Completion of multidose vaccine series in early childhood: current challenges and opportunities

Sarah Y. Michels, Matthew F. Daley, Sophia R. Newcomer

Research output: Contribution to journalReview articlepeer-review


Purpose of reviewCompletion of all doses in multidose vaccine series provides optimal protection against preventable infectious diseases. In this review, we describe clinical and public health implications of multidose vaccine series noncompletion, including current challenges to ensuring children receive all recommended vaccinations. We then highlight actionable steps toward achieving early childhood immunization goals.Recent findingsAlthough coverage levels are high for most early childhood vaccinations, rates of completion are lower for vaccinations that require multiple doses. Recent research has shown that lower family socioeconomic status, a lack of health insurance coverage, having multiple children in the household, and moving across state lines are associated with children failing to complete multidose vaccine series. These findings provide contextual evidence to support that practical challenges to accessing immunization services are impediments to completion of multidose series. Strategies, including reminder/recall, use of centralized immunization information systems, and clinician prompts, have been shown to increase immunization rates. Re-investing in these effective interventions and modernizing the public health infrastructure can facilitate multidose vaccine series completion.SummaryCompletion of multidose vaccine series is a challenge for immunization service delivery. Increased efforts are needed to address remaining barriers and improve vaccination coverage in the United States.

Original languageEnglish
Pages (from-to)176-184
Number of pages9
JournalCurrent Opinion in Infectious Diseases
Issue number3
StatePublished - Jun 1 2024


  • immunization delivery
  • immunization information systems
  • vaccine series completion
  • Vaccination/statistics & numerical data
  • Vaccines/administration & dosage
  • Humans
  • Immunization Programs
  • Child, Preschool
  • Vaccination Coverage/statistics & numerical data
  • Immunization Schedule
  • Infant


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