Childhood Vaccination Coverage Declines: CDC Data Reveals Troubling Trends for 2021-2022 Birth Cohorts

A comprehensive CDC report released today from the National Immunization Survey-Child reveals concerning trends in childhood vaccination coverage among children born in 2021 and 2022, with the most dramatic declines occurring in influenza vaccination and hepatitis B birth dose administration.

The study, published in the CDC's Morbidity and Mortality Weekly Report, titled “Vaccination Coverage by Age 24 Months Among Children Born in 2021 and 2022 — National Immunization Survey-Child, United States, 2022–2024,” analyzed vaccination data for 27,392 children representing a weighted sample of 7.5 million children. While coverage with most routine vaccines remained relatively stable compared to children born in 2019-2020, the report documents meaningful declines in 5 key vaccines and highlights persistent disparities across demographic groups and geographic regions.

The Influenza Vaccination Crisis

The most alarming finding is the 7.4 percentage point decrease in coverage with 2 or more doses of influenza vaccine by age 24 months, dropping from 61.0% among children born in 2019-2020 to 53.5% among those born in 2021-2022. This represents the lowest influenza vaccination coverage in more than a decade.

According to the report, "Vaccination against influenza decreased among children during the COVID-19 pandemic and has not yet recovered to prepandemic levels." The research team notes that parental hesitancy plays a significant role, with 30.9% of parents expressing hesitancy about influenza vaccination for children aged 6 months to 17 years.

The timing of this decline is particularly concerning given the 2024-25 influenza season data. The report references cumulative influenza-associated hospitalization rates reaching the highest levels since 2010-2011, and documents that 280 pediatric deaths from influenza were reported during the 2024-25 season. Critically, 89% of those deaths occurred in children who were not fully vaccinated against influenza.

Additional Vaccine Declines and Hepatitis B Concerns

Beyond influenza, the study documents smaller but statistically significant declines in 4 other vaccines. The hepatitis B birth dose declined by 1.8 percentage points (from 81.1 percent to 79.3 percent). While this may seem modest, the report emphasizes the critical importance of this dose for infants born to hepatitis B surface antigen-positive mothers.

The research team explains that without this protection, "approximately 90% of US infants born to women who are HBsAg-positive will develop chronic infection with [hepatitis B virus (HBV)], and approximately 25% of them will eventually die from chronic liver disease." More concerning, the data show the hepatitis B birth dose has declined steadily for the past 3 birth cohorts after increasing by 10.6 percentage points during 2014 to 2019.

Additional declines occurred for rotavirus vaccine (down 1.7 percentage points), the primary series of Haemophilus influenzae type b conjugate vaccine (down 1.0 percentage point), and 4 or more doses of pneumococcal conjugate vaccine (down 1.5 percentage points).

Persistent and Widening Disparities

The report documents substantial disparities in vaccination coverage by sociodemographic factors. Coverage differences were most pronounced between Vaccines for Children (VFC) program-eligible children and ineligible children. VFC-eligible children had 22.4 percentage points lower influenza vaccination coverage than noneligible children.

By race and ethnicity, coverage with most vaccines was lower among non-Hispanic Black or African American and Hispanic or Latino children compared to non-Hispanic White children. Coverage was highest among non-Hispanic Asian children, with some vaccines showing 14.6 percentage point differences favoring Asian children.

Geographic variation was also substantial, particularly for influenza vaccination, which ranged from 25.2 percent in Mississippi to 78.3 percent in Massachusetts. Influenza vaccine coverage declined in 30 of 56 states and local areas compared to the prior birth cohort.

Public Health Implications

The CDC emphasizes that these trends increase the risk of vaccine-preventable disease outbreaks. During 2025, the US reported 2,144 confirmed measles cases, the largest number of annual cases since measles elimination in 2000. Ninety-three percent of those cases occurred in unvaccinated persons or those with unknown vaccination status.

To address these declines, the CDC recommends several interventions, including standing orders for vaccination, immunization information systems, vaccination programs in childcare settings, strong provider recommendations, and targeted messages from credible sources. Growing the Vaccines for Children program network and ensuring it reaches all eligible children remains essential.

For IPC professionals working in pediatric settings, these findings underscore the critical importance of vaccination advocacy, patient education, and ensuring access to vaccines for all children, regardless of socioeconomic status or insurance coverage.

Reference

Hill HA, Yankey D, Elam-Evans LD, et al. Vaccination Coverage by Age 24 Months Among Children Born in 2021 and 2022 — National Immunization Survey-Child, United States, 2022–2024. MMWR Morb Mortal Wkly Rep 2026;75:146–155. DOI: http://dx.doi.org/10.15585/mmwr.mm7511a2.