Empowered by Data: Uncovering Immunization Gaps in Children and Adolescents

August 20, 2025

By Jess Donovan, MPH, Clinical Measurement Analyst, MN Community Measurement; and

Steven Inman, MD, Medical Director, Children’s Health Network

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August is National Immunization Awareness Month. Vaccines are a safe and effective way to protect both individuals and communities from serious and preventable illnesses like measles, tetanus, diphtheria, and influenza. However, the health of the community from these diseases depends on the completion of immunizations by individuals within the community. Simply put, herd immunity does not work when there are gaps in immunization coverage rates.  

An example of this is the recent measles outbreak across the country. As of August 2025, the Centers for Disease Control & Prevention (CDC) has confirmed 1,356 cases of measles in the United States of which 13% were hospitalized and with 3 deaths.1 In 92% of these cases, the vaccination status of was either unknown or unvaccinated.1 Yet, many of these cases could have been prevented with vaccination. Two doses of MMR are shown to be 97% effective in preventing measles, while one dose is 93% effective.1

The Immunization Measures 

MNCM reports on two immunization measures, the Childhood Immunization Status (Combo 10) measure and the Immunizations for Adolescents (Combo 2) measure, both of which are stewarded by the National Committee for Quality Assurance (NCQA). Measure definitions are provided below: 

  • Childhood Immunization Status (Combo 10): The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday.2 
  • Immunizations for Adolescents (Combo 2): The percentage of adolescents 13 years of age who had one dose of meningococcal vaccine, one Tdap vaccine, and the complete human papillomavirus vaccine series by their 13th birthday.3 

Spotlight on Gaps in Vaccination Coverage 

The data for these measures are aggregated and reported to MNCM by health plans.  

Analyses of these measures show: 

  • The number of children who received all recommended vaccines by their second birthday has been steadily decreasing since 2021: 53.0%, 48.1%, and 44.4%, respectively.  
  • The number of adolescents who received all recommended vaccines by their 13th birthday has also been decreasing since 2021: 36.4%, 35.8%, and 34.0%, respectively.  
  • In both the child and adolescent patient population, there are significant gaps between those with commercial insurance coverage and those with Medicaid insurance coverage: 
    • Children with Medicaid coverage have a vaccination completion rate that is 26 percentage points lower than children with commercial coverage. 
    • Adolescents with Medicaid coverage have a vaccination completion rate that is 9 percentage points lower than adolescents with commercial coverage. 

What’s Causing These Gaps? 

Because MNCM does not receive the individual vaccine coverage rates for these measures, we spoke with community partners to better understand the decline in rates. In each population, our partners found that there are two vaccines that are likely driving the declines: Influenza, or flu, vaccine for children and HPV for adolescents. 

In our report released in the beginning of 2025, Health Care in Minnesota: Summary Report on Quality, Disparities, and Cost, we spoke with Dr. Steven Inman from the Children’s Health Network (CHN) for more insight on vaccine coverage rates among children. CHN’s internal analysis showed that while most other vaccine rates have remained stable,  uptake of the flu vaccine has declined every year since  the peak rate in 2020. National HEDIS results of the measure show similar findings as well (range of 37.7% to 60% by insurance population).2 In the report (page 18), Dr. Inman also discusses strategies for improving rates, including extended clinic hours, mobile flu clinics, and sending email and text reminders to patients.  

Our Measurement & Reporting Committee (MARC) discussed both measures in their June 2025 meeting. The major driver for the decline in the Immunizations for Adolescents measure was the completion of the HPV series. The national HEDIS results for the measure also showed low completion rate of the HPV series (range of 35.7% to 37.1% by insurance population).3 Members discussed parents’ hesitancy on their child receiving the vaccination because of its association with sexual activity. Dr. Inman shared that the CHN HPV series completion rate has increased over the past three years by encouraging initiation of the HPV vaccine at age 9 or 10 years, disassociating the vaccine with puberty and with  messaging that explains how the vaccine can help prevent cancer caused by HPV,  shifting the narrative away from its link to sexual activity4.  

Vaccination Resources 

Children and adolescents aren’t the only ones who need to stay up-to-date on their vaccinations – adults do, too! As we ramp up for flu and COVID season, it’s important that patients know their vaccination status and where they can find affordable vaccines in their community. A great place to start is by asking your primary care provider. If you don’t have a primary care provider, there are still resources available in your community, including:  

To learn more about vaccine-preventable diseases, visit: 

Health Awareness Months  

Does your organization have a special event or health initiative project that relates to one of these health topics? We’d love to feature it in our blog! Please submit information about your event/project using this form. 

  1. Centers for Disease Control & Prevention (2025). Measles Cases and Outbreaks. Retrieved from https://www.cdc.gov/measles/data-research/index.html  
  2. National Committee for Quality Assurance. Childhood Immunization Status (CIS). Retrieved from https://www.ncqa.org/report-cards/health-plans/state-of-health-care-quality-report/childhood-immunization-status-cis/  
  3. National Committee for Quality Assurance. Immunizations for Adolescents (IMA). Retrieved from https://www.ncqa.org/report-cards/health-plans/state-of-health-care-quality-report/immunizations-for-adolescents-ima/  
  4. National HPV Roundtable from the American Cancer Society.  Retrieved from https://hpvroundtable.org/ 
PDF Infographic: Child & Adolescent Immunizations in Minnesota
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