Learning Objectives for this Presentation:
By the end of the presenation participants will be able to:
1) distinguish between various vaccination coverage measures
2) understand the importance of assessing all vaccination recommendations
3) select an appropriate coverage measure for a given situation

Background:
Official recommendations for routine vaccination of US children, made by the Advisory Committee on Immunization Practices (ACIP), specify the vaccines for administration, the number of doses that should be given, age ranges for administration, minimum ages at which doses are considered valid, minimum intervals between doses within a series, and several additional vaccine-specific adjustments and exceptions. Federally-reported estimates of vaccination coverage measure only compliance with the required number of doses; other recommendations are not routinely evaluated.

Objectives:
Assess compliance with, and incremental impact of, each vaccination recommendation.

Methods:
Analysis of vaccination histories for 17,563 US children aged 19-35 months from the 2005 National Immunization Survey.

Results:
Estimated coverage for the standard vaccination series accounting for all recommendations was 72%, 9 percentage points lower than coverage based solely on counting doses. Overall, 19% of children were missing one or more doses, while 8% received an invalid dose and 9% were affected by other recommendations. The proportion of non-compliance due to missed doses versus other recommendations varied by state and by antigen.

Conclusions:
Approximately 28% of children were not in compliance with official vaccination recommendations. Missed doses accounted for approximately two thirds of non-compliance, with the remainder due to mistimed doses and other requirements. Measuring compliance with all ACIP recommendations provides a valuable tool to assess and improve the quality of healthcare delivery and ensure that children and communities are optimally protected from vaccine-preventable diseases.