Background
This annual report shows vaccination coverage, or vaccination rates, from 2019-2022 among Vermont children, based on data in the Vermont Immunization Registry (IMR). It highlights changes from year to year and helps the Immunization Program focus their efforts to improve the health of Vermonters.
Ages used in this report are calculated as of December 31, 2022 and rates are based on immunizations given through that date.
About the IMR
The IMR is a secure, centralized health information system that contains immunization histories for Vermonters. While reporting all immunizations given in Vermont is required by state law, the valuable resource of individual records is used across the state by health professionals. For example, its easy and secure access allows providers to determine if you need a tetanus shot when you show up in the emergency room with a cut finger. The data in the system also informs public health officials on the vaccination rates of Vermonters by demographics, locations and vaccination type.
2022 IMR Basic Statistics
As of December 31, 2022:
- Total Number of Patients with Immunization Records: 1,028,455 (increase of >150,000 since 2020)
- Total Number of Immunizations in the IMR: 13,392,460
- Number of Immunizations added in 2022: 1,197,649
- Hospitals reporting to the IMR: All VT hospitals and Dartmouth Hitchcock Medical Center in NH
- Percent of Chain Pharmacies reporting: 100%
- Number of Provider Sites (all types) reporting: 359
- Percent of Public Schools using the IMR: 99%
Vaccine Coverage by the Age of Two
Traditionally, vaccine coverage is assessed in young children after the age of 18 months, by which time Centers for Disease Control and Prevention (CDC) recommends children should have received:
- Four doses of DTaP (Diphtheria, Tetanus, Pertussis)
- Three doses of Polio
- One dose of MMR (Measles, Mumps, Rubella)
- Four doses of Hib (Haemophilus Influenza Type B)
- Three doses of HepB (Hepatitis B)
- One dose of Varicella
- Four doses of PCV (Pneumococcal)
Collectively, these are termed the Childhood Seven Series. In 2022, 75.5% of Vermont two-year olds were up to date for the Childhood Seven Series.
The table below shows rates by vaccine series. Overall, vaccination rates have remained stable since 2019. Of note, the DTaP series and the PCV series, both of which require four doses, continue to have the lowest rates.
Vaccination rates (%) for 2 year olds are stable since 2019
Childhood Seven Series (age 2)
The below graph shows variability in the county level coverage for 2022. These ranged from a low of 59.6% in Essex County to a high of 82.0% in Rutland County.
The table compares county coverage rates over time, from 2019 to 2022. Essex County consistently has the lowest Seven Series completion rate among all Vermont counties. Variability in coverage rate over the years is higher in smaller counties (e.g., Essex and Grand Isle) compared to larger counties (e.g., Chittenden) as changes are likely influenced by small population sizes.
By County 2022
By County 2019-2022: % complete (total vaccinated)
Coverage Among Vermont Teens by Age 15
Measuring vaccine coverage in teens focuses on specific vaccines recommended from age 11 years forward, including:
- Human Papilloma Virus (HPV)
- Meningococcal vaccine
- Tdap (Tetanus, Diptheria, Pertussis)
Coverage rates of these three vaccines among teens (15 years old) were stable from 2019 to 2022 (see below figure), though rates are consistently lower for Meningococcal and HPV vaccine compared to Tdap.
Vaccination rates (%) among 15 year olds are stable since 2019
Tdap, Meningococcal, HPV Vaccine by age 15, by County, 2022
HPV
HPV vaccination is routinely recommended for teens at age 11-12. Teens who receive the first dose by the age of 15 need only one more dose to complete the series. Those who start after age 15 need a third dose to be protected. Two-thirds (66.7%) of Vermonters received at least one dose of HPV by age 15, with a low of 56.4% in Essex County and a high of 76.0% in Orange County (below map, HPV 1+ dose).
Statewide, 53.8% of Vermont youth aged 15 completed the HPV vaccine series, below the coverage goal of 80%. In six Vermont counties, more than 55% of 15-year-olds have completed the series (below map, HPV 2+ doses). These include Addison, Chittenden, Grand Isle, Orange, Rutland and Washington Counties. Teens who are immunized with HPV vaccine are protected against cervical, oral, genital and rectal cancers caused by this virus. In other areas of the state, vaccine coverage is lower: Bennington, Caledonia, Essex, Windham and Windsor are all below 50%.
Meningococcal
Teens are recommended to receive two doses of Meningococcal vaccine. The first dose between age 11-12 years and the second dose at age 16. Meningococcal coverage is assessed by measuring how many teens have received at least one dose of Meningococcal vaccine by age 15. Meningococcal vaccine coverage by age 15 in Vermont in 2022 was 74.5%. The below map (Mening 1+ dose) shows coverage varies by county, with Franklin and Grand Isle Counties achieving over 80% coverage. Essex and Windham counties have coverage under 70%.
Tdap
Tdap coverage by age 15 is over 78%, but Essex, Windham and Windsor counties are more than five percentage points below the state rate (below map, Tdap 1+ dose).
Note: Tdap, Meningococcal, and HPV vaccines are all recommended for teens in this age group by the Advisory Committee for Immunization Practices (ACIP).
Hover mouse over counties to see %
HPV 1+ dose
HPV 2+ doses
Mening 1+ dose
Tdap 1+ dose
Summary table, by county
Hepatitis A Vaccine Coverage, Various Age Groups
The vaccine for Hepatitis A is a two-dose series beginning at 12 months old, with a second dose at least six months after the first. If the vaccine is missed in their early years, children should complete the two-dose series before they turn 18.
The below figure shows rates for Hepatitis A vaccine. Rates are improving over time among all age groups, with the biggest improvement in the 13-17 year olds.
Hepatitis A vaccine uptake is improving among all age groups, 2019-2022
Conclusion
Overall, vaccination rates among children and teenagers in Vermont have remained stable from 2019 through end of 2022. While there continue to be significant differences in vaccination rates between some counties in the state, the Vermont Immunization Registry and Immunization Program will work together to understand and address these disparities.
Limitations
We are reporting these data using an IMR based denominator. We believe this is the most accurate way to report, since our numbers are based on actual individuals and not annual census estimates. We acknowledge this can make our denominators too large (and our rates, subsequently somewhat lower), as it is difficult to identify and exclude individuals who did live in Vermont but have now moved out of state. To control for this in the teen reporting only, we used the Ogive hybrid method recommended in the American Immunization Registry Association Analytic Guide for Assessing Vaccination Coverage and excluded individuals who have not received any immunizations in 10+ years.
Registry Data Sources
As of December 31, 2022, there were 1,028,455 individuals, and over 13 million immunizations in the Vermont Immunization Registry.
Approximately 78% of the 1,197,649 immunizations added to the IMR in 2022 came directly from electronic health records in provider offices and hospitals. Another 7% were loaded as flat files – many of these came from health insurers and large chain pharmacies, and others were historical information that medical practices and health clinics were able to provide. It is also possible for immunizers to directly enter information into the IMR, and this accounted for 16% of 2022 data.
Thank you to Vermont health care providers, hospitals, pharmacies and health insurers for their invaluable contributions to this health information system.