Vaccine-Preventable Infectious Disease Mortality Among Children in the Post-vaccine Era: Persistent Burden and...

Despite remarkable reductions in vaccine-preventable infectious diseases following the introduction of routine childhood immunization, preventable childhood deaths continue to occur. This study evaluated temporal trends, disease-specific mortality patterns, and demographic disparities in childhood mortality due to vaccine-preventable infectious diseases over 25 years.

A nationwide retrospective population-based study was conducted using mortality data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death databases. Deaths among children younger than 18 years attributed to vaccine-preventable infectious diseases between 1999 and 2024 were identified using the International Classification of Diseases, 10th Revision codes. Temporal trends were assessed using Joinpoint regression, while negative binomial regression was used to estimate adjusted mortality rate ratios for demographic and geographic factors.

A total of 5,520 deaths due to vaccine-preventable infectious diseases were identified, corresponding to an overall crude mortality rate of 0.29 per 100,000 children. Mortality declined initially but subsequently fluctuated without a sustained downward trend. Influenza accounted for 60.7% of all deaths and was the only disease demonstrating a significant increase in mortality over time. Significant declines were observed in pneumococcal disease mortality, meningococcal disease mortality, and infant mortality, whereas mortality among children aged five to nine years increased significantly. Negative binomial regression demonstrated significantly higher adjusted mortality rate ratios among American Indian or Alaska Native and Black or African American children compared with White children.

Childhood mortality due to vaccine-preventable infectious diseases remains an important public health concern despite substantial advances in immunization. Influenza emerged as the predominant and only disease with an increasing mortality trend, while persistent racial and geographic disparities highlight continuing inequities in disease burden. Strengthening routine and catch-up immunization programs, improving equitable access to vaccination, and maintaining robust surveillance are essential to further reduce preventable childhood deaths.