Coverage was evaluated by selected community-level characteristics matched to vaccine recipients' county of residence. § § § County-level rankings of social vulnerability from the 2018 CDC Social Vulnerability Index (SVI), which is used to identify community needs during emergencies, were categorized into quartiles based on distribution among all U.S. counties. ¶ ¶ ¶ County-level data on Social Determinants of Health**** obtained from the American Community Survey † † † † were dichotomized based on the median of all U.S. counties. § § § § County-level urbanicity was based on the 2013 National Center for Health Statistics urban-rural classification scheme. ¶ ¶ ¶ ¶ Generalized estimating equation models with binomial regression and an identity link were used to † † † Periods are based on eligibility and other process factors (e.g., phase of vaccine rollout, eligible population, supply, and programs and policy enacted) important in framing the specific needs and constraints at that time. Period 1 represented when most states opened eligibility to health care workers, residents in long-term care facilities, and older adults while there was a highly constrained supply, which overlapped phase 1a, and a portion of phase 1b (https://www.cdc.gov/mmwr/volumes/69/wr/ mm695152e2.htm). Period 2 represented when states were expanding eligibility inconsistently, and supply was becoming more available, which overlapped with phases 1b and 1c. Period 3 represented when all states expanded eligibility to all adults while supply was steady and increased, which overlapped with phases 1c and 2. § § § The following jurisdictions were excluded from all county-level analyses (National Center for Health Statistics urban-rural, SVI, and Social Determinants of Health) due to lack of county-level vaccination data: all counties in Hawaii and eight counties in California for which total population was <20,000. Among all first doses analyzed during December 14, 2020-May 22, 2021, 5.9% were missing county data and were therefore excluded from models. ¶ ¶ ¶ Fifteen elements categorized into four themes (socioeconomic status, household composition and disability, racial/ethnic minority status and language, and housing type and transportation) are included in SVI (https:// www.atsdr.cdc.gov/placeandhealth/svi/documentation/pdf/ SVI2018Documentation-H.pdf ). Overall SVI includes all 15 indicators as a composite measure (https://www.atsdr.cdc.gov/placeandhealth/svi/ fact_sheet/fact_sheet.html). One county in New Mexico was excluded because SVI ranking could not be calculated (https://www.atsdr.cdc.gov/ placeandhealth/svi/index.html). **** Measures of Social Determinants of Health from the American Community Survey: percentage of the total population 1) unemployed, 2) uninsured, 3) that earned an income below the federal poverty level, 4) without a computer (e.g., desktop or laptop computer [excludes mobile phones]), 5) with a computer but without Internet access, and 6) identifying as a racial/ethnic group other than non-Hispanic White (https://healt...

OBJECTIVES: To quantify the prevalence of parental vaccine hesitancy (VH) in the United States and examine the association of VH with sociodemographics and childhood influenza vaccination coverage. METHODS: A 6-question VH module was included in the 2018 and 2019 National Immunization Survey-Flu, a telephone survey of households with children age 6 months to 17 years. RESULTS: The percentage of children having a parent reporting they were “hesitant about childhood shots” was 25.8% in 2018 and 19.5% in 2019. The prevalence of concern about the number of vaccines a child gets at one time impacting the decision to get their child vaccinated was 22.8% in 2018 and 19.1% in 2019; the prevalence of concern about serious, long-term side effects impacting the parent’s decision to get their child vaccinated was 27.3% in 2018 and 21.7% in 2019. Only small differences in VH by sociodemographic variables were found, except for an 11.9 percentage point higher prevalence of “hesitant about childhood shots” and 9.9 percentage point higher prevalence of concerns about serious, long-term side effects among parents of Black compared with white children. In both seasons studied, children of parents reporting they were “hesitant about childhood shots” had 26 percentage points lower influenza vaccination coverage compared with children of parents not reporting hesitancy. CONCLUSIONS: One in 5 children in the United States have a parent who is vaccine hesitant, and hesitancy is negatively associated with childhood influenza vaccination. Monitoring VH could help inform immunization programs as they develop and target methods to increase vaccine confidence and vaccination coverage.

Human papillomavirus (HPV) vaccine is routinely recommended for adolescents at age 11 or 12 years for protection from cancers and other diseases caused by HPV infection. In 2012, only 53.8% of females and 20.8% of males aged 13-17 received one or more doses of HPV vaccine. Due to low vaccination uptake, the Centers for Disease Control and Prevention supported the efforts of several national partner organizations to help raise HPV vaccination rates. National partners include the Academic Pediatric Association, the American Academy of Pediatrics, the American Cancer Society, the National Area Health Education Centers Organization, and the National Association of County and City Health Officials. These national partners have focused on improving provider education on effective HPV vaccine recommendations, prioritizing HPV vaccination, forming strong partnerships, developing and disseminating HPV vaccination resources for members and the public, and quality improvement.

Most pediatric practices surveyed were aware of the shortage and were implementing the heptavalent pneumococcal conjugate vaccine recommendations. Simplified recommendations and collaborative efforts to develop and widely disseminate interim recommendations may result in increased compliance by providers.