2021 MIPS Measure #240: Childhood Immunization Status

Quality ID 240
eMeasure ID CMS117v9
High Priority Measure No
Specifications EHR
Measure Type Process
Specialty Pediatrics

Measure description

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.



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 2017a). Most childhood vaccines are between 90 and 99 percent effective in preventing diseases (HealthyChildren 2015). 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 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 (Centers for Disease Control and Prevention 2017b). When the majority of the community is immunized against a disease, other members of the community are also protected because herd immunity shields them. (National Institute of Allergy and Infectious Diseases 2014).

Clinical Recommendation Statements

Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2018 (Centers for Disease Control and Prevention 2018)

Hepatitis B (HepB)
"Minimum age: birth"
"Birth Dose (Monovalent HepB vaccine only):
-- Mother is HBsAg-Negative: 1 dose within 24 hours of birth for medically stable infants >2,000 grams. Infants <2,000 grams administer 1 dose at
chronological age 1 month or hospital discharge.
-- Mother is HBsAg-Positive: Give HepB vaccine and 0.5 mL of HBIG (at separate anatomic sites) within 12 hours of birth, regardless of birth weight. Test for HBsAg and anti-HBs at age 9–12 months. If HepB series is delayed, test 1–2 months after final dose.
-- Mother’s HBsAg status is unknown: Give HepB vaccine within 12 hours of birth, regardless of birth weight. For infants <2,000 grams, give 0.5 mL of HBIG in addition to HepB vaccine within 12 hours of birth. Determine mother’s HBsAg status as soon as possible. If mother is HBsAg-positive, give 0.5 mL of HBIG to infants >2,000 grams as soon as possible, but no later than 7 days of age.
Routine Series:
-- A complete series is 3 doses at 0, 1–2, and 6–18 months. (Monovalent HepB vaccine should be used for doses given before age 6 weeks.)
-- Infants who did not receive a birth dose should begin the series as soon as feasible.
-- Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose.
-- Minimum age for the final (3rd or 4th) dose: 24 weeks.
-- Minimum Intervals: Dose 1 to Dose 2: 4 weeks / Dose 2 to Dose 3: 8 weeks / Dose 1 to Dose 3: 16 weeks. (When 4 doses are given, substitute "Dose 4" for "Dose 3" in these calculations.) "

Diptheria, tetanus, acellular pertussis vaccinations (DTap)
"Minimum age: 6 weeks [4 years for Kinrix or Quadracel] "
"Routine vaccination:
-- 5-dose series at 2, 4, 6, and 15–18 months, and 4–6 years.
Prospectively: A 4th dose may be given as early as age 12 months if at least 6 months have elapsed since the 3rd dose.
Retrospectively: A 4th dose that was inadvertently given as early as 12 months may be counted if at least 4 months have elapsed since the 3rd dose. "

Hib (Haemophilus influenzae type b)
"Minimum age: 6 weeks"
"Routine vaccination:
-- ActHIB, Hiberix, or Pentacel: 4-dose series at 2, 4, 6, and 12–15 months.
-- PedvaxHIB: 3-dose series at 2, 4, and 12–15 months."

Polio (IPV) 
"Minimum age: 6 weeks"
"Routine vaccination:
-- 4-dose series at ages 2, 4, 6–18 months, and 4–6 years. Administer the final dose on or after the 4th birthday and at least 6 months after the previous dose."

Measles, mumps, rubella (MMR)
"Minimum age: 12 months for routine vaccination"
"Routine vaccination:
-- 2-dose series at 12–15 months and 4–6 years.
-- The 2nd dose may be given as early as 4 weeks after the 1st dose. "

Pneumococcal conjugate (PCV13)
"Minimum age: 6 weeks [PCV13]"
"Routine vaccination with PCV13:
-- 4-dose series at 2, 4, 6, and 12–15 months. "

Varicella (Var) 
"Minimum age: 12 months"
"Routine vaccination:
-- 2-dose series: 12–15 months and 4–6 years.
-- The 2nd dose may be given as early as 3 months after the 1st dose (a dose given after a 4-week interval may be counted)."

Hepatitis A (HepA)
"Minimum age: 12 months"
"Routine vaccination:
-- 2 doses, separated by 6-18 months, between the 1st and 2nd birthdays. (A series begun before the 2nd birthday should be completed even if the child turns 2 before the second dose is given.)"

Rotavirus (RV) 
"Minimum age: 6 weeks"
"Routine vaccination:
Rotarix: 2-dose series at 2 and 4 months.
RotaTeq: 3-dose series at 2, 4, and 6 months.
If any dose in the series is either RotaTeq or unknown, default to 3-dose series. "

Influenza (inactivated influenza vaccine (IIV) 
"Minimum age: 6 months"
"Routine vaccination:
-- Administer an age-appropriate formulation and dose of influenza vaccine annually. Children 6 months–8 years who did not receive at least 2 doses of influenza vaccine before July 1, 2017 should receive 2 doses separated by at least 4 weeks. "

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