Vaccination coverage among US children remained high for most routine immunizations through age two years in recent years, but declines in several vaccines—particularly influenza and the hepatitis B (HepB) birth dose—highlight growing gaps in vaccine coverage, according to a report yesterday in Morbidity and Mortality Weekly Report.
Analyzing data from 27,392 children born in 2021 and 2022, researchers from the Centers for Disease Control and Prevention (CDC) found that coverage for most recommended vaccines was similar to that seen in children born in 2019 and 2020. But coverage for five vaccines—flu, HepB birth dose, rotavirus, pneumococcal, and Haemophilus influenzae type b (Hib)—declined.
The report covers data from 2022 to 2024.
Flu, HepB vaccination rates drop
Influenza vaccination experienced the biggest decline. Coverage with at least two doses of the vaccine by age 24 months fell to 53.5% among children born in 2021–2022, down from 61.0% in the 2019–2020 birth cohort—a decline of 12.3%, or 7.5 percentage points.
The HepB birth dose dropped 1.8 percentage points (2.2%) over the same period, which, the researchers note, continued a concerning downward trend over the past three birth cohorts. The birth dose “provides the critical first line of protection against perinatal HBV infection. Without this protection, approximately 90% of U.S. infants born to women who are HBsAg-positive will develop chronic infection with HBV, and approximately 25% of them will eventually die from chronic liver disease,” the authors write.
“The HepB birth dose is also an important safety net protecting against HBV infection for infants born to the 12%–16% of pregnant women in the United States who, despite having health insurance and receiving prenatal care, are not tested for HBsAg during their pregnancy,” the authors add.
More recent data published last month reveals that, through August 2025, receipt of the HepB birth dose fell 10.3 percentage points in the previous two years, from 83.5% to 73.2%. That was before the CDC’s Advisory Committee on Immunization Practices (ACIP) voted to eliminate universal recommendations for the HBV vaccine birth dose, which will likely drive coverage down even further.
Both the flu vaccine and the HepB birth dose were recently removed from the CDC’s recommended childhood immunization schedule under the leadership of Health and Human Services Secretary Robert F. Kennedy Jr., a longtime vaccine skeptic. (Last week, a federal judge temporarily blocked the proposed cuts.)
Hib vaccination rates are also dropping, the report found. Two cases of Hib, which can cause a fatal form of meningitis, were recently reported in young children in Florida over a six-month period, despite the fact that the CDC reports 50 or fewer cases in the United States each year. One of the cases was fatal.
Coverage for several key vaccines remains high, but inequities persist
Despite those declines, coverage for several key vaccines remained high. More than 90% of children received at least one dose of measles, mumps, and rubella (MMR) vaccine (90.8%), at least one dose of varicella vaccine (90%), and three doses of poliovirus vaccine (92.1%). The proportion of children receiving no vaccines (1.2%) continued to meet the Healthy People 2030 target of 1.3% or lower.
Though fairly high, MMR coverage still falls well below the 95% target for herd immunity and is considerably below 90% in many regions, which is a major concern during the country’s worst measles outbreak in decades.
The report also underscores persistent inequities in vaccination coverage. Children eligible for the Vaccines for Children (VFC) program, a federally funded program that provides free recommended vaccines to children who might not have access or the ability to pay, had lower coverage across all vaccines compared with children who are not eligible.
Disparities were also observed by race and ethnicity and socioeconomic status. Coverage for many vaccines was lower among non-Hispanic Black children than among non-Hispanic White children. Asian children tended to have the highest coverage. Children living below the federal poverty level and those in rural areas had consistently lower vaccination rates than their higher-income and urban counterparts.
Variations by geographical region were particularly pronounced, especially for the two-dose influenza vaccine series. Coverage ranged from 25.2% in Mississippi in 2021–2022 to 78.3% in Massachusetts. From 2019–2020 to 2021–2022, coverage with two doses of influenza vaccine dropped in 30 of 56 US states and territories.
Rising measles, pertussis cases underscore need to increase uptake
Identifying gaps in coverage is important, argue the authors, as vaccine-preventable diseases continue to rise in the US. In 2025, the United States reported 2,285 measles cases, the highest annual total since elimination was declared in 2000, with 93% occurring in unvaccinated individuals or those with unknown status. And the country may eclipse the 2025 total this year by summer.
Pertussis (whooping cough) cases have also increased.
The authors point to specific strategies—such as strong, evidence-based provider recommendations, development of targeted messages from credible and trusted sources, reminders from health care providers, and increasing participation in the VFC program—as ways to boost vaccine uptake.
