the procedure for obtaining exemptions … or parental vaccine hesitancy."
Saad Omer—a professor of global health, epidemiology, and pediatrics at Emory University who has conducted research on vaccine exemptions, said, "It seems that in recent years, exemptions are going up, and the trend is likely due to parents refusing to vaccinate" (Baker, "Vitals," Axios, 10/12; Sun, Washington Post, 10/11; CDC report , 10/12; CDC report , 10/12).
The case for improving coordination between behavioral health and pediatrics
The CDC estimates that nearly $247 billion is spent annually on the treatment and management of childhood mental disorders. Further, pediatric patients and caregivers often struggle to access high-quality behavioral health expertise due to a limited number of specialists and fragmented approaches to behavioral health services.
In this presentation, we review the case for improving coordination between behavioral health and pediatrics, and describe four successful models that increase access to behavioral health care.