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Health Indicator Report of Immunizations 4:3:1:3:3:1

Immunizations are the most cost-effective health prevention measures. Development of vaccinations had been cited by the U.S. Public Health Service as one of the Ten Great Public Health Achievements in the 20th Century^1^. Vaccines play an essential role in reducing and eliminating disease. By two years of age, it is recommended that all children should have received 4 doses of diphtheria-tetanus-pertussis (DTP), 3 doses of polio, 1 dose of measles-mumps-rubella (MMR), 3 doses of Hepatitis B, 3 or 4 doses of ''Haemophilus influenzae'' type B (Hib) (depending on product type received), and 1 dose of Varicella vaccine. This recommendation is referred to in shorthand as "4:3:1:3:3:1." [[br]][[br]] ---- 1. Centers for Disease Control and Prevention. (1999). Achievements in Public Health, 1900-1999: Impact of vaccines universally recommended for children -- United States 1990-1998. ''Morbidity and Mortality Weekly Report,'' Vol. 48, (12);243-248. Atlanta, GA: author.

Childhood Immunization Coverage by Antigen, Utah, 2015

Data Source

National Immunization Survey, National Center for Health Statistics, U.S. Centers for Disease Control and Prevention

Data Interpretation Issues

The National Immunization Survey (NIS) is conducted by the Centers for Disease Control and Prevention (CDC) and uses random-digit-dialing to find households throughout the U.S. with children aged 19 to 35 months. They ask parents or guardians to tell them the vaccines (with dates) that appear on the child's "shot card" kept in the home, and they also collect demographic and socioeconomic information. At the end of the interview, they ask for permission to contact the child's vaccination providers. Providers are then contacted by mail to verify each child's vaccinations. The NIS uses a nationally representative sample, and provides estimates of coverage that are weighted to represent the entire population, nationally, and by region, state, and selected large metro areas. The large sample size (approximately 15,000) allows them to stratify (that is, subdivide) the data so that they can examine vaccination rates among different groups, for instance by income level, race, education level of mothers, and other factors. In 2014, NIS analysis for the complete 4:3:1:3:3:1 series was updated to provide a more accurate assessment of ''Haemophilus influenzae'' type B (HIB) vaccination. Past surveys classified the minimum number of Hib doses necessary as complete even though certain brands required more doses; the 2014 survey took into account the Hib vaccine brand, if known, and classified a child as complete only if the appropriate number of doses had been administered. The 2014 results are more accurate and better match methods now used by the CDC. Due to this change, the 2014 and 2015 results for 4:3:1:3:3:1 coverage are not comparable to prior years.


Children aged 19-35 months who received the recommended vaccines (4 DTaP, 3 Polio, 1 MMR, 3 Hep B, Hib full series, 1 Varicella).


Number of children aged 19-35 months that have received at least 4 doses of DTaP, 3 doses of Polio, 1 dose of MMR, 3 doses of Hep B, 3 or 4 doses of Hib (depending on product type), 1 dose of Varicella.


Children aged 19-35 months.

Healthy People Objective IID-7:

Achieve and maintain effective vaccination coverage levels for universally recommended vaccines among young children
U.S. Target: Not applicable, see subobjectives in this category

Other Objectives

Utah's 42 Community Health Indicators ===Healthy People 2020 related subobjectives and targets for IID-7:=== IID-7.1: Maintain an effective vaccination coverage level of 4 doses of the diphtheria-tetanus-acellular pertussis (DTaP) vaccine among children by age 19 to 35 months[[br]] '''U.S. Target:''' 90.0 percent [[br]][[br]] IID-7.2: Achieve and maintain an effective vaccination coverage level of 3 or 4 doses of ''Haemophilus influenzae'' type b (Hib) vaccine among children by age 19 to 35 months[[br]] '''U.S. Target:''' 90.0 percent [[br]][[br]] IID-7.3: Maintain an effective vaccination coverage level of 3 doses of hepatitis B (hep B) vaccine among children by age 19 to 35 months[[br]] '''U.S. Target:''' 90.0 percent [[br]][[br]] IID-7.4: Maintain an effective coverage level of 1 dose of measles-mumps-rubella (MMR) vaccine among children by age 19 to 35 months[[br]] '''U.S. Target:''' 90.0 percent [[br]][[br]] IID-7.5: Maintain an effective coverage level of 3 doses of polio vaccine among children by age 19 to 35 months[[br]] '''U.S. Target:''' 90.0 percent [[br]][[br]] IID-7.6: Maintain an effective coverage level of 1 dose of varicella vaccine among children by age 19 to 35 months[[br]] '''U.S. Target:''' 90.0 percent [[br]][[br]]

How Are We Doing?

Utah's coverage levels have steadily increased in past years from 68.2% of 2-year-old children fully immunized in 2011 to 80.5% in 2013. In 2015, Utah's coverage rate was 73.6%. The change to brand-specific full series analysis for HIB vaccination likely lowered coverage rates in 2014 when compared to historical 4:3:1:3:3:1 vaccination coverage rates (see data interpretation issues). These data typically fluctuate from year to year and it is useful to look at 5-10 year trends to gain a clear understanding of how well Utah is immunizing its children.

How Do We Compare With the U.S.?

In 2015, Utah's coverage rate for 4:3:1:3:3:1 immunization of 73.6% while the United States coverage rate was 75.1%. Utah's 4:3:1:3:3:1 immunization ranking (among the 50 states) was 34th in 2015, 24th in 2014, 16th in 2013, 15th in 2012, and 42nd in 2011.

What Is Being Done?

The Utah Department of Health's Immunization Program conducts annual assessments of private and public health care providers' immunization records to obtain state immunization levels. During these site visits, Utah Immunization Program provider representatives also train clinic staff on appropriate vaccine storage, handling, and administration according to the Advisory Committee on Immunization Practices (ACIP) recommended practices. Utah also has immunization coalitions that are working to maintain or improve current levels of immunization and to increase public awareness of immunizations. Utah's Statewide Immunization Information System (USIIS) provides a mechanism for health care providers to track patient immunizations and send reminder cards to Utah parents whose children are due for immunizations. USIIS also includes adult immunizations, such as pneumonia, tetanus, and influenza. Due to the increased costs of vaccine, public health clinics are now able to provide publicly purchased vaccine only to those who meet eligibility criteria and don't have insurance coverage.

Available Services

Vaccines for Children (VFC) Program: This program gives free vaccines to physicians/clinics that allow patients to remain in their medical home. Patients must qualify for this program. General information about immunizations for school-age children, adolescents, college students/missionaries, adults, and travel is available on our web site: []. For information on vaccine providers in your area, contact the Immunization Hotline at 1-800-275-0659.
Page Content Updated On 10/31/2016, Published on 12/06/2016
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Content updated: Fri, 26 May 2017 10:19:46 MDT