Gaps in Routine Childhood Immunization Among Low-Income Children at 24 Months (2019-2024).

Introduction: Vaccination rates declined during the COVID-19 pandemic and have not fully rebounded after pandemic. Declines in routine vaccination rates can lead to the increased emergence or reemergence of childhood diseases that are currently not widely circulating in the U.S. This study assessed the rates of required childhood vaccinations at 24 months from 2019 to 2024 by patient demographics and utilization. Methods: Electronic health record data from 213 community-based primary care health centers serving underserved and low-income populations in 10 states were used to calculate the routine vaccination metric over 6 years. Up-to-date rates were calculated for children with and without well-child visits. Rates were also calculated with and without the inclusion of the influenza vaccine. Results: Up-to-date vaccination rates at 24 months increased from 2019 to 2020 and declined from 2021 to 2024. The percentage of children who were up to date with all vaccines ranged from 42% in 2020 to a low of 30% in 2024. Rates were higher when the influenza vaccine was excluded and among children who had a well-child visit. Conclusions: Routine childhood vaccination rates at 24 months declined during the COVID-19 public health emergency and have continued to decline since then. Targeted strategies are needed to increase routine childhood vaccination coverage.