On kidsdata.org, immunizations are measured by the estimated number and percentage of kindergarteners who received all required immunizations by the time they started school. In California, children receive five different vaccines, many with multiple doses, between birth and kindergarten (see Footnote below tables/graphs for details). When children enter school, proof of immunizations is required.

Immunizations are among the most successful and cost-effective preventive health care interventions, helping millions of children in the U.S. and internationally avoid contracting numerous serious and potentially fatal infectious diseases (1). Current immunization schedules recommend that children and adolescents should be immunized to protect against 16 diseases. These include: polio; diphtheria, tetanus, and whooping cough; measles, mumps, and rubella; chickenpox; hepatitis A and B; the flu; haemophilus influenzae type b; pneumococcal and meningococcal diseases; rotavirus; and cervical cancer due to papillomavirus (2). Immunizations are important for the protection of the individual child as well as for public health; all of these diseases are contagious and most are spread through air or direct contact (3). For each birth cohort that is vaccinated in a timely manner, it is estimated that 33,000 lives are saved, nationwide, and that direct health care costs to society are reduced by $9.9 billion (1).

While the data on kidsdata.org reflect the estimated number and percentage of kindergarteners who received all required immunizations by the time they started school, a child is considered to have been fully immunized on time only if all immunizations were received by age 3 (4).

For more information on immunizations, please see kidsdata.org’s Research & Links Section.

Sources for this narrative:

1. U. S. Department of Health and Human Services, Healthy People 2020. (2011). Immunizations and infectious diseases. Retrieved from: http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicId=23.
2. U. S. Department of Health and Human Services, Centers for Disease Control and Prevention, Vaccines & Immunizations. (2010). Parent’s guide to childhood immunizations. Retrieved from: http://www.cdc.gov/vaccines/pubs/parents-guide/default.htm.
3. U. S. Department of Health and Human Services, Centers for Disease Control and Prevention, Vaccines & Immunizations. (2011). Parent version of 2011 recommended immunizations for children from birth through 6 years old. Retrieved from: http://www.cdc.gov/vaccines/schedules/index.html
4. Centers for Disease Control and Prevention. (2010). National, state, and local area vaccination coverage among children aged 19-35 months—United States, 2009. Morbidity and Mortality Weekly Report, 59(36) 1171-1177. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5936a2.htm?s_cid=mm5936a2_w

State policy currently requires proof of recommended immunizations as a condition of entry into kindergarten and licensed child care, which means that immunization rates are relatively high for children in licensed child care settings – or by the time children enter kindergarten. But infants and toddlers, who are particularly vulnerable to communicable diseases, have lower vaccination rates (1), even though a battery of immunizations is recommended by age 2. Teens also may fail to receive needed booster vaccinations or “catch-up” vaccinations that they have missed (2), and new state law requires proof of a pertussis booster for students in 7-12th grade. State policy can improve immunization rates for the youngest children by helping to ensure that they see a doctor; that their parents understand the importance of timely vaccinations; and that affordable vaccination resources are available (3, 4).

According to research and subject experts, policy and program options that could improve immunization rates include:

• Providing affordable health insurance coverage to all children that reduces the out-of-pocket costs of immunizations (3), and ensuring that children have a “medical home” (4, 5)
• Supporting public education about the importance of timely immunization, along with other interventions, such as reminder systems (3, 4); educational materials should be culturally appropriate and presented in a way parents can understand (6)
• Ensuring more universal use of immunization registry systems, which are confidential, computerized systems that contain children's vaccination histories within a geographic area, and advancing communication among registries (3)
• Exploring additional options for reaching adolescents who need to complete recommended courses of vaccination (2)
• Minimizing barriers that restrict access to vaccinations, such as cost, clinic accessibility, and vaccine availability (6)

For more policy ideas about immunizations, visit kidsdata.org's Research & Links section on this page, the California Immunization Coalition or Shots for School. Also see Policy Implications under the Health Care topic on kidsdata.org.

Sources for this narrative:

1. California HealthCare Foundation. (2010). Quality of care facts and figures. California Health Care Almanac. Retrieved from: http://www.chcf.org/chart-cart/presentations/quality-care-settings
2. Morbidity and Mortality Weekly Report. (2010). National, state, and local area vaccination coverage among adolescents aged 13-17 years --- United States, 2009. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5932a3.htm
3. Kroger, A.T. et al. (2011). General recommendations on immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6002a1.htm?s_cid=rr6002a1_e
4. National Vaccines Advisory Committee. (2003). Standards for child and adolescent immunization practices. Pediatrics, 112(4), 958-963. Retrieved from: http://pediatrics.aappublications.org/cgi/reprint/112/4/958.pdf
5. Allred, N. J., et al. (2007). The association of health insurance and continuous primary care in the medical home on vaccination coverage for 19- to 35-month-old children. Pediatrics, 119(1), S4-11. Retrieved from: http://pediatrics.aappublications.org/cgi/reprint/119/Supplement_1/S4
6. Kimmel, S. R., et al. (2007). Addressing immunization barriers, benefits, and risks. Journal of Family Practice, 56(2), S61-69. Retrieved from: http://www.jfponline.com/uploadedFiles%2FJournal_Site_Files%2FJournal_of_Family_Practice%2Fsupplement_archive%2FJFPSupp_Vaccines07_0207.pdf

The California School Immunization Law requires that children receive certain immunizations before entering school. According to 2011 estimates, about 9 out of 10 California kindergartners (91.0%) received all state-required immunizations by the time they entered school, similar to previous years. Across counties with available data, the percentage ranged from 71.6% to 98.3% in 2011. In most California counties from 2001 to 2011, the percentage of fully immunized children entering kindergarten stayed relatively stable, but a few counties showed notable increases or decreases.

• Childhood Immunization: Medline Plus, U.S. National Library of Medicine, National Institutes of Health
• Immunization, Child Trends Databank
• Immunization: Updates and Information, American Academy of Pediatrics, Childhood Immunization Support Program
• Pediatrics: Infectious Disease and Immunity
• Vaccines and Immunizations, Centers for Disease Control and Prevention

• Delivering Adolescent Vaccinations in the Medical Home: A New Era? (Journal Supplement 1), 01/2008, Pediatrics, Szilagyi et al.
• Measuring Immunization Coverage among Preschool Children: Past, Present, and Future Opportunities, 2006, Epidemiologic Reviews, Salmon et al.
• One in Four California Adolescent Girls Have Had Human Papillomavirus Vaccination, 02/2009, UCLA Center for Health Policy Research, Grant et al.
• Pediatrics Issue Supplement 5: Vaccines and Immunizations, 12/2009, Pediatrics
• Policy Statement: Increasing Immunization Coverage, 2010, American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine and Council on Community Pediatrics
• Securing a Healthy Future: The Commonwealth Fund State Scorecard on Child Health System Performance, 2011, The Commonwealth Fund, How et al.
• Timeliness of Childhood Vaccinations in the United States: Days Undervaccinated and Number of Vaccines Delayed, 03/09/2005, The Journal of the American Medical Association, Luman et al.
• U.S. National Vaccine Strategy, 2012, U.S. Department of Health and Human Services
• Vaccine Beliefs of Parents Who Oppose Compulsory Vaccination, 2005, Public Health Reports, Kennedy, Brown & Gust

• San Diego County Report Card on Children & Families, 2011, The Children's Initiative and Johnson Group Consulting, Inc.
• Tulare County Children’s Report Card 2010, 2011, Children's Services Network

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Do you have a local or regional report relevant to a topic on kidsdata.org? If you’d like to add it to our research and links section, please send it to us at kidsdata@lpfch.org.