Children and Adolescents Unvaccinated Against Measles: Geographic Clustering, Parents' Beliefs, and Missed Opportunities.
OBJECTIVE
We evaluated the extent to which children and adolescents were not vaccinated against measles ("unvaccinated"), clustering within U.S. counties, and factors associated with unvaccination, including parents' vaccine-related beliefs and missed opportunities.


METHODS
We analyzed data from the 2010-2013 National Immunization Survey (NIS) and NIS-Teen Survey of households with 19- to 35-month-old children and 13- to 17-year-old adolescents, respectively. We used provider-reported vaccination histories to assess measles vaccination status.


RESULTS
In 2013, 7.5% of children and 4.5% of adolescents were unvaccinated against measles. Four-fifths (80.0%) of unvaccinated children lived in counties containing 41.9% of the nation's children, and 80.0% of unvaccinated adolescents lived in counties containing 30.4% of the nation's adolescents. Multivariable statistical analyses found that 74.6% of children who were unvaccinated against measles missed being vaccinated for reasons other than parents' negative vaccine-related beliefs, and 89.6% could be deemed as having at least one missed opportunity for being vaccinated against measles because they were administered at least one dose of other recommended vaccines after 12 months of age. Among adolescents, multivariable analyses found that only demographic factors, not vaccine-related parental beliefs, were independently associated with being unvaccinated.


CONCLUSIONS
Reasons other than negative vaccine-related beliefs, including missed opportunities, accounted for the vast majority of unvaccinated children and adolescents.
Centers for Disease Control and Prevention, National Center for Immunizations and Respiratory Disease, Immunization Services Division, Atlanta, GA.
Philip J
PJ
Smith
University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA.
Edgar K
EK
Marcuse
Centers for Disease Control and Prevention, National Center for Immunizations and Respiratory Disease, Immunization Services Division, Atlanta, GA.
Jane F
JF
Seward
Centers for Disease Control and Prevention, National Center for Immunizations and Respiratory Disease, Immunization Services Division, Atlanta, GA.
Zhen
Z
Zhao
Emory University, Atlanta, GA.
Walter A
WA
Orenstein
D000293:Adolescent; D000704:Analysis of Variance; D002675:Child, Preschool; D016000:Cluster Analysis; D060740:Disease Eradication / Q000639:trends; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data; D005191:Family Characteristics; D005260:Female; D005843:Geography; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008297:Male; D008457:Measles / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D008458:Measles Vaccine / Q000008:administration & dosage* / Q000191:economics; D017057:Medically Uninsured; D010290:Parents / Q000523:psychology*; D012923:Social Class; D014481:United States / Q000453:epidemiology
D008458:Measles Vaccine