Childhood Vaccination

Introduction

This toolkit summarizes content from the Childhood Vaccination Evidence Accelerator and the MCHbest database. The peer-reviewed literature supporting this work can be found in the Established Evidence database. Use the resources below as you develop effective evidence-based/informed programs and measures.

From the MCH Block Grant Guidance. Vaccination is one of the greatest public health achievements of the 20th century, resulting in dramatic declines in morbidity and mortality for many infectious diseases.¹ Childhood vaccination in particular is considered among the most cost-effective preventive services available, as it averts a potential lifetime lost to death and disability.² Currently, there are 15 different vaccines recommended by the Centers for Disease Control and Prevention from birth through age 18, many of which require multiple doses for effectiveness as well as boosters to sustain immunity.3 While there was no significant decline in overall vaccination coverage for the combined 7-vaccine series for children aged 24 months in 2020 and 2021, the first two year sof the COVID-19 pandemic, vaccination coverage declined, however, for by 4-5 percentage points for children living below the federal poverty line or in rural areas.4Hl The childhood immunization status measure for health plans is part of the Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP and the National Committee for Quality Assurance’s Healthcare Effectiveness Data and Information Set.

Goal. To increase the percent of children and adolescents who have completed recommended vaccines.

Note. Access other related measures in this Population Domain through the Toolkits page.

Detail Sheet: Start with the MCH Block Grant Guidance

DEFINITION

Numerator:

Number of children who have completed the combined 7-vaccine series of routinely recommended vaccinations (4:3:1:3*:3:1:4 or ≥4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine; ≥3 doses of poliovirus vaccine; ≥1 dose of measles-containing vaccine; ≥3 or ≥4 doses (depending upon product type) of Haemophilus influenzae type b conjugate vaccine; ≥3 doses of hepatitis B vaccine; ≥1 dose of varicella vaccine; and ≥4 doses of pneumococcal conjugate vaccine) by age 24 months

Denominator:

Number of children born in a calendar year

Units: 100

Text: Percent

HEALTHY PEOPLE 2030 OBJECTIVE

Related to IID Objective 02: Reduce the proportion of children who receive 0 doses of recommended vaccines by age 2 years. (Baseline: 1.3% of children born in 2015 had received 0 doses of recommended vaccines by their 2nd birthday, Target: 1.3%) Related to Immunization and Infectious Disease (IID) Objective 06: Increase the vaccination coverage level of 4 doses of the diphtheria-tetanus-acellular pertussis (DTaP) vaccine among children by age 2 years. (Baseline: 80.7% of children born in 2015 received 4 or more doses of DTaP by their 2nd birthday, Target: 90.0%) Related to IID Objective 03: Maintain the vaccination coverage level of 1 doses of the measles-mumps-rubella (MMR) vaccine among children by age 2 years. (Baseline: 90.8% of children born in 2015 received at least 1 does of MMR by their 2nd birthday, Target: 90.8%)

DATA SOURCES

National Immunization Survey (NIS) MCH

POPULATION DOMAIN

Child Health

MEASURE DOMAIN

Clinical Health System/Health Behavior

1. Accelerate with Evidence—Start with the Science

The first step to accelerate effective, evidence-based/informed programs is ensuring that the strategies we implement are meaningful and have high potential to affect desired change. Read more about using evidence-based/informed programs and then use this section to find strategies that you can adopt or adapt for your needs.

Evidence-based/Informed Strategies: MCHbest Database

The following strategies have emerged from studies in the scientific literature as being effective in advancing the measure. Use the links below to read more about each strategy or access the MCHbest database to find additional strategies.

Chart of Evidence-Linked Strategies and Tools
Evidence-Informed			Evidence-Based
Mixed Evidence	Emerging Evidence	Expert Opinion	Moderate Evidence	Scientifically Rigorous
Collaboration with Schools and Educators (2023) Community Engagement and Involvement (2018) Health Education in Schools (2023)	Addressing Vaccine Hesitancy (2020) Client or Family Incentive Rewards (2015) Parental Reminder and Recall Systems (2020) Partnerships with Healthcare Providers (2018) School and Childcare Requirements (2020) Social Media and Online Engagement (2020)	Collaboration with Pharmacies and Retail Clinics (2018)	Enhanced Access to Vaccination Services (2021) Immunization Information Systems (2014) Mobile Vaccination Clinics (2020) Paid Sick Leave Laws (2022) Parental Education (2021) School-Based Vaccination Programs (2022) Vaccine Education and Awareness Campaigns (2022) Vaccination Programs in WIC Settings (2016)	Community Outreach and Partnerships (2022) Data Monitoring and Analysis (2021) Home Visiting (2021) Policy Interventions (2023) Provider Assessment and Feedback (2021) Provider Training and Communication (2021) Standing Orders (2016) Text Message-Based Health Interventions (2019)

Field-Based Strategies: Find promising programs from AMCHP’s Innovation Hub

Cutting Edge:

Group Home Visiting Education (ND; 2021)
School Nurse Education (MO; 2019)

Emerging:

Text Messaging (OK; 2016)

Promising:

Health Education, Case Management, and Patient Navigation (NY; 2019)
Home Visiting and Parent Education (VA; 2020)
New Parent Kit (CA; 2008)
Parental Engagement Program (TN; 2021)

Best:

Community Health Workers (AZ; 2023)

2. Think Upstream with Planning Tools—Lead with the Need

The second step in developing effective, evidence-based/informed programs challenges us to plan upstream to ensure that our work addresses issues early and is measurable in “turning the curve” on big issues that face MCH populations. Read more about moving from root causes to responsive programs and then use this section to align your work with the data and needs of your populations.

Move from Need to Strategy

Use Root-Cause Analysis (RCA) and Results-Based Accountability (RBA) tools to build upon the science to determine how to address needs.

Planning Tools: Use these tools to move from data to action

3. Work Together with Implementation Tools—Move from Planning to Practice

The third step in developing effective, evidence-based/informed programs calls us to work together to ensure that programs are implementable and moveable within the realities of Title V programs and lead to improved health outcomes for all people. Read more about implementation tools designed for MCH population change and then use this section to develop responsive strategies to bring about change that is responsive to the needs of your populations.

Additional MCH Evidence Center Resources: Access supplemental materials from the literature

Systematic reviews showcase how interventions, like tightening rules around exemptions in school-based requirements, are associated with increased vaccination uptake and completion.¹⁰ Strategies such as reducing costs, linking immunizations to Women Infant and Children (WIC) services, and home visiting, have been impactful for increasing vaccinations among groups with low access to immunization services.¹³

Find field-based resources focused on improving childhood vaccination rates relevant to Title V programs in the MCH Digital Library.
Search the Established Evidence database for peer-reviewed research articles related to strategies for improving childhood vaccination rates.
Request Technical Assistance from the MCH Evidence Center
MCH Evidence Center Frameworks and Toolkits:

Implementation Resources: Use these field-generated resources to affect change

Practice. The following tools can be used to translate evidence to action to advance this NPM:

BeSD Tools and Practical Guidance (WHO). This guidebook supports the use of tools around behavioral and social drivers of vaccination.
Immunization Services Checklist (CDC). CDC’s checklist for clear-cut ways to improve a practice’s efficiency and increase coverage rates.

Partnership. The following organizations focus efforts on increasing childhood vaccinations:

The National Center for Health Research focuses on vaccination efforts through the Vaccines for Children Program.
Community Preventive Services Task Force provides snapshots, recommendations, and considerations for vaccination implementation.

References

Introductory References: From the MCH Block Grant Guidance

¹ Centers for Disease Control and Prevention (CDC). Ten great public health achievements--United States, 1900-1999. MMWR Morb Mortal Wkly Rep. 1999;48(12):241-243. https://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm

(2) Maciosek MV, LaFrance AB, Dehmer SP, et al. Updated Priorities Among Effective Clinical Preventive Services [published correction appears in Ann Fam Med. 2017 Mar;15(2):104]. Ann Fam Med. 2017;15(1):14-22. doi:10.1370/afm.2017. https://www.annfammed.org/content/15/1/14

(3) CDC. Child and Adolescent Immunization Schedule by Age (June 2024). Birth-18 Years Immunization Schedule.

4) Hill HA, Chen M, Elam-Evans LD, Yankey D, Singleton JA. Vaccination Coverage by Age 24 Months Among Children Born During 2018-2019 - National Immunization Survey-Child, United States, 2019-2021. MMWR Morb Mortal Wkly Rep. 2023;72(2):33-38. Published 2023 Jan 13. doi:10.15585/mmwr.mm7202a3 https://www.cdc.gov/mmwr/volumes/72/wr/mm7202a3.htm#T2_down

Evidence Tools Childhood Vaccination