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- Definition: Percentage of children in kindergarten with all required immunizations.Number of children in kindergarten with all required immunizations.
- Data Source: California Dept. of Public Health, Immunization Branch, Kindergarten Assessment Results (Feb. 2016).
- Footnote: Years presented are the final year of a school year (e.g., 2015-16 is shown as 2016). Data are aggregated from school-level data, which are reported for schools with 10 or more students enrolled in kindergarten. All required immunizations include 5 doses of DTP/DTaP/DT vaccine (4 doses meets the requirement if at least one was given on or after the fourth birthday); 4 doses of polio vaccine (3 doses meets the requirement if at least one was given on or after the fourth birthday); 2 doses of MMR vaccine (may be given separately or combined, but both doses must be given on or after the first birthday); 3 doses of hepatitis B vaccine; and 1 dose of varicella vaccine (or physician-documented varicella disease history or immunity). LNE (Low Number Event) refers to percentages that have been suppressed because fewer than 20 children had all required immunizations. N/A means that data are not available.
- Measures of Immunizations on Kidsdata.org
On kidsdata.org, immunizations are measured by the number and percentage of kindergartners 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. When children enter school, proof of immunizations is required. Data also are available for the number and percentage of kindergartners who received immunization exemptions, by type of exemption.
Reported cases of vaccine-preventable childhood diseases also are provided, specifically the number of cases and rates for the 12 vaccine-preventable childhood diseases reported by the California Department of Public Health: diphtheria, Haemophilus influenzae, hepatitis A, hepatitis B, measles, meningococcal disease, mumps, pertussis (whooping cough), polio, rubella (German measles), tetanus (lockjaw), and varicella (chickenpox).Vaccine-preventable childhood disease data reflect the number of reported cases with two exceptions in the data for California and counties: (1) Only varicella cases resulting in hospitalization or death are reported, and (2) Haemophilus influenzae is only reported for children under age 15.
- Health Care
- Delayed or No Medical Care
- Length of Time Since Last Routine Health Check-Up
- Visited the Emergency Room in Last Year, by Type of Insurance
- Uninsured at Any Point in Last Year
- Health Insurance Coverage (Regions of 65,000 Residents or More), by Type of Insurance and Age
- Health Insurance Coverage (Regions of 10,000 Residents or More), by Type of Insurance and Age
- Medi-Cal Point-in-Time Enrollment
- Receipt of Care Within a Medical Home (Regions of 70,000 Residents or More)
- Adequate Health Services Provided at School (Staff Reported)
- School Health Centers
- Why This Topic Is Important
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). Annual immunization against influenza also is recommended. Immunizations are important for the protection of the individual child as well as for the protection of others with whom an infected child might come in contact; all of these diseases are contagious and most are spread through air or direct contact (3). For each U.S. 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 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. Healthy People 2020. (n.d.). Immunizations and infectious diseases. Retrieved from: http://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases
2. Centers for Disease Control and Prevention. (2015). Parent’s guide to childhood immunizations. Retrieved from: http://www.cdc.gov/vaccines/pubs/parents-guide
3. Centers for Disease Control and Prevention. (2016). 2016 recommended immunizations for children from birth through 6 years old. Retrieved from: http://www.cdc.gov/vaccines/schedules/index.html
4. Elam-Evans, L. D., et al. (2014). National, state, and local area vaccination coverage among children aged 19-35 months—United States, 2013. Morbidity and Mortality Weekly Report, 63(34), 741-748. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6334a1.htm
- How Children Are Faring
The California School Immunization Law requires that children receive certain immunizations before entering school. In 2016, 93% of California kindergartners received all state-required immunizations by the time they entered school, a slight increase in comparison to recent years. Among counties with available data in 2016, percentages ranged from 77% to 100%.
Some students are exempt from the immunization requirements. In 2016, 2.4% of California kindergartners were exempt due to their parents' personal beliefs, 0.2% were exempt for medical conditions, and 4.4% were exempt for other reasons. An additional 0.2% were overdue for one or more immunizations. The percentage of children with personal belief exemptions in 2016 ranged widely at the county level, from less than 1% to more than 18%, among counties with available data.
In 2014, the number of cases of pertussis (whooping cough), a highly contagious and potentially life-threatening disease that is vaccine-preventable, peaked in California. That year, 11,213 cases of pertussis were diagnosed, accounting for 34% of all of the cases diagnosed in the U.S. California's 2014 pertussis rate, 29 per 100,000 people, was almost three times the rate nationwide (10.3). There was striking variation at the county level, with rates per 100,000 ranging from 0.0 to more than 100.0 in some Northern California counties. Pertussis accounts for the majority of all vaccine-preventable diseases diagnosed.
- Policy Implications
State policy currently requires proof of recommended immunizations as a condition of entry into kindergarten, preschool, and licensed child care, which means that immunization rates are relatively high for children entering those settings (1). Overall, however, infants and toddlers have lower vaccination rates than school-age children, making them particularly vulnerable to communicable diseases (2). State policy can improve immunization rates by helping to ensure that children see a doctor, parents understand the importance of timely vaccinations, and affordable and accessible vaccination resources are available. Progress has been made in this regard; recently, the Affordable Care Act mandated that private health plans fully cover the costs of all recommended vaccinations. However, issues of access and education persist (3, 4, 5). According to research and subject experts, policy options that could improve immunization rates include:
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 our Health Care topic.
- Exploring additional options for reaching adolescents, who frequently fail to complete the recommended courses of vaccinations (3)
- 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 (4)
- 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” (5, 6)
- Supporting public education about the importance of timely immunization, along with other interventions, such as reminder systems (4, 5, 7) and creating educational materials that are easy to understand and culturally appropriate (7)
- Minimizing barriers that restrict access to vaccinations, such as cost, clinic accessibility, and vaccine availability (7)
- Equipping pediatricians and other health care advisors with the tools to address the concerns of vaccine-hesitant parents (8)
- Assessing the process and availability of non-medical exemptions for opting out of immunizations, as exemption rates are up nationwide and are highest in states that have easy exemptions procedures and allow for nonmedical exemptions, such as California (9)
- Exploring strategies to increase the HPV vaccination rate among teens by administering it during the same visit as other vaccines and educating parents and youth as to its importance (3, 10).
Sources for this narrative:
1. California Department of Public Health, Immunization Branch. (2015). 2014-2015 child care and school fact sheet. Retrieved from: http://www.cdph.ca.gov/programs/immunize/pages/immunizationlevels.aspx
2. Salmon, D. A., et al. (2006). Measuring immunization coverage among preschool children: Past, present, and future opportunities. Epidemiologic Reviews, 28(1), 27-40. Retrieved from: http://epirev.oxfordjournals.org/content/28/1/27
3. Elam-Evans, L. D., et al. (2014). National, state, and local area vaccination coverage among children aged 19-35 months—United States, 2013. Morbidity and Mortality Weekly Report, 63(34), 741-748. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6334a1.htm
4. Centers for Disease Control and Prevention. (2011). General recommendations on immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 60(RR-2), 1-60. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6002a1.htm?s_cid=rr6002a1_e
5. American Academy of Pediatrics. (2013). Adolescent immunizations: Strategies for increasing coverage rates. Retrieved from: https://www.aap.org/en-us/Documents/immunization_topstrategiesforincreasingcoverage.pdf
6. 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(Suppl. 1), S4-S11. Retrieved from: http://pediatrics.aappublications.org/content/119/Supplement_1/S4
7. Kimmel, S. R., et al. (2007). Addressing immunization barriers, benefits, and risks. Journal of Family Practice, 56(2), S61-S69. Retrieved from: https://www.researchgate.net/publication/6534790_Addressing_immunization_barriers_benefits_and_risks
8. American Academy of Pediatrics. (2013). Addressing common concerns of vaccine-hesitant parents. Retrieved from: https://www.aap.org/en-us/Documents/immunization_vaccine-hesitant%20parent_final.pdf
9. Omer, S. B., et al. (2012). Vaccination policies and rates of exemption from immunization, 2005-2011. New England Journal of Medicine, 367(12), 1170-1171. Retrieved from: http://www.nejm.org/doi/full/10.1056/NEJMc1209037
10. Centers for Disease Control and Prevention. (2013). Human papillomavirus vaccination coverage among adolescent girls, 2007-2012, and postlicensure vaccine safety monitoring, 2006-2013—United States. Morbidity and Mortality Weekly Report, 62(29), 591-595. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6229a4.htm
- Websites with Related Information
- American Academy of Pediatrics: Immunization
- California Dept. of Public Health: Immunization Branch
- California Immunization Coalition
- Centers for Disease Control and Prevention: Vaccines & Immunizations
- Healthy People 2020: Immunization and Infectious Diseases, U.S. Dept. of Health and Human Services
- MedlinePlus: Childhood Immunization, U.S. National Library of Medicine
- PATH: Vaccine Resource Library
- Pediatrics: Infectious Disease, American Academy of Pediatrics
- Shots for School
- Vaccines.gov, U.S. Dept. of Health and Human Services
- Key Reports and Research
- Challenges to Immunization: The Experiences of Homeless Youth, 2012, BMC Public Health, Doroshenko, A., et al.
- Delivering Adolescent Vaccinations in the Medical Home: A New Era?, 2008, Pediatrics, Szilagyi, P. G., et al.
- Financing of Childhood and Adolescent Vaccines, 2009, Pediatrics, 124(Suppl. 5)
- High Immunization Rates Don’t Mean Schools Are Risk-Free, 2013, JAMA: The Journal of the American Medical Association
- Increasing Immunization Coverage, 2010, Pediatrics, American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine and Council on Community Pediatrics
- Legislative Challenges to School Immunization Mandates: 2009-2012, 2014, JAMA: The Journal of the American Medical Association, Omer, S. B., et al.
- Measles — United States, January 4–April 2, 2015, 2015, Morbidity and Mortality Weekly Report, Clemmons, N. S., et al.
- National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2014, 2015, Morbidity and Mortality Weekly Report, Reagan-Steiner, S., et al.
- Policies to Promote Child Health, 2015, The Future of Children
- Progress Stalls On Vaccine-Preventable Diseases, 2015, Population Reference Bureau, Jarosz, B., & Naik, R.
- Solutions to Reducing Vaccine-Preventable Childhood Diseases, 2015, Population Reference Bureau, Naik, R., & Jarosz, B.
- Teen Immunization Rates Improve, But HPV Vaccination Lags Behind, 2013, JAMA: The Journal of the American Medical Association
- Timing of Measles Immunization and Effective Population Vaccine Coverage, 2012, Pediatrics, Bielicki, J. A., et al.
- U.S. National Vaccine Plan, U.S. Dept. of Health & Human Services
- Vaccination Coverage Among Children in Kindergarten — United States, 2013–14 School Year, 2014, Morbidity and Mortality Weekly Report, Seither, R., et al.
- Vaccination Policies and Rates of Exemption from Immunization, 2005–2011, 2012, New England Journal of Medicine, Omer, S. B., et al.
- Vaccines Are Not Associated with Autism: An Evidence-Based Meta-Analysis of Case-Control and Cohort Studies, 2014, Vaccine, Taylor, L. E., et al.
- County/Regional Reports
- 2014 Youth Wellbeing Report Card, Santa Monica Cradle to Career
- Community Health Assessment 2015, Los Angeles County Dept. of Public Health
- Healthy San Mateo 2010: Vaccine Chapter Addendum, San Mateo County Health Services Agency
- Key Indicators of Health by Service Planning Area, 2017, Los Angeles County Dept. of Public Health
- Orange County Community Indicators Report, 2017, Orange County Community Indicators Project
- San Diego County Report Card on Children and Families, 2015, The Children's Initiative & Live Well San Diego
- The 23rd Annual Report on the Conditions of Children in Orange County, 2016, Orange County Children's Partnership
- More Data Sources For Immunizations
- California Health Interview Survey, UCLA Center for Health Policy Research
- Child Trends Databank: Immunization
- Childstats.gov, Federal Interagency Forum on Child and Family Statistics
- Immunization Rates in Child Care and Schools, California Dept. of Public Health, Immunization Branch
- National Immunization Survey (NIS) - Children (19-35 months), Centers for Disease Control and Prevention
- Shots for School
- Vaccine-Preventable Disease Surveillance, California Dept. of Public Health
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