Failure to Complete Multidose Vaccine Series in Early Childhood

Sarah Y. Michels, Linda M. Niccolai, James L. Hadler, Rain E. Freeman, Alexandria N. Albers, Jason M. Glanz, Matthew F. Daley, Sophia R. Newcomer

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


BACKGROUND: Most early childhood immunizations require 3 to 4 doses to achieve optimal protection. Our objective was to identify factors associated with starting but not completing multidose vaccine series. METHODS: Using 2019 National Immunization Survey-Child data, US children ages 19 to 35 months were classified in 1 of 3 vaccination patterns: (1) completed the combined 7-vaccine series, (2) did not initiate $1 of the 7 vaccine series, or (3) initiated all series, but did not complete $1 multidose series. Associations between sociodemographic factors and vaccination pattern were evaluated using multivariable log-linked binomial regression. Analyses accounted for the survey’s stratified design and complex weighting. RESULTS: Among 16 365 children, 72.9% completed the combined 7-vaccine series, 9.9% did not initiate $1 series, and 17.2% initiated, but did not complete $1 multidose series. Approximately 8.4% of children needed only 1 additional vaccine dose from 1 of the 5 multidose series to complete the combined 7-vaccine series. The strongest associations with starting but not completing multidose vaccine series were moving across state lines (adjusted prevalence ratio [aPR] 5 1.45, 95% confidence interval [CI]: 1.18–1.79), number of children in the household (2 to 3: aPR 5 1.29, 95% CI: 1.05–1.58; 4 or more: aPR 5 1.68, 95% CI: 1.30–2.18), and lack of insurance coverage (aPR 5 2.03, 95% CI: 1.42–2.91). CONCLUSIONS: More than 1 in 6 US children initiated but did not complete all doses in multidose vaccine series, suggesting children experienced structural barriers to vaccination. Increased focus on strategies to encourage multidose series completion is needed to optimize protection from preventable diseases and achieve vaccination coverage goals.

Original languageEnglish
Article numbere2022059844
Issue number2
StatePublished - Aug 1 2023


  • Humans
  • Child, Preschool
  • Infant
  • Vaccination
  • Vaccines
  • Vaccination Coverage
  • Family Characteristics


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