​Childhood Immunization Status—Combination 3

Measure Definition​

The Childhood Immunization Status—Combination 3 measure calculates the percentage of children identified as having the following vaccinations: four diphtheria, tetanus, and pertussis (DTaP); three inactivated poliovirus (IPV); one measles, mumps, and rubella (MMR); three Haemophilus influenza type B (HiB); three hepatitis B; one varicella-zoster virus (chicken pox or VZV); and four pneumococcal conjugate vaccinations on or before the child’s second birthday.


Disease prevention is the key to public health, and one of the most basic methods for the prevention of diseases is immunization. Immunizations are the safest and most effective tools for protecting children from various potentially serious childhood diseases. Vaccines are proven to help children stay healthy and avoid the harmful effects of diseases such as diphtheria, tetanus, hepatitis, polio, measles, mumps, and rubella. While the rates of vaccine-preventable diseases are very low in the United States, the viruses and bacteria that cause these infectious diseases still exist. Measles is one of the most infectious diseases in the world and frequently is imported into the United States. More than 90 percent of people who are not immunized will get the virus if exposed and as many as three out of every 1,000 cases will result in death in the United States.40 Additionally, the Centers for Disease Control and Prevention (CDC) estimates that one-third of the lifelong hepatitis B virus infections in the United States resulted from infections acquired during infancy or during the first few years of life. Furthermore, without proper immunization, the potential to pass on vaccine-preventable diseases such as measles, mumps, and pertussis (whooping cough) to unprotected persons increases drastically. For example, in 2006, an outbreak of mumps among college students in the U.S. led to more than 6,500 reported cases of mumps across multiple states.

The social and direct economic costs of ensuring each child receives the Centers for Disease Control and Prevention (CDC) Advisory Committee for Immunization Practices’ (ACIP’s) recommended schedule of vaccines far outweighs the costs of not providing routine immunizations. Childhood vaccines prevent 10.5 million diseases among all children born in the United States in a given year and are a cost-effective preventive measure. It is estimated that for every $1 spent on immunizations, as many as $29 can be saved in direct and indirect costs. A child with chicken pox on average misses five to six days of school and adult caretakers three to four days of work. Based on an estimate of the 2001 U.S. birth cohort, routine childhood immunizations (as recommended by the ACIP) net an economic and societal cost savings of $9.9 billion and $43.3 billion, respectively.

Despite the established guidelines and documented benefits and risks associated with childhood immunization, a gap in coverage still exists. Evidence has shown that the population at greatest risk for under-immunization are minority children from low-income families or children that live in inner-city or rural areas.45 In 2007, almost 25 percent of children in the United States 19 to 35 months old did not receive the recommended vaccinations. For these reasons, leading health care organizations and professionals widely agree that the need to focus on increasing childhood immunization rates in the United States still remains crucial. Intentional undervaccination, often due to parents’ concern with vaccine adverse events, has also led to preventable disease outbreaks. In 2008, an intentionally unvaccinated child unknowingly infected with measles resulted in the largest outbreak in San Diego, California, since 1991. Over 800 people were exposed and 12 additional cases were identified at a net public sector cost of $10, 376 per case.

To see how Managed Care reported on Childhood Immunization Status—Combination 3, click here

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Last modified date: 10/18/2019 1:58 PM