This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (25)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Smith, P. J.
Right arrow Articles by Barker, L. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Smith, P. J.
Right arrow Articles by Barker, L. E.
Related Collections
Right arrow Infectious Disease & Immunity
Right arrowRelated AAP Red Book topics:
Measles
Hepatitis B
Haemophilus influenzae Infections
Poliovirus Infections
PEDIATRICS Vol. 114 No. 1 July 2004, pp. 187-195

Children Who Have Received No Vaccines: Who Are They and Where Do They Live?

Philip J. Smith, PhD, MS, Susan Y. Chu, PhD, MSPH and Lawrence E. Barker, PhD

From the Centers for Disease Control and Prevention, National Immunization Program, Atlanta, Georgia

Context. Each year 2.1 million children 19 to 35 months of age are undervaccinated. Among these are children who have received no vaccinations. Unvaccinated children are at increased risk of acquiring and transmitting vaccine-preventable diseases.

Objectives. To assess whether the characteristics of children with no vaccinations differ from those of undervaccinated children, to monitor trends in the numbers of unvaccinated children, and to identify states with high rates and counties with large numbers of unvaccinated children.

Design. A nationally representative probability sample of children 19 to 35 months of age was collected annually between 1995 and 2001. Vaccination histories were ascertained from children's medical providers. Undervaccinated children had received ≥1 dose of diphtheria-tetanus-pertussis, polio, measles, Haemophilus influenzae type b, hepatitis B, or varicella vaccine but were not fully vaccinated. Unvaccinated children were children who were reported as having no medical providers and having received no vaccinations or children whose medical providers reported administering no vaccinations.

Participants. A total of 151 720 children sampled between 1995 and 2001, 795 of whom were unvaccinated.

Results. Undervaccinated children tended to be black, to have a younger mother who was not married and did not have a college degree, to live in a household near the poverty level, and to live in a central city. Unvaccinated children tended to be white, to have a mother who was married and had a college degree, to live in a household with an annual income exceeding $75 000, and to have parents who expressed concerns regarding the safety of vaccines and indicated that medical doctors have little influence over vaccination decisions for their children. Unvaccinated children were more likely to be male than female. Annually, ~17 000 children were unvaccinated. The largest numbers of unvaccinated children lived in counties in California, Illinois, New York, Washington, Pennsylvania, Texas, Oklahoma, Colorado, Utah, and Michigan. States that allowed philosophical exemptions to laws mandating vaccinations for children as they entered school had significantly higher estimated rates of unvaccinated children.

Conclusions. Unvaccinated children have characteristics that are distinctly different from those of undervaccinated children. Unvaccinated children are clustered geographically, increasing the risk of transmitting vaccine-preventable diseases to both unvaccinated and undervaccinated children.

Key Words: exemptor • undervaccinated • unvaccinated

Abbreviations: CI, confidence interval • NIS, National Immunization Survey • PKAM, Parental Knowledge and Attitudes topical module • RDD, random-digit dialing • UTD, up-to-date • NUTD, not up-to-date • VPD, vaccine-preventable disease • MSA, metropolitan statistical area

Received for publication Dec 2, 2003; Accepted Mar 2, 2004.




This article has been cited by other articles:


Home page
 JAMAHome page
Measles--United States, January 1-April 25, 2008
JAMA, June 11, 2008; 299(22): 2621 - 2623.
[Full Text] [PDF]

Home page
 BMJHome page
P. McIntyre and J. Leask
Improving uptake of MMR vaccine
BMJ, April 5, 2008; 336(7647): 729 - 730.
[Full Text] [PDF]

Home page
 PediatricsHome page
K. S. O'Connor and M. D. Bramlett
Vaccination Coverage by Special Health Care Needs Status in Young Children
Pediatrics, April 1, 2008; 121(4): e768 - e774.
[Abstract] [Full Text] [PDF]

Home page
 Ann Fam MedHome page
A. L. Sussman, D. Helitzer, M. Sanders, B. Urquieta, M. Salvador, and K. Ndiaye
HPV and Cervical Cancer Prevention Counseling With Younger Adolescents: Implications for Primary Care
Ann. Fam. Med, July 1, 2007; 5(4): 298 - 304.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
B. H. Levi
Addressing Parents' Concerns About Childhood Immunizations: A Tutorial for Primary Care Providers
Pediatrics, July 1, 2007; 120(1): 18 - 26.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
P. J. Smith, A. M. Kennedy, K. Wooten, D. A. Gust, and L. K. Pickering
Association Between Health Care Providers' Influence on Parents Who Have Concerns About Vaccine Safety and Vaccination Coverage
Pediatrics, November 1, 2006; 118(5): e1287 - e1292.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
E. A. Flanagan-Klygis, L. Sharp, and J. E. Frader
Dismissing the Family Who Refuses Vaccines: A Study of Pediatrician Attitudes
Arch Pediatr Adolesc Med, October 1, 2005; 159(10): 929 - 934.
[Abstract] [Full Text] [PDF]

Home page
 AAP NewsHome page
C. Kemp
Which children receive no vaccines?
AAP News, September 1, 2004; 25(3): 106 - 106.
[Full Text] [PDF]