title: Vaccination coverage estimates for selected counties: achievement of Healthy People 2010 goals and association with indices of access to care, economic conditions, and demographic composition.
abstract: OBJECTIVE
  We provided vaccination coverage estimates for 181 counties; evaluated the extent to which Healthy People 2010 (HP 2010) vaccination coverage objectives were achieved; and examined how variations in those estimates depend on access to care and economic conditions.
  
  
  METHODS
  We analyzed data for 24,031 children aged 19 to 35 months sampled from the 2004 and 2005 National Immunization Survey.
  
  
  RESULTS
  Children living in the 181 counties represented 49% of all the 19- to 35-month-old children living in the U.S. None of the 181 counties had coverage for the polio, measles-mumps-rubella, Haemophilus influenzae type B, and hepatitis B vaccines that was significantly lower than the HP 2010 objective of 90% coverage. However, as many as 30.4% of the counties did not achieve the HP 2010 objective for diphtheria, tetanus toxoids, and acellular pertussis or diphtheria and tetanus toxoids and pertussis (DtaP/DTP), and as many as 6.6% did not achieve the goal for varicella (VAR). If children who received three doses of DTaP/DTP had received a final fourth dose, and if all children had received one dose of VAR, all of the 181 counties would have achieved the HP 2010 vaccination coverage target of 80% for the entire 4:3:1:3:3:1 vaccination series. Factors found to be associated with low county-level vaccination coverage rates were correlates of poverty, and factors found to be associated with high county-level vaccination coverage rates were correlates of access to pediatric services.
  
  
  CONCLUSIONS
  HP 2010 vaccination coverage goals for all 181 counties can be achieved by improving vaccination coverage for only two vaccines. Those goals may be achieved most efficiently by targeting interventions in counties where indices of poverty are high or where access to pediatric services is low.
authors.affiliation: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA 30333, USA. PSmith3@cdc.gov
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Smith
authors.forename: James A
authors.initials: JA
authors.lastname: Singleton
mesh_terms: D002675:Child, Preschool; D006297:Health Services Accessibility; D040361:Healthy People Programs; D006801:Humans; D007223:Infant; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care; D011203:Poverty; D017062:Small-Area Analysis; D012959:Socioeconomic Factors; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*