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The Best (& Worst) States for Vaccinating Children

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Eric Stauffer is a former insurance agent and banker turned consumer advocate. His priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best...

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UPDATED: Mar 19, 2020

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closeup of vaccine with single-use needle

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Thanks to a worldwide vaccination effort led by the World Health Organization, smallpox became the first disease to be completely eradicated in 1978. Since then, the United States has eliminated other diseases including polio (in 1979) and measles (in 2000) as a result of the collective immunity acquired through vaccination. However, in the last several years, diseases like measles have returned to the U.S., with a significant spike in the number of cases reported.

New data from the CDC shows a more than 3X increase in the number of measles cases between 2018 and 2019.

The number of reported measles cases in 2019 is the highest since 1992, countering a long-term downward trend since the measles vaccination program started in 1963.

While the current measles vaccine is about 97 percent effective at preventing the disease, the majority of new measles cases are among groups of people who were not vaccinated.

line graph showing Measles cases over time

Disparities in vaccination rates have long persisted across certain demographic groups due to differences in health care access. For example, affluent children are more likely to be vaccinated than children in low-income communities. However, increased parental concern over vaccine safety and efficacy has rejuvenated a social movement aiming to prevent children’s vaccinations.

The anti-vaccination movement, which gained prominence in the U.S. through social media and television talk shows, is weakening the nation’s collective immunity.

This became particularly evident in 2014 during one of the most infamous measles outbreaks in recent years, which originated in Disneyland and spread to 111 cases nationwide.

Some victims were too young to have been vaccinated, but almost half did not receive vaccines due to “philosophical or religious objections,” a phenomenon that has been growing in recent years.

Given recent outbreaks in measles and the rise of the anti-vaccination movement, researchers here at ExpertInsuranceReviews.com wanted to find which states are best and worst at vaccinating their children. Using data from the Centers for Disease Control and Prevention’s National Immunization Survey, we examined how many children have completed the combined 7-vaccine series, which includes:

  • 4 or more doses of DTaP
  • 3 or more doses of Polio
  • 1 or more dose of MMR
  • Hib full series (3 or 4 doses)
  • 3 or more doses of HepB
  • 1 or more dose of Varicella
  • 4 or more doses of PCV

There are large differences in vaccination rates across many state lines; for example Montana and North Dakota are at opposite ends of the spectrum despite their geographic proximity. Interestingly, Western states including Oregon, Arizona, and Washington, which ordinarily score well in health-related measures, have low vaccination rates among kids. With the exception of New York State, New England is the only region with consistently high combined vaccination rates in the U.S.

Let’s jump in to the 20 best and worst states starting with the 10 with the most children immunized against these diseases.

The 10 States with the Highest Child Vaccination Rates

Boston, Massachusetts, USA cityscape with the State House.

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#1 – Massachusetts

  • Combined 7-vaccine series: 85.9%
  • DTaP (≥4 doses): 92.5%
  • Polio (≥3 doses): 97.5%
  • MMR (≥1 dose): 96.9%
  • Hib (full series): 92.3%
  • HepB (≥3 doses): 74.8%
  • Varicella (≥1 dose): 97.3%
  • PCV (≥4 doses): 93.3%
State Capitol of North Dakota, Bismarck

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#2 – North Dakota

  • Combined 7-vaccine series: 85.6%
  • DTaP (≥4 doses): 90.2%
  • Polio (≥3 doses): 95.1%
  • MMR (≥1 dose): 93.6%
  • Hib (full series): 90.3%
  • HepB (≥3 doses): 88.2%
  • Varicella (≥1 dose): 92.2%
  • PCV (≥4 doses): 89.5%

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Nebraska State Capitol, Lincoln, Nebraska, United States of America, North America

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#3 – Nebraska

  • Combined 7-vaccine series: 85.5%
  • DTaP (≥4 doses): 95.3%
  • Polio (≥3 doses): 95.1%
  • MMR (≥1 dose): 94.9%
  • Hib (full series): 92.0%
  • HepB (≥3 doses): 87.4%
  • Varicella (≥1 dose): 95.4%
  • PCV (≥4 doses): 92.2%
Connecticut State Capitol in Hartford, Connecticut, USA during autumn.

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#4 – Connecticut

  • Combined 7-vaccine series: 85.2%
  • DTaP (≥4 doses): 93.1%
  • Polio (≥3 doses): 97.7%
  • MMR (≥1 dose): 96.3%
  • Hib (full series): 90.9%
  • HepB (≥3 doses): 80.2%
  • Varicella (≥1 dose): 99.5%
  • PCV (≥4 doses): 90.8%
Des Moines, Iowa - Different views of State Capitol Building

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#5 – Iowa

  • Combined 7-vaccine series: 81.9%
  • DTaP (≥4 doses): 92.4%
  • Polio (≥3 doses): 96.0%
  • MMR (≥1 dose): 92.9%
  • Hib (full series): 87.6%
  • HepB (≥3 doses): 82.3%
  • Varicella (≥1 dose): 91.2%
  • PCV (≥4 doses): 92.5%
Capitol Building Harrisburg, Pennsylvania

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#6 – Pennsylvania

  • Combined 7-vaccine series: 81.5%
  • DTaP (≥4 doses): 89.1%
  • Polio (≥3 doses): 94.2%
  • MMR (≥1 dose): 96.1%
  • Hib (full series): 86.1%
  • HepB (≥3 doses): 83.4%
  • Varicella (≥1 dose): 94.5%
  • PCV (≥4 doses): 92.5%
Alabama State Capitol in Montgomery, Alabama.

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#7 – Alabama

  • Combined 7-vaccine series: 81.3%
  • DTaP (≥4 doses): 91.1%
  • Polio (≥3 doses): 93.9%
  • MMR (≥1 dose): 94.8%
  • Hib (full series): 88.0%
  • HepB (≥3 doses): 78.3%
  • Varicella (≥1 dose): 94.4%
  • PCV (≥4 doses): 86.3%
Raleigh, North Carolina, USA State Capitol Building.

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#8 – North Carolina

  • Combined 7-vaccine series: 80.8%
  • DTaP (≥4 doses): 89.8%
  • Polio (≥3 doses): 96.2%
  • MMR (≥1 dose): 94.0%
  • Hib (full series): 87.1%
  • HepB (≥3 doses): 73.7%
  • Varicella (≥1 dose): 94.4%
  • PCV (≥4 doses): 88.9%
Colorado State Capital Building in Denver, Colorado

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#9 – Colorado

  • Combined 7-vaccine series: 80.0%
  • DTaP (≥4 doses): 89.9%
  • Polio (≥3 doses): 91.3%
  • MMR (≥1 dose): 92.8%
  • Hib (full series): 87.8%
  • HepB (≥3 doses): 73.2%
  • Varicella (≥1 dose): 91.1%
  • PCV (≥4 doses): 85.2%

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The state house capital building of New Hampshire is located in the city of Concord, NH, USA with surrounding grounds.

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#10 – New Hampshire

  • Combined 7-vaccine series: 79.8%
  • DTaP (≥4 doses): 91.1%
  • Polio (≥3 doses): 95.9%
  • MMR (≥1 dose): 93.0%
  • Hib (full series): 87.6%
  • HepB (≥3 doses): 73.2%
  • Varicella (≥1 dose): 89.2%
  • PCV (≥4 doses): 86.0%

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The 10 States with the Lowest Child Vaccination Rates

Montana's State Capitol Building, Helena, Montana, USA

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#1 – Montana

  • Combined 7-vaccine series: 64.0%
  • DTaP (≥4 doses): 81.0%
  • Polio (≥3 doses): 93.5%
  • MMR (≥1 dose): 92.1%
  • Hib (full series): 76.3%
  • HepB (≥3 doses): 75.4%
  • Varicella (≥1 dose): 89.7%
  • PCV (≥4 doses): 79.3%
Indiana state capitol building in Indianapolis

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#2 – Indiana

  • Combined 7-vaccine series: 67.3%
  • DTaP (≥4 doses): 82.2%
  • Polio (≥3 doses): 93.4%
  • MMR (≥1 dose): 92.1%
  • Hib (full series): 76.0%
  • HepB (≥3 doses): 78.6%
  • Varicella (≥1 dose): 89.4%
  • PCV (≥4 doses): 77.5%
Olympia, Washington, USA state capitol building at dusk.

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#3 – Washington

  • Combined 7-vaccine series: 68.6%
  • DTaP (≥4 doses): 84.4%
  • Polio (≥3 doses): 88.3%
  • MMR (≥1 dose): 93.8%
  • Hib (full series): 76.9%
  • HepB (≥3 doses): 72.0%
  • Varicella (≥1 dose): 93.0%
  • PCV (≥4 doses): 80.4%
St. Paul state capital building

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#4 – Minnesota

  • Combined 7-vaccine series: 68.9%
  • DTaP (≥4 doses): 82.5%
  • Polio (≥3 doses): 93.5%
  • MMR (≥1 dose): 93.2%
  • Hib (full series): 81.5%
  • HepB (≥3 doses): 68.0%
  • Varicella (≥1 dose): 91.2%
  • PCV (≥4 doses): 83.0%
The South Carolina State House in Columbia.

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#5 – South Carolina

  • Combined 7-vaccine series: 70.1%
  • DTaP (≥4 doses): 89.2%
  • Polio (≥3 doses): 94.2%
  • MMR (≥1 dose): 89.8%
  • Hib (full series): 80.0%
  • HepB (≥3 doses): 71.3%
  • Varicella (≥1 dose): 92.4%
  • PCV (≥4 doses): 85.3%
Jackson, Mississippi, USA cityscape at dusk.

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#6 – Mississippi

  • Combined 7-vaccine series: 70.2%
  • DTaP (≥4 doses): 81.1%
  • Polio (≥3 doses): 92.3%
  • MMR (≥1 dose): 91.3%
  • Hib (full series): 78.7%
  • HepB (≥3 doses): 75.5%
  • Varicella (≥1 dose): 92.0%
  • PCV (≥4 doses): 79.1%

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Missouri State Capital Building in Jefferson City, Missouri

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#7 – Missouri

  • Combined 7-vaccine series: 70.4%
  • DTaP (≥4 doses): 80.4%
  • Polio (≥3 doses): 96.6%
  • MMR (≥1 dose): 88.1%
  • Hib (full series): 75.5%
  • HepB (≥3 doses): 84.3%
  • Varicella (≥1 dose): 89.2%
  • PCV (≥4 doses): 78.9%
Capitol Building in Phoenix Arizona

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#8 – Arizona

  • Combined 7-vaccine series: 70.7%
  • DTaP (≥4 doses): 84.5%
  • Polio (≥3 doses): 90.6%
  • MMR (≥1 dose): 91.1%
  • Hib (full series): 76.7%
  • HepB (≥3 doses): 79.6%
  • Varicella (≥1 dose): 91.8%
  • PCV (≥4 doses): 76.2%
Tallahassee, Florida, USA at the historic Florida State Capitol Building.

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#9 – Florida

  • Combined 7-vaccine series: 70.8%
  • DTaP (≥4 doses): 85.7%
  • Polio (≥3 doses): 94.1%
  • MMR (≥1 dose): 92.6%
  • Hib (full series): 79.6%
  • HepB (≥3 doses): 66.2%
  • Varicella (≥1 dose): 92.9%
  • PCV (≥4 doses): 79.9%
Albany, New York, USA at the New York State Capitol.

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#10 – New York

  • Combined 7-vaccine series: 70.9%
  • DTaP (≥4 doses): 85.7%
  • Polio (≥3 doses): 94.8%
  • MMR (≥1 dose): 93.0%
  • Hib (full series): 83.3%
  • HepB (≥3 doses): 72.0%
  • Varicella (≥1 dose): 93.4%
  • PCV (≥4 doses): 86.6%

Detailed Findings & Methodology

Data on children’s vaccination coverage for the combined 7-vaccine series are from the Centers for Disease Control and Prevention’s National Immunization Survey. The combined 7-vaccine series includes: 4 or more doses of DTaP, 3 or more doses of Polio, 1 or more doses of MMR, Hib full series (3 or 4 doses, depending on product type received), 3 or more doses of HepB, 1 or more doses of Varicella, and 4 or more doses of PCV.

Vaccine statistics by state are for 19- to 35-month old children born in 2015 and 2016. The numbers of measles cases by year, as well as vaccination rates by demographic group, are also from the CDC.

Race plays a significant role when it comes to vaccinations. Nationally, there is a consistent gap of almost 6 percentage points between the vaccination rate of whites and Asians compared to African-Americans and Native Americans. A characteristic even more impactful than race is poverty status—the analysis found that those below the poverty level have lower vaccination rates by 10 percentage points, a gap which has been consistent for the last decade, and which poses a serious health threat.

Vaccination rate by race

Despite the recent outbreaks in the U.S. and abroad, the combined 7-vaccine series rate has actually increased from 40 percent to more than 70 percent nationally since 2009. This is largely thanks to more vaccinations for Rotavirus and Hib (influenzae), which were previously at lower levels.

The most pressing issue today is that a number of close-knit communities choose to exempt their children from vaccinations, frequently due to “philosophical or religious” reasons.

In 2014, when the U.S. experienced the largest measles outbreak in decades, more than half of those infected were from an underimmunized Amish community, which chose not to vaccinate their children.

Vaccination rate by poverty

The MMR vaccine, which protects children from measles, mumps, and rubella, has been associated with sizable controversy ever since a study was published linking the vaccine to autism. While the study has been retracted and debunked numerous times, healthcare workers and researchers still struggle to persuade some parents to vaccinate their children.

During the eradication of smallpox campaign, non-existing infrastructure, war conflict, and lack of trust in health authorities proved to be the toughest challenges. Today, despite improvements in infrastructure and living conditions, misinformation and lack of trust in authorities are proving as difficult to overcome as 50 years ago.

Complete Results: All States + D.C.

StateRankAvgDTaPPolioMMRHibHepBVaricellaPCV
Massachusetts185.9%92.5%97.5%96.9%92.3%74.8%97.3%93.3%
North Dakota285.6%90.2%95.1%93.6%90.3%88.2%92.2%89.5%
Nebraska385.5%95.3%95.1%94.9%92.0%87.4%95.4%92.2%
Connecticut485.2%93.1%97.7%96.3%90.9%80.2%99.5%90.8%
Iowa581.9%92.4%96.0%92.9%87.6%82.3%91.2%92.5%
Pennsylvania681.5%89.1%94.2%96.1%86.1%83.4%94.5%92.5%
Alabama781.3%91.1%93.9%94.8%88.0%78.3%94.4%86.3%
North Carolina880.8%89.8%96.2%94.0%87.1%73.7%94.4%88.9%
Colorado980.0%89.9%91.3%92.8%87.8%73.2%91.1%85.2%
New Hampshire1079.8%91.1%95.9%93.0%87.6%73.2%89.2%86.0%
Kentucky1179.3%91.9%99.0%95.4%88.2%83.9%95.3%89.9%
Illinois1279.1%90.4%96.2%94.1%86.2%75.0%95.2%88.1%
Vermont1379.0%86.6%94.0%91.5%85.6%58.1%90.4%87.7%
New Mexico1478.8%91.3%96.4%93.6%86.2%70.0%92.3%85.8%
West Virginia1578.6%89.3%93.9%92.8%88.4%72.9%92.0%87.6%
Arkansas1678.6%90.9%93.6%96.5%86.4%76.3%94.8%81.5%
New Jersey1778.4%90.1%95.5%96.5%87.2%68.0%94.2%88.3%
Wisconsin1878.0%89.8%96.0%98.0%85.9%81.5%97.7%85.2%
Delaware1977.4%90.8%95.4%94.2%83.8%81.2%94.3%92.0%
Maine2077.3%94.7%94.0%94.0%84.3%70.1%93.9%87.7%
South Dakota2176.8%84.7%91.0%95.5%84.3%79.2%95.0%87.8%
Maryland2276.6%85.7%94.0%93.6%87.3%75.1%92.8%85.0%
Georgia2376.5%88.3%96.3%94.3%84.0%77.4%94.5%83.6%
Virginia2476.4%91.5%96.9%92.8%85.7%74.2%96.5%91.4%
Tennessee2576.1%89.4%93.3%93.0%84.6%71.2%93.8%80.8%
Idaho2675.9%87.0%91.8%94.4%85.1%73.1%93.6%85.1%
Utah2775.9%87.2%92.3%90.5%82.6%85.2%90.6%84.0%
Texas2875.7%89.1%94.8%93.0%84.3%79.4%92.6%85.4%
Kansas2975.7%83.8%94.2%95.9%81.9%67.6%98.8%85.3%
Rhode Island3075.1%89.4%97.5%94.9%86.8%79.7%96.3%92.4%
Louisiana3174.7%83.8%95.6%94.4%87.3%79.8%94.4%83.1%
Hawaii3274.3%89.8%92.4%93.0%81.9%75.9%87.5%84.8%
District of Columbia3373.3%91.2%94.3%91.9%82.5%75.2%93.4%87.2%
Ohio3473.2%90.1%92.5%94.0%81.5%78.8%89.7%84.0%
Michigan3573.2%84.7%94.9%94.4%83.1%77.7%96.3%82.9%
Wyoming3672.6%82.0%92.9%89.2%85.0%62.5%89.6%82.1%
California3772.2%87.8%91.9%92.0%82.1%68.9%98.1%80.2%
Alaska3871.9%80.4%91.4%88.8%82.6%69.7%85.3%80.7%
Nevada3971.3%84.5%90.2%92.0%80.5%76.4%91.1%80.1%
Oklahoma4071.2%86.1%94.0%91.9%82.3%78.5%92.8%82.0%
Oregon4171.1%81.0%95.0%94.9%79.9%77.3%94.1%83.3%
New York4270.9%85.7%94.8%93.0%83.3%72.0%93.4%86.6%
Florida4370.8%85.7%94.1%92.6%79.6%66.2%92.9%79.9%
Arizona4470.7%84.5%90.6%91.1%76.7%79.6%91.8%76.2%
Missouri4570.4%80.4%96.6%88.1%75.5%84.3%89.2%78.9%
Mississippi4670.2%81.1%92.3%91.3%78.7%75.5%92.0%79.1%
South Carolina4770.1%89.2%94.2%89.8%80.0%71.3%92.4%85.3%
Minnesota4868.9%82.5%93.5%93.2%81.5%68.0%91.2%83.0%
Washington4968.6%84.4%88.3%93.8%76.9%72.0%93.0%80.4%
Indiana5067.3%82.2%93.4%92.1%76.0%78.6%89.4%77.5%
Montana5164.0%81.0%93.5%92.1%76.3%75.4%89.7%79.3%
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References:

  1. https://www.who.int/about/bugs_drugs_smoke_chapter_1_smallpox.pdf
  2. https://www.cdc.gov/measles/cases-outbreaks.html
  3. https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002578
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122668/
  5. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6414a1.htm
  6. https://www.cdc.gov/mmwr/volumes/68/wr/mm6817e1.htm
  7. https://www.medscape.com/viewarticle/716322
  8. https://vaccine-safety-training.org/mmr-vaccine-increases.html
  9. http://feeds.feedburner.com/Expertinsurancereviews

About Eric Stauffer

Author: Eric StaufferI am a former insurance agent and banker turned consumer advocate. My priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

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