News and Views: Can You Answer These Questions about Vaccine Coverage Rates?

Have you had a chance to review the recently released 2015 National Immunization Survey (NIS) data? How about the 2015-16 kindergarten vaccination coverage data? If so, see how well you can do answering these multiple-choice questions about the findings. If not, take a guess at the findings then see if you were right.

Do you know?

1. During the last five years (2011-15), NIS data have shown which of the following trends related to 1) vaccine coverage with the combined (seven-vaccine) series* and 2) the percent of infants who have not received any immunizations?
   1. Both have increased significantly.
   2. Both have stayed about the same.
   3. Both have decreased significantly.
   4. Coverage has increased significantly while rates of non-vaccinated infants have decreased significantly.
   5. Coverage has decreased significantly while rates of non-vaccinated infants have increased significantly.
2. During the 2015 NIS survey, which of the following vaccines were below 90 percent coverage?
   1. At least four doses of DTaP vaccine
   2. Complete series of Hib vaccine (three or four doses depending on product)
   3. At least four doses of pneumococcal vaccine
   4. At least one dose of hepatitis A vaccine
   5. Complete series of rotavirus vaccine (two or three doses depending on product)
   6. All of the above
3. Statistically significant differences in 2015 NIS vaccine coverage rates were found based on which of the following?
   1. Race/ethnicity
   2. Poverty level
   3. Rural or urban residence
   4. All of the above
4. Which two states had the highest combined seven-vaccine series rates?
   1. Virginia and West Virginia
   2. Connecticut and North Dakota
   3. Massachusetts and Delaware
   4. Alaska and Florida
   5. Arkansas and Iowa
5. What percent of babies are getting hepatitis B vaccine between birth and 3 days?
   1. 92 percent
   2. 82 percent
   3. 72 percent
   4. 62 percent
6. How did overall vaccine exemption rates in kindergarten children change between the 2014-15 and 2015-16 school years?
   1. Increased by 0.2 percent
   2. No change
   3. Decreased by 0.2 percent
   4. None of the above
7. How many states had non-medical exemption rates of 4 percent or more?
   1. Two
   2. Four
   3. Six
   4. Eight
8. How many states provide, or will soon provide, online access to local-level data related to vaccination rates, exemption rates or both?
   1. 15
   2. 20
   3. 25
   4. 30

How did you do?

1. The correct choice is b. Both coverage with the combined seven-vaccine series* and the rates of infants with no immunizations have stayed about the same. This news is mixed:
   1. The good news: The percent of infants receiving no vaccines has consistently remained low, around 0.8 percent throughout the five-year period.
   2. The “just okay” news: Between 2011 and 2015 infant coverage increased only slightly from 68.5 percent to 72.2 percent. This means that each year about 30 percent of infants are not up to date according to the recommended immunization schedule.
2. The correct choice is f. About 15 to 20 of every 100 infants have not received all doses of DTaP, Hib, pneumococcal, and hepatitis A vaccines. About 20 to 25 of every 100 infants have not received all doses of rotavirus vaccine.
3. The correct choice is d. Table 2 in the MMWR publication of the 2015 NIS data shows the differences in coverage.
4. The correct choice is b. Connecticut had the highest combination coverage at 80.6 percent and North Dakota had 80.2 percent. The lowest rates of combined coverage were in Virginia (64.4 percent) and West Virginia (64.9 percent). Refer to Table 3 to see how your state did.
5. The correct choice is c. About 72 percent of babies are getting the first dose of hepatitis B vaccine by 3 days of age. Unfortunately, this means that again in 2015 about one-quarter did not. Of those, about 800 will develop chronic hepatitis B infections that could have been prevented. Find out more about the importance of the birth dose of hepatitis B vaccine and ways to implement birth-dose programs or recognize hospitals that have robust birth dose vaccination programs from the Immunization Action Coalition.
6. The correct choice is a. Median exemption rates increased about 0.2 percent. However, the percent of exemptions varied widely across states. View Table 2 in the kindergarten report to see how your state compares.
7. The correct choice is d. Eight states had nonmedical exemption rates of 4 percent or more, including Oregon (6.2 percent), Idaho (5.8 percent), Vermont (5.5 percent), Alaska (4.7 percent), Arizona (4.5 percent), Utah (4.4 percent), Colorado (4.3 percent) and Maine (4.0 percent).
8. The correct choice is c. Twenty-five states provide access to online information related to local vaccine coverage or exemption rates or both. This is increased from 21 states in last year’s survey.

If you are interested in seeing more of the data related to these surveys, the reports can be accessed online at:

• Vaccination Coverage Among Children Aged 19–35 Months — United States, 2015, published in MMWR, Oct. 7, 2016; 65(39):1065-71.
• Vaccine Coverage Among Children in Kindergarten — United States, 2015-16 School Year, published in MMWR, Oct. 7, 2016; 65(39):1057-64.

* The combined seven-vaccine series measured included completion of at least four doses of DTaP vaccine, three doses of polio vaccine, one dose of measles-containing vaccine, complete series of Hib vaccine, three doses of hepatitis B vaccine, one dose of varicella vaccine and four doses of pneumococcal vaccine.