Vaccination Rates in U.S. Children: Declines and Health Implications

Recent analyses reveal that while vaccination rates for routine immunizations in U.S. children up to two years of age have generally been robust, significant declines persist in certain vaccines, according to a recent Centers for Disease Control and Prevention (CDC) report in the Morbidity and Mortality Weekly Report. Notably, the influenza and hepatitis B (HepB) birth dose vaccines have recorded considerable decreases in coverage.

The CDC study analyzed data from 27,392 children born between 2021 and 2022, comparing it to vaccination rates of children born in 2019 and 2020. The study observed reduced coverage for vaccines including influenza, HepB birth dose, rotavirus, pneumococcal, and Haemophilus influenzae type b (Hib).

Influenza vaccination coverage experienced the largest decline, dropping to 53.5% in the 2021–2022 cohort from 61.0% in the 2019–2020 cohort. The HepB birth dose saw a continued downward trend, with a 1.8 percentage point decline over recent years. This dose is crucial for preventing perinatal HBV infection and chronic liver disease in infants born to mothers positive for the Hepatitis B surface antigen.

Further data up to August 2025 indicates a HepB birth dose coverage drop from 83.5% to 73.2% over two years. This decline precedes revised recommendations by the CDC’s Advisory Committee on Immunization Practices, which may further impact vaccination rates. Hib vaccine coverage also declined, with cases in Florida highlighting potential health risks.

Despite these declines, most children received key vaccines, with over 90% receiving at least one dose of the measles, mumps, and rubella (MMR) vaccine, varicella vaccine, and three doses of the poliovirus vaccine, meeting Healthy People 2030 goals. However, MMR coverage remains below the herd immunity threshold of 95%, presenting concern amidst a significant measles outbreak. Disparities in vaccination rates emerge by socioeconomic status, race, and geography, notably among children eligible for the Vaccines for Children (VFC) program.

Geographically, influenza vaccination coverage varied, with stark differences from 25.2% in Mississippi to 78.3% in Massachusetts during the 2021–2022 period. Between 2019–2020 and 2021–2022, 30 of 56 states and territories experienced declines in influenza vaccine coverage.

The report emphasizes the urgent need to identify and address gaps in vaccine coverage, especially amid rising vaccine-preventable diseases. In 2025, a surge in measles cases marked the highest since 2000, notably among unvaccinated individuals. Strategies to boost vaccine uptake include strong healthcare provider recommendations, targeted messaging, and increased VFC program participation.