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 or four H influenza type B (Hib); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday

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CPT(R) contained in the Measure specifications is copyright 2004-2021 American Medical Association. LOINC(R) copyright 2004-2021 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2021 International Health Terminology Standards Development Organisation. ICD-10 copyright 2021 World Health Organization. All Rights Reserved.

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Infants and toddlers are particularly vulnerable to infectious diseases because their immune systems have not built up the necessary defenses to fight infection (Centers for Disease Control and Prevention (CDC, 2019). Most childhood vaccines are between 90 and 99 percent effective in preventing diseases (American Academy of Pediatrics, 2013). Vaccination of each U.S. birth cohort with the current childhood immunization schedule prevents approximately 42,000 deaths and 20 million cases of disease and saves nearly $14 billion in direct costs and $69 billion in societal costs each year (Zhou et al., 2014). 

Immunizing a child not only protects that child's health but also the health of the community, especially for those who are not immunized or are unable to be immunized due to other health complications (CDC, 2018).

This measure looks for childhood vaccinations that should be completed by age 2, in accordance with the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (CDC ACIP) recommended child and adolescent immunization schedule (CDC ACIP 2021). 

-- For the 2021–22 season, see the 2021–22 ACIP influenza vaccine recommendations.

Higher score indicates better quality

Reference Type: CITATION

Reference Text: 'American Academy of Pediatrics. (2013). Why Immunize Your Child. Retrieved September 10, 2020, from: http://www.healthychildren.org/english/safety-prevention/immunizations/Pages/Why-Immunize-Your-Child.aspx'

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention (CDC). (2019). Common Questions About Vaccines. Retrieved September 10, 2020, from https://www.cdc.gov/vaccines/parents/FAQs.html'

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention. (2021). Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States. Retrieved July 26, 2021, from https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html#note-flu'

Reference Type: CITATION

Reference Text: 'Grohskopf LA, Alyanak E, Ferdinands JM, et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021–22 Influenza Season. MMWR Recomm Rep 2021;70(No. RR-5),1–28. DOI: http://dx.doi.org/10.15585/mmwr.rr7005a1 external icon.'

Reference Type: CITATION

Reference Text: 'Zhou, F., Shefer, A., Wenger, J., Messonnier, M., Wang, L. Y., Lopez, A., … Rodewald, L. (2014). Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009. Pediatrics, 133(4), 577–585. https://doi.org/10.1542/peds.2013-0698'

Recommended vaccines: Vaccines and the schedule of vaccines as recommended by the ACIP for children two years of age. The measure may differ slightly from the ACIP recommendations because the measure focuses on immunizations that are appropriate by age 2. Also, there may be small differences when there are shortages for a particular vaccine.

The measure allows a grace period by measuring compliance with these recommendations between birth and age two.

This eCQM is a patient-based measure.
 
This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

TBD

Children who turn 2 years of age during the measurement period and have a visit during the measurement period

Equals Initial Population

Exclude children with any of the following on or before the child’s second birthday:
•	Severe combined immunodeficiency
•	Immunodeficiency
•	HIV
•	Lymphoreticular cancer, multiple myeloma or leukemia
•	Intussusception

Exclude children who are in hospice care for any part of the measurement period.

Diphtheria, tetanus, and pertussis (DTaP) vaccination
Children with any of the following on or before the child’s second birthday meet criteria:
•	At least four DTaP vaccinations, with different dates of service. Do not count a vaccination administered prior to 42 days after birth.
•	Anaphylaxis due to the diphtheria, tetanus or pertussis vaccine.
•	Encephalitis due to the diphtheria, tetanus or pertussis vaccine.

Poliovirus vaccination (IPV)
At least three IPV vaccinations, with different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.

Measles, mumps, and rubella vaccination (MMR)
Children with either of the following meet criteria:
•	At least one MMR vaccination on or between the child’s first and second birthdays.
•	All of the following anytime on or before the child’s second birthday (on the same or different date of service):
o	History of measles
o	History of mumps
o	History of rubella

Haemophilus influenzae type b vaccination (HiB)
Children with either of the following meet criteria on or before the child’s second birthday:
•	At least three HiB vaccinations, with different dates of service. Do not count a vaccination administered prior to 42 days after birth.
•	Anaphylaxis due to the HiB vaccine.

Hepatitis B
Children with any of the following on or before the child’s second birthday meet criteria:
•	At least three hepatitis B vaccinations, with different dates of service.
o	One of the three vaccinations can be a newborn hepatitis B vaccination during the eight-day period that begins on the date of birth and ends seven days after the date of birth. For example, if the member’s date of birth is December 1, the newborn hepatitis B vaccination must be on or between December 1 and December 8.
•	Anaphylaxis due to the hepatitis B vaccine.
•	History of hepatitis B illness.

Varicella vaccination (VZV)
Children with either of the following meet criteria:
•	At least one VZV vaccination, with a date of service on or between the child’s first and second birthdays.
•	History of varicella zoster (e.g., chicken pox) illness on or before the child’s second birthday.

Pneumococcal Conjugate
At least four pneumococcal conjugate vaccinations, with different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.

Hepatitis A
Children with either of the following meet criteria:
•	At least one hepatitis A vaccination, with a date of service on or between the child’s first and second birthdays.
•	History of hepatitis A illness on or before the child’s second birthday.

Rotavirus	
Children with any of the following meet criteria:
•	At least two doses of the two-dose rotavirus vaccine on different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.
•	At least three doses of the three-dose rotavirus vaccine on different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.
•	At least one dose of the two-dose rotavirus vaccine and at least two doses of the three-dose rotavirus vaccine, all on different dates of service, on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.
•	Anaphylaxis due to the rotavirus vaccine on or before the child’s second birthday.

Influenza
At least two influenza vaccinations, with different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 6 months (180 days) after birth.
•	One of the two vaccinations can be an LAIV vaccination administered on the child’s second birthday. Do not count an LAIV vaccination administered before the child’s second birthday.

Not Applicable

None

For every patient evaluated by this measure also identify payer, race, ethnicity and sex