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Original site: www.cdc.gov/mmwr/preview/mmwrhtml/mm5916a1.htm | RestoredCDC.org is an independent project, not affiliated with CDC or any federal entity. Visit CDC.gov for free official information. Due to archival on January 6, 2025, recent outbreak data is unavailable. Videos are not restored. Access data.restoredcdc.org for restored data. Use of this site implies acceptance of this disclaimer.[More]About Us Report Bug Compare ContentSkip directly to search Skip directly to A to Z list Skip directly to site contentCDC HomeCDC 24/7: Saving Lives. Protecting People.™Note: Javascript is disabled or is not supported by your browser. For this reason, some items on this page will be unavailable. For more information about this message, please visit this page: About CDC.gov.Morbidity and Mortality Weekly Report (MMWR)* MMWR******** Digg* Add this to your sitePersons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail.Interim Results: State-Specific Seasonal Influenza Vaccination Coverage --- United States, August 2009--January 2010Please note: An erratum has been published for this article. To view the erratum, please click here.WeeklyApril 30, 2010 / 59(16);477-484The advent of the 2009 influenza A (H1N1) pandemic in April 2009 made the 2009--10 influenza season highly unusual. Public awareness of the potential seriousness of influenza was heightened by media coverage of pandemic-associated hospitalizations and deaths, especially among younger persons. In the fall, the distribution of two separate influenza vaccines began, with distinct, although overlapping, recommendations from the Advisory Committee on Immunization Practices (ACIP) (1,2). In addition, 2009--10 was the first full season in which ACIP's recommendation to vaccinate all children aged 5--18 years (2) was implemented. To provide preliminary state-specific estimates of seasonal influenza vaccination coverage, CDC analyzed Behavioral Risk Factor Surveillance System (BRFSS) and National 2009 H1N1 Flu Survey (NHFS) data collected during October 2009--February 2010. By January 31, estimated state seasonal influenza vaccination coverage among persons aged ≥6 months ranged from 30.3% to 54.5% (median: 40.6%). Median coverage was 41.2% for children aged 6 months--17 years, 38.3% for adults aged 18--49 years with high-risk conditions, 28.8% for adults aged 18--49 years without high-risk conditions, 45.5% for adults aged 50--64 years, and 69.3% for adults aged ≥65 years. These results, compared with the previous season (3), suggest large increases in coverage for children and a moderate increase for adults aged 18--49 years without high-risk conditions. Health departments should identify best practices that lead to higher vaccination coverage and should support effective vaccination services (e.g., school-located vaccination programs and office-based protocols, such as reminder/recall and standing orders).The advent of the 2009 influenza A (H1N1) pandemic in April 2009 made the 2009--10 influenza season highly unusual. Public awareness of the potential seriousness of influenza was heightened by media coverage of pandemic-associated hospitalizations and deaths, especially among younger persons. In the fall, the distribution of two separate influenza vaccines began, with distinct, although overlapping, recommendations from the Advisory Committee on Immunization Practices (ACIP) (1,2). In addition, 2009--10 was the first full season in which ACIP's recommendation to vaccinate all children aged 5--18 years (2) was implemented. To provide preliminary state-specific estimates of seasonal influenza vaccination coverage, CDC analyzed Behavioral Risk Factor Surveillance System (BRFSS) and National 2009 H1N1 Flu Survey (NHFS) data collected during October 2009--February 2010. By January 31, estimated state seasonal influenza vaccination coverage among persons aged ≥6 months ranged from 30.3% to 54.5% (median: 40.6%). Median coverage was 41.2% for children aged 6 months--17 years, 38.3% for adults aged 18--49 years with high-risk conditions, 28.8% for adults aged 18--49 years without high-risk conditions, 45.5% for adults aged 50--64 years, and 69.3% for adults aged ≥65 years. These results, compared with the previous season (3), suggest large increases in coverage for children and a moderate increase for adults aged 18--49 years without high-risk conditions. Health departments should identify best practices that lead to higher vaccination coverage and should support effective vaccination services (e.g., school-located vaccination programs and office-based protocols, such as reminder/recall and standing orders).CDC used data collected during October 2009--February 2010 from two separate surveys, BRFSS and NHFS. BRFSS respondents in 50 states, the District of Columbia, and two territories were asked if they (or their children, in 43 states) had been vaccinated for the "seasonal flu" in the past 12 months, and if so, in which month.* NHFS respondents aged ≥18 years were asked whether they (or their children) had received "seasonal flu vaccination" since August, and if so, in which month. † Similar questions were asked about "H1N1 flu" vaccination in both surveys (4). The Council of American Survey and Research Organizations (CASRO) NHFS response rates were 35% for landline and 27% for cellular telephones; cooperation rates were 45% and 57%, respectively. The median state CASRO BRFSS response and cooperation rates were 54% and 76%, respectively.CDC used data collected during October 2009--February 2010 from two separate surveys, BRFSS and NHFS. BRFSS respondents in 50 states, the District of Columbia, and two territories were asked if they (or their children, in 43 states) had been vaccinated for the "seasonal flu" in the past 12 months, and if so, in which month.* NHFS respondents aged ≥18 years were asked whether they (or their children) had received "seasonal flu vaccination" since August, and if so, in which month. †Similar questions were asked about "H1N1 flu" vaccination in both surveys (4). The Council of American Survey and Research Organizations (CASRO) NHFS response rates were 35% for landline and 27% for cellular telephones; cooperation rates were 45% and 57%, respectively. The median state CASRO BRFSS response and cooperation rates were 54% and 76%, respectively.To improve the precision of state-level estimates from each survey, CDC first combined the monthly data collected during October 2009--February 2010 and estimated the cumulative proportion of persons vaccinated with at least 1 dose during August--January by using the Kaplan-Meier survival analysis procedure. To improve precision for subgroups within states, particularly children, CDC then combined the estimates from BRFSS and NHFS (5). § The 2009--10 BRFSS survey included 18,368 children and 152,128 adults; the NHFS included 60,786 children and 31,135 adults. CDC performed Pearson correlations among children and adults to determine if state-specific seasonal coverage was associated with state-specific H1N1 coverage or with coverage during past seasons. For comparison to estimated national vaccination coverage for the 2008--09 influenza season, overall, and by month, CDC analyzed the BRFSS adult and child data available from 19 states that fully participated in a special early survey conducted January--February 2009 (3). Student t-tests were used to determine statistical difference between groups.To improve the precision of state-level estimates from each survey, CDC first combined the monthly data collected during October 2009--February 2010 and estimated the cumulative proportion of persons vaccinated with at least 1 dose during August--January by using the Kaplan-Meier survival analysis procedure. To improve precision for subgroups within states, particularly children, CDC then combined the estimates from BRFSS and NHFS (5). § The 2009--10 BRFSS survey included 18,368 children and 152,128 adults; the NHFS included 60,786 children and 31,135 adults. CDC performed Pearson correlations among children and adults to determine if state-specific seasonal coverage was associated with state-specific H1N1 coverage or with coverage during past seasons. For comparison to estimated national vaccination coverage for the 2008--09 influenza season, overall, and by month, CDC analyzed the BRFSS adult and child data available from 19 states that fully participated in a special early survey conducted January--February 2009 (3). Student t-tests were used to determine statistical difference between groups.Among children aged 6 months--17 years, estimated national 2009--10 seasonal coverage was 40.0% (16 percentage points higher than in 2008--09) (3). State-specific 2009--10 coverage for children ranged from 23.6% (Nevada) to 67.2% (Hawaii) (U.S. median: 41.2%); coverage among adults aged ≥18 years ranged from 32.4% (Nevada) to 52.5% (Minnesota) (U.S. median: 40.6%) (Table 1). State-specific child and adult (age ≥18 years) coverages were correlated positively (r = 0.68), with a wider range of coverage among state-specific child levels compared with adult levels (Figure 1). Seasonal state coverage also correlated positively with 2009 H1N1 state coverage (5) among children (r = 0.72) and adults (r = 0.72). Among adults, state coverage in 2009--10 was correlated positively with coverage in 2007--08 (r = 0.81) (CDC, unpublished data, 2010).Among children aged 6 months--17 years, estimated national 2009--10 seasonal coverage was 40.0% (16 percentage points higher than in 2008--09) (3). State-specific 2009--10 coverage for children ranged from 23.6% (Nevada) to 67.2% (Hawaii) (U.S. median: 41.2%); coverage among adults aged ≥18 years ranged from 32.4% (Nevada) to 52.5% (Minnesota) (U.S. median: 40.6%) (Table 1). State-specific child and adult (age ≥18 years) coverages were correlated positively (r = 0.68), with a wider range of coverage among state-specific child levels compared with adult levels (Figure 1). Seasonal state coverage also correlated positively with 2009 H1N1 state coverage (5) among children (r = 0.72) and adults (r = 0.72). Among adults, state coverage in 2009--10 was correlated positively with coverage in 2007--08 (r = 0.81) (CDC, unpublished data, 2010).Among adults aged 18--49 years, national seasonal vaccination coverage was higher for persons with high-risk conditions (36.2%) than without high-risk conditions (27.6%). This difference also was statistically significant in 10 states (Table 1). Coverage ranged from 21.2% (Mississippi) to 63.4% (Minnesota) for the high-risk group, and for the persons not at high risk, 19.4% (Florida) to 43.1% (South Dakota). Seasonal coverage for adults aged 18--49 years with high-risk conditions was similar to coverage in 2008--09. Among younger adults without such conditions, coverage was 30% higher in 2009--10 than in 2008--09 (20.8%) (3; CDC, unpublished data, 2010).National seasonal influenza vaccination coverage was 45.0% for adults aged 50--64 years and 68.0% for adults aged ≥65 years, similar to previous seasons. Coverage ranged from 33.7% (Florida) to 56.3% (Hawaii) for adults aged 50--64 years and from 59.3% (Idaho) to 78.6% (New Mexico) for adults aged ≥65 years (Table 1).National seasonal influenza vaccination coverage was 45.0% for adults aged 50--64 years and 68.0% for adults aged ≥65 years, similar to previous seasons. Coverage ranged from 33.7% (Florida) to 56.3% (Hawaii) for adults aged 50--64 years and from 59.3% (Idaho) to 78.6% (New Mexico) for adults aged ≥65 years (Table 1).Among all persons aged ≥6 months, coverage was higher among non-Hispanic whites (42.5%) compared with non-Hispanic blacks (32.2%) and Hispanics (33.6%) (Table 2), and was similar to Asians (41.7%; 95% confidence interval [CI] = 38.1--45.3) and American Indians/Alaska Natives (40.1%; CI = 35.7--44.5). Among adults, blacks (31.1%; CI = 29.1--33.1) and Hispanics (30.9%; CI = 28.2--33.6) had lower coverage than whites (43.0%; CI = 42.4--43.6). Among children, coverage among blacks was lowest (32.7%; CI = 29.5--35.9), followed by Hispanics (39.3%; CI = 36.0--42.6) and whites (40.3%; CI = 38.9--41.7).Among all persons aged ≥6 months, coverage was higher among non-Hispanic whites (42.5%) compared with non-Hispanic blacks (32.2%) and Hispanics (33.6%) (Table 2), and was similar to Asians (41.7%; 95% confidence interval [CI] = 38.1--45.3) and American Indians/Alaska Natives (40.1%; CI = 35.7--44.5). Among adults, blacks (31.1%; CI = 29.1--33.1) and Hispanics (30.9%; CI = 28.2--33.6) had lower coverage than whites (43.0%; CI = 42.4--43.6). Among children, coverage among blacks was lowest (32.7%; CI = 29.5--35.9), followed by Hispanics (39.3%; CI = 36.0--42.6) and whites (40.3%; CI = 38.9--41.7).Coverage for persons aged ≥6 months was higher during September and October and lower in November compared with 2008--09 (Figure 2). One or more seasonal doses reportedly were administered to 29.1 million children (CI = 28.1--30.0 million) and 89.7 million adults (CI = 88.3--91.2 million), for an estimated 118.8 million vaccinees (CI = 117.1--120.5 million) during August 2009--January 2010.Coverage for persons aged ≥6 months was higher during September and October and lower in November compared with 2008--09 (Figure 2). One or more seasonal doses reportedly were administered to 29.1 million children (CI = 28.1--30.0 million) and 89.7 million adults (CI = 88.3--91.2 million), for an estimated 118.8 million vaccinees (CI = 117.1--120.5 million) during August 2009--January 2010.Reported byH Ding, MD, PJ Lu, MD, PhD, GL Euler, DrPH, C Furlow, PhD, LN Bryan, MS, B Bardenheier, MA, MPH, E Monsell, AG Gonzalez-Feliciano, MPH, C LeBaron, MD, PM Wortley, MD, JA Singleton, MS, Immunization Svc Div; M Town, MS, L Balluz, ScD, Div of Behavioral Science, Office of Surveillance, Epidemiology, and Laboratory Svcs, CDC.Editorial NoteSeasonal influenza vaccination during 2009--10 occurred under unique circumstances. In October 2009, the distribution of influenza A (H1N1) 2009 monovalent vaccine was added to the ongoing distribution of the seasonal influenza vaccine that started in August. The populations recommended for 2009 H1N1 vaccination were different from, but overlapped, those recommended for seasonal vaccination (1,2). For this unusual season, coverage for seasonal vaccination of children aged 6 months--17 years (40%) was higher than coverage estimates for the previous season (24% from BRFSS [3] and 30% from NHIS [CDC, unpublished data, 2009]). Coverage for healthy adults aged 18--49 years also was moderately higher (3). These higher coverage levels for 2009--10 might reflect increased awareness of the seriousness of influenza associated with the H1N1 pandemic. Influenza activity due to 2009 H1N1 virus increased during summer and early fall, when only seasonal vaccine was available, and was associated with a threefold higher levels of hospitalizations and deaths among persons aged <65 years compared with previous seasons (6). ¶ Higher coverage in children also might reflect the first full year of expansion of ACIP recommendations for all children aged 6 months--18 years to receive annual influenza vaccination (2). Nevertheless, despite increased attention to influenza during the fall, no significant increase in coverage occurred among those aged 18--49 years with high-risk conditions, underscoring the challenges associated with increasing coverage in this group.Seasonal influenza vaccination during 2009--10 occurred under unique circumstances. In October 2009, the distribution of influenza A (H1N1) 2009 monovalent vaccine was added to the ongoing distribution of the seasonal influenza vaccine that started in August. The populations recommended for 2009 H1N1 vaccination were different from, but overlapped, those recommended for seasonal vaccination (1,2). For this unusual season, coverage for seasonal vaccination of children aged 6 months--17 years (40%) was higher than coverage estimates for the previous season (24% from BRFSS [3] and 30% from NHIS [CDC, unpublished data, 2009]). Coverage for healthy adults aged 18--49 years also was moderately higher (3). These higher coverage levels for 2009--10 might reflect increased awareness of the seriousness of influenza associated with the H1N1 pandemic. Influenza activity due to 2009 H1N1 virus increased during summer and early fall, when only seasonal vaccine was available, and was associated with a threefold higher levels of hospitalizations and deaths among persons aged <65 years compared with previous seasons (6). ¶ Higher coverage in children also might reflect the first full year of expansion of ACIP recommendations for all children aged 6 months--18 years to receive annual influenza vaccination (2). Nevertheless, despite increased attention to influenza during the fall, no significant increase in coverage occurred among those aged 18--49 years with high-risk conditions, underscoring the challenges associated with increasing coverage in this group.Seasonal vaccination coverage varied widely among states, particularly among children. The strong positive correlations between 2009--10 seasonal state levels with both current 2009 H1N1 vaccine coverage and with previous season coverage suggests that certain factors that differ among states (e.g., medical-care delivery infrastructure, population norms, and effectiveness of state and local immunization programs) might explain at least part of the state-level variation in vaccination levels. Increased coverage in September likely reflects the early availability of vaccine supplies, coupled with increased demand, compared with previous seasons.The lower seasonal influenza vaccination coverage for Hispanics and blacks observed during 2009--10 compared with whites among persons aged ≥6 months also has been observed in previous seasons among adults (3). The reasons for racial/ethnic disparities and their variations by state are multifactorial. Broad use of interventions to systematize offering of vaccination (e.g., routine offering of vaccine to all patients) is one important component of efforts to reduce these disparities (7).The lower seasonal influenza vaccination coverage for Hispanics and blacks observed during 2009--10 compared with whites among persons aged ≥6 months also has been observed in previous seasons among adults (3). The reasons for racial/ethnic disparities and their variations by state are multifactorial. Broad use of interventions to systematize offering of vaccination (e.g., routine offering of vaccine to all patients) is one important component of efforts to reduce these disparities (7).The estimate of 119 million persons in the United States receiving at least 1 dose of seasonal vaccine certainly is an overestimate because only 114--115 million doses were distributed in the United States. The actual number of first doses available to be administered to the surveyed population was even lower because of unused doses, a second dose administered to children aged <9 years, and institutional use of doses (e.g., military and long-term care facilities not surveyed by BRFSS). The overestimate based on the surveys likely was caused by nonresponse bias, which has been observed for telephone surveys conducted during previous seasons, and recall bias for self-report or parental report of vaccination.The findings in this report are subject to at least six other limitations. First, misclassification of H1N1 for seasonal vaccine, unique to this season, might have contributed to some overreporting. However, the high seasonal vaccination coverage in September before 2009 H1N1 vaccine was available suggests that survey respondents generally were able to distinguish between the two types of influenza vaccinations. Second, both BRFSS and NHFS are telephone-based surveys and thus do not include persons without telephone service. Also, BRFSS is limited to households with landlines. Third, response rates for both surveys were low (5), which increases the risk for nonresponse bias. Fourth, for these surveys, self-reported vaccination status is not validated with medical records and is subject to respondents' recall bias. Fifth, combining BRFSS and NHFS estimates increased the sample to approximately 260,000 persons, but differences in survey methods (e.g., different sampling frame, survey questions, operations, response rates, and weighting) might lead to different levels of bias that are averaged in the combined estimates of this report (5). Given all of these factors combined, the net bias (estimated coverage minus actual coverage) range likely is 10%--15%.** This range was probably higher than in previous seasons due, in part, to higher media coverage of the pandemic. Nevertheless, because demand for seasonal influenza vaccination in 2009--10 remained strong even after vaccine was in short supply in some places, a higher proportion of available doses likely were used this season compared with previous seasons. Finally, the 2008--09 BRFSS child coverage data slightly underestimated coverage through January and were based on only 19 states reporting (3). However, 2008--09 estimates of overall coverage levels and distribution by month matched those of the 2007--08 season.Even with increased demand for vaccination this season, influenza vaccination levels were well below Healthy People 2010 targets of 60% for noninstitutionalized adults aged 18--64 years with high-risk conditions and 90% for adults aged ≥65 years (objectives 14-29a and 14-29c) (8). School-located vaccination was implemented in many communities for 2009 H1N1 vaccination (CDC, unpublished data, 2010), and the experience acquired might lead to greater use of this strategy in fall 2010, and thereby contribute to ongoing gains in influenza vaccination.Even with increased demand for vaccination this season, influenza vaccination levels were well below Healthy People 2010 targets of 60% for noninstitutionalized adults aged 18--64 years with high-risk conditions and 90% for adults aged ≥65 years (objectives 14-29a and 14-29c) (8). School-located vaccination was implemented in many communities for 2009 H1N1 vaccination (CDC, unpublished data, 2010), and the experience acquired might lead to greater use of this strategy in fall 2010, and thereby contribute to ongoing gains in influenza vaccination.AcknowledgmentsThe findings in this report are based, in part, on contributions by KR Copeland, N Ganesh, M Stanislawski, and N Davis, National Opinion Research Center, Chicago, Illinois; state BRFSS coordinators; the Div of Behavioral Science, Office of Surveillance, Epidemiology, and Laboratory Svcs; and the H1N1 Vaccine Coverage Monitoring Team, CDC.References1. CDC. Use of influenza A (H1N1) 2009 monovalent vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR 2009;58(No. RR-10).2. CDC. Prevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR 2009;58 (No. RR-8).3. CDC. Influenza vaccination coverage among children and adults---United States, 2008--09 influenza season. MMWR 2009;58:1091--5.4. CDC. Interim results: influenza A (H1N1) 2009 monovalent vaccination coverage---United States, October--December 2009. MMWR 2010;59:44--8.5. CDC. Interim results: state-specific influenza A (H1N1) 2009 monovalent vaccination coverage---United States, October 2009--January 2010. MMWR 2010;59:363--8.6. CDC. Update: influenza activity---United States, August 30, 2009--March 27, 2010, and composition of the 2010--11 influenza vaccine. MMWR 2010;59:423--30.7. Fiscella K. Anatomy of racial disparity in influenza vaccination. Health Serv Res 2005;40:539--50.8. US Department of Health and Human Services. Healthy people 2010 (conference ed., in 2 vols.). Washington, DC: US Department of Health and Human Services; 2000. Available at http://www.health.gov/healthypeople. Accessed April 22, 2010.* Respondents were asked, "Now I will ask you questions about seasonal flu. A flu shot is an influenza vaccine injected into your arm. During the past 12 months, have you had a seasonal flu shot? During what month and year did you receive your most recent seasonal flu shot? The seasonal flu vaccine sprayed in the nose is also called FluMist. During the past 12 months, have you had a seasonal flu vaccine that was sprayed in your nose? During what month and year did you receive your most recent seasonal flu vaccine that was sprayed in your nose?" Additional information about BRFSS is available at http://www.cdc.gov/brfss.† Respondents were asked, "Since August 2009, have you had a seasonal flu vaccination? There are two types of seasonal flu vaccinations. One is a shot and the other is a spray, mist or drop in the nose. During what month did you receive your most recent seasonal flu vaccine? Was your most recent seasonal flu vaccine a shot or the spray in the nose? The seasonal flu vaccine can be given either as a shot or a nasal spray, also called FluMist." The landline sample was augmented with a sample of children aged <18 years identified during screening for the National Immunization Survey. Additional information about NHFS is available at http://www.cdc.gov/nis/h1n1_introduction.htm and http:/nish1n1_flu_survey.pdf .†Respondents were asked, "Since August 2009, have you had a seasonal flu vaccination? There are two types of seasonal flu vaccinations. One is a shot and the other is a spray, mist or drop in the nose. During what month did you receive your most recent seasonal flu vaccine? Was your most recent seasonal flu vaccine a shot or the spray in the nose? The seasonal flu vaccine can be given either as a shot or a nasal spray, also called FluMist." The landline sample was augmented with a sample of children aged <18 years identified during screening for the National Immunization Survey. Additional information about NHFS is available at http://www.cdc.gov/nis/h1n1_introduction.htm and http://www.cdc.gov/nis/data/h1n1_flu_survey.pdf .§ Combined estimates were weighted averages of the BRFSS and NHFS estimates, with weights being determined by the effective sample sizes. The effective sample sizes take into account the design of each survey and are determined as the unweighted sample size divided by the design effect. The design effect is the ratio of the variance of a survey estimate to the variance had the survey design used a simple random sample; surveys with large design effects are less efficient. CDC estimated state and age-group--specific design effects based on estimated proportions vaccinated each month, using data from each survey from October 2009 through February 2010. Among states, the median design effects for children were 1.9 for NHFS and 1.3 for BRFSS, with the BRFSS estimate receiving a median of 34% of the weight in the combined average estimate. For adults, median design effects were 1.2 for NHFS and 1.5 for BRFSS, with BRFSS estimates receiving a median of 80% of the weight. The NHFS estimate was used alone when no data were available from BRFSS.§ Combined estimates were weighted averages of the BRFSS and NHFS estimates, with weights being determined by the effective sample sizes. The effective sample sizes take into account the design of each survey and are determined as the unweighted sample size divided by the design effect. The design effect is the ratio of the variance of a survey estimate to the variance had the survey design used a simple random sample; surveys with large design effects are less efficient. CDC estimated state and age-group--specific design effects based on estimated proportions vaccinated each month, using data from each survey from October 2009 through February 2010. Among states, the median design effects for children were 1.9 for NHFS and 1.3 for BRFSS, with the BRFSS estimate receiving a median of 34% of the weight in the combined average estimate. For adults, median design effects were 1.2 for NHFS and 1.5 for BRFSS, with BRFSS estimates receiving a median of 80% of the weight. The NHFS estimate was used alone when no data were available from BRFSS.¶ Additional information available at http://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm.¶ Additional information available at http://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm.** Before estimating the net overreporting bias observed, subtractions from the amount of doses distributed were made for estimates of 6 million unused doses and for additional coverage not included in this report (e.g., an estimate of 2 million second doses to children aged <9 years and approximately 2 million doses administered to persons in the military and nursing homes).What is already known on this topic?The 2009--10 influenza season was highly unusual because 1) public awareness of the potential seriousness of influenza was heightened by media coverage of H1N1 pandemic--associated hospitalizations and deaths, especially among younger persons; 2) in the fall, the distribution of two separate influenza vaccines began, with distinct, although overlapping, recommendations from the Advisory Committee on Immunization Practices (ACIP); and 3) it was the first full season in which ACIP's recommendation to vaccinate all children aged 5--18 years was implemented.What is added by this report?Compared with the previous influenza season, 2009--10 saw a 67% relative increase in estimated coverage for children and a 30% relative increase for adults aged 18--49 years without high-risk conditions.What are the implications for public health practice?Health departments should identify strategies that increase coverage (e.g., school-located vaccination programs and office-based protocols, such as reminder/recall and standing orders) and other community interventions to supplement the routine vaccination services provided by health-care providers.TABLE 1. Estimated seasonal influenza vaccination coverage among children and adults,* by U.S. Department of Health and Human Services (HHS) region, state, and selected age and risk subgroups --- United States, Behavioral Risk Factor Surveillance System (BRFSS) and National 2009 H1N1 Flu Survey (NHFS), end of January 2010 †TABLE 1. Estimated seasonal influenza vaccination coverage among children and adults,* by U.S. Department of Health and Human Services (HHS) region, state, and selected age and risk subgroups --- United States, Behavioral Risk Factor Surveillance System (BRFSS) and National 2009 H1N1 Flu Survey (NHFS), end of January 2010 â€HHS region and state/area Unweighted sample size All persons aged ≥6 mos Children aged 6 mos--17 yrs Persons aged ≥18 yrs Persons aged 18--49 yrs at high risk § Persons aged 18--49 yrs not at high risk All persons aged 50--64 yrs All persons aged ≥65 yrsHHS region and state/area Unweighted sample size All persons aged ≥6 mos Children aged 6 mos--17 yrs Persons aged ≥18 yrs Persons aged 18--49 yrs at high risk § Persons aged 18--49 yrs not at high risk All persons aged 50--64 yrs All persons aged ≥65 yrsNo. ¶ % (95% CI**) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI)No. ¶ % (95% CI**) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI)All states combined 262,417 39.7 (±0.6) 40.0 (±1.4) 39.6 (±0.6) 36.2 (±1.5) 27.6 (±0.9) 45.0 (±1.3) 68.0 (±0.9)All states combined 262,417 39.7 (±0.6) 40.0 (±1.4) 39.6 (±0.6) 36.2 (±1.5) 27.6 (±0.9) 45.0 (±1.3) 68.0 (±0.9)Region 1 25,533 48.0 (±1.8) 55.7 (±5.1) 45.4 (±1.7) 44.6 (±4.3) 31.6 (±2.5) 51.1 (±2.8) 72.9 (±2.6)Region 1 25,533 48.0 (±1.8) 55.7 (±5.1) 45.4 (±1.7) 44.6 (±4.3) 31.6 (±2.5) 51.1 (±2.8) 72.9 (±2.6)Connecticut †† 4,534 42.6 (±3.3) 46.2 (±5.7) 41.3 (±4.1) 39.8 (±10.5) §§ 27.2 (±6.0) 47.8 (±7.4) 69.1 (±6.6)Connecticut ††4,534 42.6 (±3.3) 46.2 (±5.7) 41.3 (±4.1) 39.8 (±10.5) §§ 27.2 (±6.0) 47.8 (±7.4) 69.1 (±6.6)Maine ¶¶ 5,313 48.1 (±2.6) 57.2 (±7.5) 46.2 (±2.7) 43.7 (±7.4) 34.3 (±6.5) 48.0 (±3.9) 73.2 (±4.2)Maine ¶¶ 5,313 48.1 (±2.6) 57.2 (±7.5) 46.2 (±2.7) 43.7 (±7.4) 34.3 (±6.5) 48.0 (±3.9) 73.2 (±4.2)Massachusetts ¶¶ *** 6,347 51.5 (±3.4) 61.6 (±9.4) 47.5 (±3.0) 47.1 (±7.0) 32.4 (±4.2) 54.1 (±4.7) 76.4 (±4.2)Massachusetts ¶¶ *** 6,347 51.5 (±3.4) 61.6 (±9.4) 47.5 (±3.0) 47.1 (±7.0) 32.4 (±4.2) 54.1 (±4.7) 76.4 (±4.2)New Hampshire 3,892 47.0 (±3.2) 49.7 (±6.9) 46.2 (±3.6) 43.6 (±10.8) §§ 34.7 (±5.4) 53.0 (±5.5) 69.3 (±5.0)New Hampshire 3,892 47.0 (±3.2) 49.7 (±6.9) 46.2 (±3.6) 43.6 (±10.8) §§ 34.7 (±5.4) 53.0 (±5.5) 69.3 (±5.0)Rhode island 3,156 50.3 (±3.9) 57.0 (±10.8) §§ 48.5 (±4.0) 52.3 (±8.0) 33.9 (±4.7) 52.9 (±6.1) 73.1 (±5.8)Rhode island 3,156 50.3 (±3.9) 57.0 (±10.8) §§ 48.5 (±4.0) 52.3 (±8.0) 33.9 (±4.7) 52.9 (±6.1) 73.1 (±5.8)Vermont*** 2,291 41.0 (±3.6) 46.8 (±7.4) 39.8 (±4.0) 36.7 (±16.5) §§ 30.3 (±8.4) 41.0 (±6.8) 66.9 (±6.7)Vermont*** 2,291 41.0 (±3.6) 46.8 (±7.4) 39.8 (±4.0) 36.7 (±16.5) §§ 30.3 (±8.4) 41.0 (±6.8) 66.9 (±6.7)Region 2 11,180 39.3 (±2.0) 41.3 (±5.4) 38.6 (±2.1) 39.0 (±5.2) 28.7 (±3.5) 42.5 (±3.6) 66.1 (±3.5)Region 2 11,180 39.3 (±2.0) 41.3 (±5.4) 38.6 (±2.1) 39.0 (±5.2) 28.7 (±3.5) 42.5 (±3.6) 66.1 (±3.5)New Jersey*** 5,683 37.7 (±2.6) 42.7 (±7.5) 36.1 (±2.4) 31.0 (±4.8) 24.9 (±3.1) 39.7 (±4.0) 62.8 (±4.4)New Jersey*** 5,683 37.7 (±2.6) 42.7 (±7.5) 36.1 (±2.4) 31.0 (±4.8) 24.9 (±3.1) 39.7 (±4.0) 62.8 (±4.4)New York 5,497 40.0 (±2.7) 40.6 (±7.1) 39.8 (±2.8) 42.6 (±7.3) 30.3 (±4.9) 43.7 (±4.9) 67.6 (±4.7)New York 5,497 40.0 (±2.7) 40.6 (±7.1) 39.8 (±2.8) 42.6 (±7.3) 30.3 (±4.9) 43.7 (±4.9) 67.6 (±4.7)Region 3 27,045 42.8 (±1.3) 45.9 (±3.6) 42.0 (±1.4) 40.6 (±3.6) 28.1 (±2.0) 47.0 (±2.2) 70.8 (±2.1)Region 3 27,045 42.8 (±1.3) 45.9 (±3.6) 42.0 (±1.4) 40.6 (±3.6) 28.1 (±2.0) 47.0 (±2.2) 70.8 (±2.1)Delaware*** 3,805 42.3 (±3.3) 42.9 (±6.6) 42.2 (±3.8) 40.6 (±11.0) §§ 34.3 (±11.2) §§ 52.4 (±7.2) 67.4 (±5.4)Delaware*** 3,805 42.3 (±3.3) 42.9 (±6.6) 42.2 (±3.8) 40.6 (±11.0) §§ 34.3 (±11.2) §§ 52.4 (±7.2) 67.4 (±5.4)District of Columbia*** 2,843 40.0 (±5.1) 34.8 (±15.5) §§ 41.4 (±5.0) 38.9 (±13.7) §§ 36.0 (±8.3) 40.6 (±6.8) 63.3 (±8.0)District of Columbia*** 2,843 40.0 (±5.1) 34.8 (±15.5) §§ 41.4 (±5.0) 38.9 (±13.7) §§ 36.0 (±8.3) 40.6 (±6.8) 63.3 (±8.0)Maryland ¶¶ 5,672 44.3 (±2.6) 51.0 (±6.9) 42.3 (±2.7) 43.2 (±7.4) 28.4 (±4.0) 48.6 (±4.1) 69.7 (±4.6)Maryland ¶¶ 5,672 44.3 (±2.6) 51.0 (±6.9) 42.3 (±2.7) 43.2 (±7.4) 28.4 (±4.0) 48.6 (±4.1) 69.7 (±4.6)Pennsylvania ¶¶ 6,776 42.2 (±2.3) 47.8 (±6.5) 40.6 (±2.3) 38.2 (±5.4) 24.8 (±3.2) 45.7 (±3.8) 70.4 (±3.5)Pennsylvania ¶¶ 6,776 42.2 (±2.3) 47.8 (±6.5) 40.6 (±2.3) 38.2 (±5.4) 24.8 (±3.2) 45.7 (±3.8) 70.4 (±3.5)Virginia*** 4,138 43.0 (±2.5) 40.8 (±6.0) 43.5 (±2.7) 43.7 (±8.4) 31.7 (±4.2) 46.8 (±4.6) 73.6 (±4.1)Virginia*** 4,138 43.0 (±2.5) 40.8 (±6.0) 43.5 (±2.7) 43.7 (±8.4) 31.7 (±4.2) 46.8 (±4.6) 73.6 (±4.1)West Virginia 3,811 43.3 (±2.8) 41.2 (±9.8) 43.8 (±2.4) 36.3 (±7.7) 29.1 (±4.1) 51.9 (±3.9) 68.5 (±3.6)West Virginia 3,811 43.3 (±2.8) 41.2 (±9.8) 43.8 (±2.4) 36.3 (±7.7) 29.1 (±4.1) 51.9 (±3.9) 68.5 (±3.6)Region 4 46,594 36.9 (±1.2) 36.8 (±3.4) 37.0 (±1.2) 29.4 (±3.1) 25.3 (±1.8) 39.9 (±1.8) 66.1 (±1.7)Region 4 46,594 36.9 (±1.2) 36.8 (±3.4) 37.0 (±1.2) 29.4 (±3.1) 25.3 (±1.8) 39.9 (±1.8) 66.1 (±1.7)Alabama †† 4,903 35.6 (±2.7) 33.5 (±6.3) 36.4 (±2.9) 39.1 (±8.8) 21.8 (±4.3) 39.8 (±5.0) 65.0 (±4.4)Alabama ††4,903 35.6 (±2.7) 33.5 (±6.3) 36.4 (±2.9) 39.1 (±8.8) 21.8 (±4.3) 39.8 (±5.0) 65.0 (±4.4)Florida ¶¶ 10,721 31.6 (±2.0) 26.4 (±4.3) 33.0 (±2.2) 22.1 (±7.2) 19.4 (±3.7) 33.7 (±3.7) 64.3 (±3.1)Florida ¶¶ 10,721 31.6 (±2.0) 26.4 (±4.3) 33.0 (±2.2) 22.1 (±7.2) 19.4 (±3.7) 33.7 (±3.7) 64.3 (±3.1)Georgia 4,039 34.4 (±3.5) 30.8 (±7.1) 35.4 (±4.0) 27.3 (±7.7) 27.7 (±6.3) 41.3 (±5.5) 60.6 (±5.1)Georgia 4,039 34.4 (±3.5) 30.8 (±7.1) 35.4 (±4.0) 27.3 (±7.7) 27.7 (±6.3) 41.3 (±5.5) 60.6 (±5.1)Kentucky 5,525 41.3 (±2.7) 37.1 (±5.6) 42.3 (±3.1) 39.2 (±9.4) 30.3 (±5.4) 47.3 (±4.5) 69.0 (±4.3)Kentucky 5,525 41.3 (±2.7) 37.1 (±5.6) 42.3 (±3.1) 39.2 (±9.4) 30.3 (±5.4) 47.3 (±4.5) 69.0 (±4.3)Mississippi 6,443 35.1 (±3.0) 31.7 (±10.4) §§ 36.0 (±2.6) 21.2 (±4.2) 26.8 (±4.3) 37.9 (±3.9) 66.3 (±3.9)Mississippi 6,443 35.1 (±3.0) 31.7 (±10.4) §§ 36.0 (±2.6) 21.2 (±4.2) 26.8 (±4.3) 37.9 (±3.9) 66.3 (±3.9)North Carolina ¶¶ *** 5,270 45.8 (±4.4) 59.8 (±14.9) §§ 40.9 (±2.9) 33.9 (±7.9) 29.8 (±4.1) 44.2 (±4.7) 71.6 (±4.8)North Carolina ¶¶ *** 5,270 45.8 (±4.4) 59.8 (±14.9) §§ 40.9 (±2.9) 33.9 (±7.9) 29.8 (±4.1) 44.2 (±4.7) 71.6 (±4.8)South Carolina 5,616 37.2 (±2.6) 32.6 (±6.0) 38.8 (±2.9) 33.6 (±8.6) 28.3 (±4.2) 39.9 (±4.6) 68.0 (±4.2)South Carolina 5,616 37.2 (±2.6) 32.6 (±6.0) 38.8 (±2.9) 33.6 (±8.6) 28.3 (±4.2) 39.9 (±4.6) 68.0 (±4.2)Tennessee 4,077 42.1 (±3.1) 44.5 (±8.9) 41.5 (±3.2) 34.8 (±7.0) 28.8 (±4.1) 46.1 (±4.8) 69.5 (±4.6)Tennessee 4,077 42.1 (±3.1) 44.5 (±8.9) 41.5 (±3.2) 34.8 (±7.0) 28.8 (±4.1) 46.1 (±4.8) 69.5 (±4.6)Region 5 29,931 39.8 (±1.2) 38.2 (±3.1) 40.3 (±1.2) 40.6 (±3.4) 28.1 (±1.9) 43.8 (±1.9) 68.4 (±1.9)Region 5 29,931 39.8 (±1.2) 38.2 (±3.1) 40.3 (±1.2) 40.6 (±3.4) 28.1 (±1.9) 43.8 (±1.9) 68.4 (±1.9)Illinois 4,841 39.0 (±2.9) 39.1 (±6.9) 39.0 (±3.1) 36.3 (±9.9) 28.7 (±4.9) 41.4 (±5.0) 67.6 (±4.9)Illinois 4,841 39.0 (±2.9) 39.1 (±6.9) 39.0 (±3.1) 36.3 (±9.9) 28.7 (±4.9) 41.4 (±5.0) 67.6 (±4.9)Indiana 6,376 40.9 (±3.1) 46.2 (±9.7) 39.2 (±2.5) 29.9 (±7.6) 26.5 (±3.9) 48.2 (±4.4) 67.3 (±4.1)Indiana 6,376 40.9 (±3.1) 46.2 (±9.7) 39.2 (±2.5) 29.9 (±7.6) 26.5 (±3.9) 48.2 (±4.4) 67.3 (±4.1)Michigan †† 5,371 36.0 (±2.6) 32.4 (±5.9) 37.2 (±2.8) 43.3 (±6.2) 23.0 (±4.0) 41.3 (±4.0) 66.9 (±4.2)Michigan ††5,371 36.0 (±2.6) 32.4 (±5.9) 37.2 (±2.8) 43.3 (±6.2) 23.0 (±4.0) 41.3 (±4.0) 66.9 (±4.2)Minnesota 4,638 51.9 (±3.4) 49.2 (±5.5) 52.5 (±3.9) 63.4 (±7.1) 41.5 (±6.6) 55.3 (±4.9) 74.1 (±4.6)Minnesota 4,638 51.9 (±3.4) 49.2 (±5.5) 52.5 (±3.9) 63.4 (±7.1) 41.5 (±6.6) 55.3 (±4.9) 74.1 (±4.6)Ohio 5,847 37.7 (±2.5) 35.3 (±6.1) 38.8 (±2.4) 41.3 (±4.9) 26.3 (±3.0) 41.3 (±3.5) 64.9 (±4.0)Ohio 5,847 37.7 (±2.5) 35.3 (±6.1) 38.8 (±2.4) 41.3 (±4.9) 26.3 (±3.0) 41.3 (±3.5) 64.9 (±4.0)Wisconsin 2,858 39.9 (±3.0) 37.0 (±7.6) 40.6 (±3.3) 33.4 (±11.4) §§ 27.0 (±5.7) 41.7 (±5.3) 74.3 (±5.1)Wisconsin 2,858 39.9 (±3.0) 37.0 (±7.6) 40.6 (±3.3) 33.4 (±11.4) §§ 27.0 (±5.7) 41.7 (±5.3) 74.3 (±5.1)Region 6 28,054 40.7 (±1.6) 43.7 (±3.5) 39.9 (±1.8) 34.7 (±4.8) 28.7 (±2.3) 45.8 (±3.1) 70.3 (±2.6)Region 6 28,054 40.7 (±1.6) 43.7 (±3.5) 39.9 (±1.8) 34.7 (±4.8) 28.7 (±2.3) 45.8 (±3.1) 70.3 (±2.6)Arkansas ¶¶ *** 3,524 49.4 (±6.0) 65.3 (±15.8) §§ 41.0 (±3.7) 36.6 (±12.3) §§ 31.9 (±6.6) 44.5 (±5.7) 66.6 (±4.9)Arkansas ¶¶ *** 3,524 49.4 (±6.0) 65.3 (±15.8) §§ 41.0 (±3.7) 36.6 (±12.3) §§ 31.9 (±6.6) 44.5 (±5.7) 66.6 (±4.9)Louisiana 4,630 40.6 (±2.7) 42.2 (±5.2) 40.1 (±3.1) 35.1 (±7.8) 29.7 (±4.9) 39.8 (±4.1) 70.6 (±5.9)Louisiana 4,630 40.6 (±2.7) 42.2 (±5.2) 40.1 (±3.1) 35.1 (±7.8) 29.7 (±4.9) 39.8 (±4.1) 70.6 (±5.9)New Mexico 5,536 45.7 (±3.3) 49.9 (±8.1) 44.3 (±3.5) 47.1 (±7.3) 31.7 (±4.7) 45.0 (±5.6) 78.6 (±6.2)New Mexico 5,536 45.7 (±3.3) 49.9 (±8.1) 44.3 (±3.5) 47.1 (±7.3) 31.7 (±4.7) 45.0 (±5.6) 78.6 (±6.2)Oklahoma 3,976 40.4 (±3.0) 37.2 (±6.8) 41.6 (±3.3) 26.7 (±6.3) 29.5 (±4.7) 47.8 (±6.6) 69.6 (±5.5)Oklahoma 3,976 40.4 (±3.0) 37.2 (±6.8) 41.6 (±3.3) 26.7 (±6.3) 29.5 (±4.7) 47.8 (±6.6) 69.6 (±5.5)Texas 10,388 39.4 (±2.2) 40.5 (±4.7) 39.1 (±2.5) 34.5 (±6.9) 27.9 (±3.2) 46.7 (±4.4) 70.1 (±3.6)Texas 10,388 39.4 (±2.2) 40.5 (±4.7) 39.1 (±2.5) 34.5 (±6.9) 27.9 (±3.2) 46.7 (±4.4) 70.1 (±3.6)Region 7 26,376 42.8 (±1.6) 38.8 (±3.1) 44.1 (±1.8) 42.6 (±6.8) 31.5 (±3.1) 45.9 (±3.1) 71.9 (±2.8)Region 7 26,376 42.8 (±1.6) 38.8 (±3.1) 44.1 (±1.8) 42.6 (±6.8) 31.5 (±3.1) 45.9 (±3.1) 71.9 (±2.8)Iowa 4,571 48.8 (±2.7) 44.1 (±5.8) 50.2 (±3.1) 38.3 (±9.1) 38.9 (±4.9) 51.3 (±5.1) 76.0 (±4.4)Iowa 4,571 48.8 (±2.7) 44.1 (±5.8) 50.2 (±3.1) 38.3 (±9.1) 38.9 (±4.9) 51.3 (±5.1) 76.0 (±4.4)Kansas ¶¶ 9,421 41.7 (±2.0) 38.3 (±3.8) 43.5 (±2.4) 33.1 (±7.2) 33.2 (±4.0) 47.4 (±3.1) 71.6 (±3.0)Kansas ¶¶ 9,421 41.7 (±2.0) 38.3 (±3.8) 43.5 (±2.4) 33.1 (±7.2) 33.2 (±4.0) 47.4 (±3.1) 71.6 (±3.0)Missouri †† 3,511 38.7 (±3.1) 34.4 (±6.8) 39.7 (±3.4) 44.2 (±13.5) §§ 25.0 (±5.8) 41.8 (±5.9) 69.4 (±5.3)Missouri ††3,511 38.7 (±3.1) 34.4 (±6.8) 39.7 (±3.4) 44.2 (±13.5) §§ 25.0 (±5.8) 41.8 (±5.9) 69.4 (±5.3)Nebraska 8,873 47.8 (±3.1) 42.9 (±7.7) 49.7 (±3.1) 58.3 (±6.8) 40.0 (±5.5) 48.8 (±3.5) 74.1 (±3.5)Nebraska 8,873 47.8 (±3.1) 42.9 (±7.7) 49.7 (±3.1) 58.3 (±6.8) 40.0 (±5.5) 48.8 (±3.5) 74.1 (±3.5)Region 8 26,380 41.8 (±1.9) 40.4 (±5.6) 42.3 (±1.5) 46.5 (±5.2) 31.0 (±2.9) 48.9 (±2.2) 70.4 (±2.4)Region 8 26,380 41.8 (±1.9) 40.4 (±5.6) 42.3 (±1.5) 46.5 (±5.2) 31.0 (±2.9) 48.9 (±2.2) 70.4 (±2.4)Colorado*** 5,387 42.6 (±3.3) 42.9 (±11.3) §§ 42.4 (±2.7) 48.9 (±8.9) 31.4 (±5.3) 48.0 (±3.7) 73.7 (±4.1)Colorado*** 5,387 42.6 (±3.3) 42.9 (±11.3) §§ 42.4 (±2.7) 48.9 (±8.9) 31.4 (±5.3) 48.0 (±3.7) 73.7 (±4.1)Montana ¶¶†† 4,808 37.5 (±2.5) 31.6 (±5.3) 39.4 (±2.8) 44.6 (±7.1) 27.3 (±4.6) 42.6 (±4.3) 61.3 (±4.7)Montana ¶¶††4,808 37.5 (±2.5) 31.6 (±5.3) 39.4 (±2.8) 44.6 (±7.1) 27.3 (±4.6) 42.6 (±4.3) 61.3 (±4.7)North Dakota 3,646 44.3 (±3.0) 45.5 (±7.4) 44.0 (±3.2) 39.8 (±9.6) 33.5 (±4.4) 45.5 (±4.6) 69.8 (±4.8)North Dakota 3,646 44.3 (±3.0) 45.5 (±7.4) 44.0 (±3.2) 39.8 (±9.6) 33.5 (±4.4) 45.5 (±4.6) 69.8 (±4.8)South Dakota 4,016 52.7 (±3.5) 54.0 (±8.2) 52.3 (±3.9) 47.4 (±9.6) 43.1 (±6.1) 53.4 (±6.5) 74.8 (±4.5)South Dakota 4,016 52.7 (±3.5) 54.0 (±8.2) 52.3 (±3.9) 47.4 (±9.6) 43.1 (±6.1) 53.4 (±6.5) 74.8 (±4.5)Utah 3,853 38.5 (±3.7) 36.5 (±8.6) 39.7 (±3.0) 47.4 (±11.7) §§ 27.3 (±4.3) 54.0 (±4.6) 66.0 (±5.2)Utah 3,853 38.5 (±3.7) 36.5 (±8.6) 39.7 (±3.0) 47.4 (±11.7) §§ 27.3 (±4.3) 54.0 (±4.6) 66.0 (±5.2)Wyoming 4,670 39.6 (±2.4) 39.6 (±6.0) 39.7 (±2.5) 29.9 (±8.4) 28.8 (±4.3) 44.4 (±4.0) 69.6 (±3.5)Wyoming 4,670 39.6 (±2.4) 39.6 (±6.0) 39.7 (±2.5) 29.9 (±8.4) 28.8 (±4.3) 44.4 (±4.0) 69.6 (±3.5)Region 9 20,455 37.2 (±2.3) 35.3 (±4.1) 37.9 (±2.8) 29.7 (±5.5) 25.7 (±3.3) 50.1 (±7.3) 64.1 (±3.9)Region 9 20,455 37.2 (±2.3) 35.3 (±4.1) 37.9 (±2.8) 29.7 (±5.5) 25.7 (±3.3) 50.1 (±7.3) 64.1 (±3.9)Arizona †† 3,600 40.6 (±4.7) 41.3 (±12.0) §§ 40.4 (±4.8) 43.4 (±10.8) §§ 29.3 (±7.3) 40.6 (±8.2) 68.4 (±7.1)Arizona ††3,600 40.6 (±4.7) 41.3 (±12.0) §§ 40.4 (±4.8) 43.4 (±10.8) §§ 29.3 (±7.3) 40.6 (±8.2) 68.4 (±7.1)California 7,225 36.4 (±2.9) 33.7 (±4.8) 37.5 (±3.5) 26.7 (±6.8) 25.2 (±4.0) 52.6 (±9.3) 63.3 (±4.9)California 7,225 36.4 (±2.9) 33.7 (±4.8) 37.5 (±3.5) 26.7 (±6.8) 25.2 (±4.0) 52.6 (±9.3) 63.3 (±4.9)Hawaii ¶¶ 5,400 54.5 (±3.5) 67.2 (±8.3) 47.6 (±3.0) 38.3 (±8.6) 33.8 (±5.3) 56.3 (±4.6) 75.1 (±4.1)Hawaii ¶¶ 5,400 54.5 (±3.5) 67.2 (±8.3) 47.6 (±3.0) 38.3 (±8.6) 33.8 (±5.3) 56.3 (±4.6) 75.1 (±4.1)Nevada ¶¶†† 4,230 30.3 (±3.0) 23.6 (±5.2) 32.4 (±3.6) 32.6 (±9.3) 20.2 (±4.8) 38.1 (±5.7) 59.6 (±5.3)Nevada ¶¶††4,230 30.3 (±3.0) 23.6 (±5.2) 32.4 (±3.6) 32.6 (±9.3) 20.2 (±4.8) 38.1 (±5.7) 59.6 (±5.3)TABLE 1. (Continued) Estimated seasonal influenza vaccination coverage among children and adults,* by U.S. Department of Health and Human Services (HHS) region, state, and selected age and risk subgroups --- United States, Behavioral Risk Factor Surveillance System (BRFSS) and National 2009 H1N1 Flu Survey (NHFS), end of January 2010 †TABLE 1. (Continued) Estimated seasonal influenza vaccination coverage among children and adults,* by U.S. Department of Health and Human Services (HHS) region, state, and selected age and risk subgroups --- United States, Behavioral Risk Factor Surveillance System (BRFSS) and National 2009 H1N1 Flu Survey (NHFS), end of January 2010 â€HHS region and state/area Unweighted sample size All persons aged ≥6 mos Children aged 6 mos--17 yrs Persons aged ≥18 yrs Persons aged 18--49 yrs at high risk § Persons aged 18--49 yrs not at high risk All persons aged 50--64 yrs All persons aged ≥65 yrsHHS region and state/area Unweighted sample size All persons aged ≥6 mos Children aged 6 mos--17 yrs Persons aged ≥18 yrs Persons aged 18--49 yrs at high risk § Persons aged 18--49 yrs not at high risk All persons aged 50--64 yrs All persons aged ≥65 yrsNo. ¶ % (95% CI**) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI)No. ¶ % (95% CI**) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI)Region 10 20,869 38.6 (±1.5) 38.8 (±4.4) 38.5 (±1.4) 38.9 (±4.0) 25.7 (±2.1) 43.2 (±2.2) 68.7 (±2.3)Region 10 20,869 38.6 (±1.5) 38.8 (±4.4) 38.5 (±1.4) 38.9 (±4.0) 25.7 (±2.1) 43.2 (±2.2) 68.7 (±2.3)Alaska 2,585 36.6 (±4.8) 35.0 (±8.4) 37.2 (±5.8) 32.7 (±11.5) §§ 26.2 (±7.1) 46.2 (±9.4) 81.6 (±8.9)Alaska 2,585 36.6 (±4.8) 35.0 (±8.4) 37.2 (±5.8) 32.7 (±11.5) §§ 26.2 (±7.1) 46.2 (±9.4) 81.6 (±8.9)Idaho 4,003 33.8 (±2.6) 30.5 (±6.0) 35.1 (±2.8) 28.4 (±8.7) 24.6 (±4.2) 42.1 (±4.6) 59.3 (±5.0)Idaho 4,003 33.8 (±2.6) 30.5 (±6.0) 35.1 (±2.8) 28.4 (±8.7) 24.6 (±4.2) 42.1 (±4.6) 59.3 (±5.0)Oregon 4,527 38.3 (±2.8) 34.7 (±6.7) 39.2 (±3.0) 34.0 (±7.3) 27.8 (±4.7) 42.1 (±4.9) 67.6 (±5.3)Oregon 4,527 38.3 (±2.8) 34.7 (±6.7) 39.2 (±3.0) 34.0 (±7.3) 27.8 (±4.7) 42.1 (±4.9) 67.6 (±5.3)Washington †† 9,754 40.0 (±2.3) 43.9 (±7.4) 38.9 (±1.9) 44.6 (±5.8) 24.6 (±2.7) 43.7 (±2.6) 70.1 (±2.6)Washington ††9,754 40.0 (±2.3) 43.9 (±7.4) 38.9 (±1.9) 44.6 (±5.8) 24.6 (±2.7) 43.7 (±2.6) 70.1 (±2.6)Median ††† 4,670 40.6 41.2 40.6 38.3 28.8 45.5 69.3Median †††4,670 40.6 41.2 40.6 38.3 28.8 45.5 69.3Range ††† 2,291--10,721 30.3--54.5 23.6--67.2 32.4--52.5 21.2--63.4 19.4--43.1 33.7--56.3 59.3--78.6Range †††2,291--10,721 30.3--54.5 23.6--67.2 32.4--52.5 21.2--63.4 19.4--43.1 33.7--56.3 59.3--78.6U.S. territories §§§ 2,623 11.3 (±3.1) --- ††† --- ††† 11.3 (±3.1) --- ††† --- ††† --- ††† --- ††† 10.0 (±3.3) 20.6 (±4.9)U.S. territories §§§ 2,623 11.3 (±3.1) --- †††--- †††11.3 (±3.1) --- †††--- †††--- †††--- †††10.0 (±3.3) 20.6 (±4.9)Guam ¶¶¶ --- --- --- --- --- --- --- --- --- --- --- --- --- --- ---Guam ¶¶¶ --- --- --- --- --- --- --- --- --- --- --- --- --- --- ---Puerto Rico 1,710 11.1 (±3.1) ---**** ---**** 11.1 (±3.1) ---**** ---**** ---**** ---**** 9.7 (±3.3) 20.3 (±5.1)Puerto Rico 1,710 11.1 (±3.1) ---**** ---**** 11.1 (±3.1) ---**** ---**** ---**** ---**** 9.7 (±3.3) 20.3 (±5.1)U.S. Virgin Islands 913 --- --- --- --- 19.7 (±4.3) ---**** ---**** 12.7 (±6.9) 24.1 (±5.9) 37.5 (±9.6)U.S. Virgin Islands 913 --- --- --- --- 19.7 (±4.3) ---**** ---**** 12.7 (±6.9) 24.1 (±5.9) 37.5 (±9.6)* Coverage estimates are for persons with reported vaccination during August 2009--January 2010 who were interviewed during October 2009--February 2010.† Percentages are weighted to the U.S. population.†Percentages are weighted to the U.S. population.§ High risk includes asthma, other lung problems, diabetes, heart disease, kidney problems, anemia, or weakened immune system caused by a chronic illness or by medicines taken for a chronic illness.§ High risk includes asthma, other lung problems, diabetes, heart disease, kidney problems, anemia, or weakened immune system caused by a chronic illness or by medicines taken for a chronic illness.¶ Respondents with missing vaccination information were excluded; the missing rates are 7.5% for BRFSS and 2.8% for NHFS.¶ Respondents with missing vaccination information were excluded; the missing rates are 7.5% for BRFSS and 2.8% for NHFS.** Confidence interval.†† Estimates for adults with high-risk conditions were significantly higher compared with adults with no high-risk conditions in the following states: Connecticut, Alabama, Michigan, Missouri, Colorado, Montana, Utah, Arizona, Nevada, and Washington.††Estimates for adults with high-risk conditions were significantly higher compared with adults with no high-risk conditions in the following states: Connecticut, Alabama, Michigan, Missouri, Colorado, Montana, Utah, Arizona, Nevada, and Washington.§§ Estimates might be unreliable because confidence interval half-width is >10.§§ Estimates might be unreliable because confidence interval half-width is >10.¶¶ Child estimates were significantly higher than adult estimates in the following states: Maine, Massachusetts, Maryland, Pennsylvania, Florida, North Carolina, Arkansas, Kansas, Montana, Hawaii, and Nevada.¶¶ Child estimates were significantly higher than adult estimates in the following states: Maine, Massachusetts, Maryland, Pennsylvania, Florida, North Carolina, Arkansas, Kansas, Montana, Hawaii, and Nevada.*** BRFSS data were not collected for children in Massachusetts, Vermont, New Jersey, District of Columbia, Virginia, North Carolina, Arkansas, and Colorado. BRFSS data were not collected for adults aged 18--49 years not at high risk in Vermont and Delaware.††† Excludes U.S. territories.†††Excludes U.S. territories.§§§ Estimates for U.S. territories are from BRFSS only.§§§ Estimates for U.S. territories are from BRFSS only.¶¶¶ Guam did not collect BRFSS data in 2009 and 2010.¶¶¶ Guam did not collect BRFSS data in 2009 and 2010.**** Estimates might be unreliable; relative standard error >0.30.FIGURE 1. Estimates of child and adult state-specific cumulative seasonal influenza vaccination coverage* --- Behavioral Risk Factor Surveillance System (BRFSS) and National H1N1 Flu Survey (NHFS) combined, 50 U.S. states and the District of Columbia, end of January 2010* Coverage estimates are for persons with reported vaccination during August 2009--January 2010 who were interviewed during October 2009--February 2010.Alternate Text: The figure above shows estimates of child and adult state-specific cumulative seasonal influenza vaccination coverage for the 50 States and the District of Columbia from the Behavioral Risk Factor Surveillance System (BRFSS) and National H1N1Flu Survey (NHFS) combined data. State-specific child and adult (age ≥18 years) coverage were correlated positively (r = 0.68), with wider range of coverage among state-specific child levels compared with adult levels.Alternate Text: The figure above shows estimates of child and adult state-specific cumulative seasonal influenza vaccination coverage for the 50 States and the District of Columbia from the Behavioral Risk Factor Surveillance System (BRFSS) and National H1N1Flu Survey (NHFS) combined data. State-specific child and adult (age ≥18 years) coverage were correlated positively (r = 0.68), with wider range of coverage among state-specific child levels compared with adult levels.TABLE 2. Estimated seasonal influenza vaccination coverage among persons aged ≥6 months,* by U.S. Department of Health and Human Services (HHS) region, state, and racial/ethnic group --- United States, Behavioral Risk Factor Surveillance System (BRFSS) and National 2009 H1N1 Flu Survey (NHFS), end of January 2010 †TABLE 2. Estimated seasonal influenza vaccination coverage among persons aged ≥6 months,* by U.S. Department of Health and Human Services (HHS) region, state, and racial/ethnic group --- United States, Behavioral Risk Factor Surveillance System (BRFSS) and National 2009 H1N1 Flu Survey (NHFS), end of January 2010 â€HHS region and state/area Non-Hispanic white persons aged ≥6 mos Non-Hispanic black persons aged ≥6 mos Hispanic persons aged ≥6 mos Persons of other race/ethnicity aged ≥6 mosHHS region and state/area Non-Hispanic white persons aged ≥6 mos Non-Hispanic black persons aged ≥6 mos Hispanic persons aged ≥6 mos Persons of other race/ethnicity aged ≥6 mosNo. §¶ % (95% CI**) No. % (95% CI) No. % (95% CI) No. % (95% CI)No. §¶ % (95% CI**) No. % (95% CI) No. % (95% CI) No. % (95% CI)All states combined 201,361 42.5 BHO (±0.6) 21,864 32.2 WO (±1.9) 20,082 33.6 WO (±2.3) 17,445 40.0 WBH (±2.4)All states combined 201,361 42.5 BHO (±0.6) 21,864 32.2 WO (±1.9) 20,082 33.6 WO (±2.3) 17,445 40.0 WBH (±2.4)Region 1 22,185 48.8 (±2.0) 767 45.2 (±8.6) 1,252 42.7 (±6.4) 1,146 46.9 (±6.4)Region 1 22,185 48.8 (±2.0) 767 45.2 (±8.6) 1,252 42.7 (±6.4) 1,146 46.9 (±6.4)Connecticut 3,653 44.9 (±4.0) 268 34.8 (±14.2) †† 327 35.8 (±9.6) 255 38.4 (±13.4) ††Connecticut 3,653 44.9 (±4.0) 268 34.8 (±14.2) ††327 35.8 (±9.6) 255 38.4 (±13.4) †â€Maine 5,014 48.3 (±2.7) --- §§ --- §§ --- §§ 79 47.3 (±18.5) †† 151 35.8 (±13.6) ††Maine 5,014 48.3 (±2.7) --- §§ --- §§ --- §§ 79 47.3 (±18.5) ††151 35.8 (±13.6) †â€Massachusetts ¶¶ 5,076 51.8 (±3.9) 313 55.6 (±12.8) †† 505 47.1 (±10.4) †† 401 49.2 (±9.3)Massachusetts ¶¶ 5,076 51.8 (±3.9) 313 55.6 (±12.8) ††505 47.1 (±10.4) ††401 49.2 (±9.3)New Hampshire 3,651 46.3 O (±3.4) --- §§ --- §§ --- §§ 59 39.4 O (±18.8) †† 124 71.6 WH (±15.7) ††New Hampshire 3,651 46.3 O (±3.4) --- §§ --- §§ --- §§ 59 39.4 O (±18.8) ††124 71.6 WH (±15.7) †â€Rhode Island 2,655 52.4 B (±4.0) 118 25.9 WHO (±12.3) †† 248 47.4 B (±17.5) †† 118 46.8 B (±16.7) ††Rhode Island 2,655 52.4 B (±4.0) 118 25.9 WHO (±12.3) ††248 47.4 B (±17.5) ††118 46.8 B (±16.7) †â€Vermont ¶¶ 2,136 41.2 (±3.7) --- §§ --- §§ --- §§ 34 --- §§ --- §§ 97 38.6 (±18.4) ††Vermont ¶¶ 2,136 41.2 (±3.7) --- §§ --- §§ --- §§ 34 --- §§ --- §§ 97 38.6 (±18.4) †â€Region 2 8,115 42.2 BH (±2.1) 1,151 29.1 WO (±6.1) 1,112 34.1 WO (±6.4) 686 45.4 BH (±9.2)Region 2 8,115 42.2 BH (±2.1) 1,151 29.1 WO (±6.1) 1,112 34.1 WO (±6.4) 686 45.4 BH (±9.2)New Jersey ¶¶ 4,103 43.0 BHO (±2.6) 595 28.6 W (±8.0) 557 26.9 W (±7.4) 384 34.0 W (±7.3)New Jersey ¶¶ 4,103 43.0 BHO (±2.6) 595 28.6 W (±8.0) 557 26.9 W (±7.4) 384 34.0 W (±7.3)New York 4,012 41.8 B (±2.9) 556 29.3 WO (±8.0) 555 37.3 (±8.6) 302 50.7 B (±13.1) ††New York 4,012 41.8 B (±2.9) 556 29.3 WO (±8.0) 555 37.3 (±8.6) 302 50.7 B (±13.1) †â€Region 3 20,372 45.4 B (±1.6) 3,940 34.0 W (±4.0) 1,130 38.7 (±6.7) 1,441 40.5 (±7.0)Region 3 20,372 45.4 B (±1.6) 3,940 34.0 W (±4.0) 1,130 38.7 (±6.7) 1,441 40.5 (±7.0)Delaware 2,881 44.6 B (±4.1) 480 32.2 W (±8.2) 187 49.1 (±15.8) †† 251 42.5 (±14.5) ††Delaware 2,881 44.6 B (±4.1) 480 32.2 W (±8.2) 187 49.1 (±15.8) ††251 42.5 (±14.5) †â€District of Columbia ¶¶ 1,307 54.0 BH (±8.5) 1,156 31.7 W (±5.8) 181 34.2 W (±10.6) †† 175 45.6 (±14.2) ††District of Columbia ¶¶ 1,307 54.0 BH (±8.5) 1,156 31.7 W (±5.8) 181 34.2 W (±10.6) ††175 45.6 (±14.2) †â€Maryland 3,890 47.8 B (±2.9) 1,117 37.2 W (±6.4) 227 39.6 (±10.8) †† 398 49.4 (±11.1) ††Maryland 3,890 47.8 B (±2.9) 1,117 37.2 W (±6.4) 227 39.6 (±10.8) ††398 49.4 (±11.1) †â€Pennsylvania 5,603 43.4 (±2.6) 597 35.6 (±10.3) †† 290 42.5 (±13.2) †† 233 32.2 (±15.9) ††Pennsylvania 5,603 43.4 (±2.6) 597 35.6 (±10.3) ††290 42.5 (±13.2) ††233 32.2 (±15.9) †â€Virginia ¶¶ 3,110 48.0 BH (±3.2) 518 29.7 W (±7.0) 195 33.4 W (±11.8) †† 282 40.6 (±11.1) ††Virginia ¶¶ 3,110 48.0 BH (±3.2) 518 29.7 W (±7.0) 195 33.4 W (±11.8) ††282 40.6 (±11.1) †â€West Virginia 3,581 43.8 (±2.9) 72 34.9 (±15.0) †† 50 --- §§ --- §§ 102 39.9 (±19.0) ††West Virginia 3,581 43.8 (±2.9) 72 34.9 (±15.0) ††50 --- §§ --- §§ 102 39.9 (±19.0) †â€Region 4 34,229 41.4 BHO (±1.4) 8,404 28.9 W (±3.0) 1,874 25.4 WO (±4.8) 1,671 33.4 WH (±5.3)Region 4 34,229 41.4 BHO (±1.4) 8,404 28.9 W (±3.0) 1,874 25.4 WO (±4.8) 1,671 33.4 WH (±5.3)Alabama 3,419 38.9 B (±3.5) 1,174 27.4 W (±5.2) 124 35.4 (±16.6) †† 152 32.4 (±15.3) ††Alabama 3,419 38.9 B (±3.5) 1,174 27.4 W (±5.2) 124 35.4 (±16.6) ††152 32.4 (±15.3) †â€Florida 8,474 35.8 H (±2.2) 898 28.3 (±8.9) 859 22.7 W (±6.7) 374 26.0 (±9.7)Florida 8,474 35.8 H (±2.2) 898 28.3 (±8.9) 859 22.7 W (±6.7) 374 26.0 (±9.7)Georgia 2,703 39.7 BH (±4.1) 901 28.0 W (±7.0) 220 23.2 W (±11.5) †† 194 28.7 (±12.2) ††Georgia 2,703 39.7 BH (±4.1) 901 28.0 W (±7.0) 220 23.2 W (±11.5) ††194 28.7 (±12.2) †â€Kentucky 4,579 40.8 (±3.3) 569 47.7 (±14.0) †† 107 40.3 (±20.7) †† 194 40.2 (±13.5) ††Kentucky 4,579 40.8 (±3.3) 569 47.7 (±14.0) ††107 40.3 (±20.7) ††194 40.2 (±13.5) †â€Mississippi 4,056 42.6 B (±3.6) 2,093 23.7 W (±3.9) 117 32.8 (±14.5) †† 128 29.8 (±16.7) ††Mississippi 4,056 42.6 B (±3.6) 2,093 23.7 W (±3.9) 117 32.8 (±14.5) ††128 29.8 (±16.7) †â€North Carolina ¶¶ 3,992 50.8 B (±5.7) 768 32.8 W (±6.8) 218 40.2 (±12.5) †† 272 42.4 (±14.1) ††North Carolina ¶¶ 3,992 50.8 B (±5.7) 768 32.8 W (±6.8) 218 40.2 (±12.5) ††272 42.4 (±14.1) †â€South Carolina 3,703 43.0 BH (±3.7) 1,476 25.4 WO (±5.2) 132 24.4 W (±14.1) †† 213 39.3 B (±12.6) ††South Carolina 3,703 43.0 BH (±3.7) 1,476 25.4 WO (±5.2) 132 24.4 W (±14.1) ††213 39.3 B (±12.6) †â€Tennessee 3,303 45.3 B (±3.9) 525 31.0 W (±8.1) 97 --- §§ --- §§ 144 48.5 (±18.1) ††Tennessee 3,303 45.3 B (±3.9) 525 31.0 W (±8.1) 97 --- §§ --- §§ 144 48.5 (±18.1) †â€Region 5 24,022 41.6 BO (±1.3) 2,978 30.1 W (±5.0) 1,391 38.5 (±7.2) 1,351 34.4 W (±5.2)Region 5 24,022 41.6 BO (±1.3) 2,978 30.1 W (±5.0) 1,391 38.5 (±7.2) 1,351 34.4 W (±5.2)Illinois 3,444 42.4 BO (±3.3) 610 29.4 W (±11.4) †† 510 37.0 (±11.6) †† 267 30.4 W (±10.9) ††Illinois 3,444 42.4 BO (±3.3) 610 29.4 W (±11.4) ††510 37.0 (±11.6) ††267 30.4 W (±10.9) †â€Indiana 5,026 40.9 (±2.6) 727 42.8 (±13.0) †† 365 41.2 (±14.8) †† 191 34.2 (±13.6) ††Indiana 5,026 40.9 (±2.6) 727 42.8 (±13.0) ††365 41.2 (±14.8) ††191 34.2 (±13.6) †â€Michigan 4,068 38.1 (±2.8) 822 27.4 (±10.4) †† 141 32.7 (±14.6) †† 292 29.2 (±9.2)Michigan 4,068 38.1 (±2.8) 822 27.4 (±10.4) ††141 32.7 (±14.6) ††292 29.2 (±9.2)Minnesota 4,147 53.9 B (±3.7) 126 29.7 W (±12.6) †† 133 47.1 (±19.3) †† 222 43.7 (±13.8) ††Minnesota 4,147 53.9 B (±3.7) 126 29.7 W (±12.6) ††133 47.1 (±19.3) ††222 43.7 (±13.8) †â€Ohio 4,887 39.3 B (±2.5) 525 27.9 W (±6.7) 123 38.6 (±13.9) †† 268 33.6 (±10.6) ††Ohio 4,887 39.3 B (±2.5) 525 27.9 W (±6.7) 123 38.6 (±13.9) ††268 33.6 (±10.6) †â€Wisconsin 2,450 39.7 (±3.8) 168 33.0 (±12.0) †† 119 46.9 (±20.2) †† 111 45.6 (±18.0) ††Wisconsin 2,450 39.7 (±3.8) 168 33.0 (±12.0) ††119 46.9 (±20.2) ††111 45.6 (±18.0) †â€Region 6 17,519 43.1 B (±1.9) 2,750 34.4 WO (±4.6) 5,616 38.6 (±4.7) 1,971 43.7 B (±7.0)Region 6 17,519 43.1 B (±1.9) 2,750 34.4 WO (±4.6) 5,616 38.6 (±4.7) 1,971 43.7 B (±7.0)Arkansas ¶¶ 2,767 53.1 B (±7.1) 434 32.1 WO (±9.5) 145 44.5 (±16.1) †† 146 54.5 B (±14.2) ††Arkansas ¶¶ 2,767 53.1 B (±7.1) 434 32.1 WO (±9.5) 145 44.5 (±16.1) ††146 54.5 B (±14.2) †â€Louisiana 3,211 43.5 B (±3.2) 1,113 34.0 W (±5.2) 135 45.0 (±13.6) †† 158 45.0 (±20.3) ††Louisiana 3,211 43.5 B (±3.2) 1,113 34.0 W (±5.2) 135 45.0 (±13.6) ††158 45.0 (±20.3) †â€New Mexico 2,904 42.6 O (±4.1) 88 54.3 (±15.6) †† 1,977 45.0 O (±6.1) 537 58.2 WH (±9.6)New Mexico 2,904 42.6 O (±4.1) 88 54.3 (±15.6) ††1,977 45.0 O (±6.1) 537 58.2 WH (±9.6)Oklahoma 2,824 42.8 H (±3.7) 257 33.4 (±12.4) †† 290 30.8 W (±10.8) †† 598 37.2 (±7.6)Oklahoma 2,824 42.8 H (±3.7) 257 33.4 (±12.4) ††290 30.8 W (±10.8) ††598 37.2 (±7.6)Texas 5,813 41.3 (±2.8) 858 34.8 (±7.5) 3,069 38.0 (±5.4) 532 42.7 (±11.7) ††Texas 5,813 41.3 (±2.8) 858 34.8 (±7.5) 3,069 38.0 (±5.4) 532 42.7 (±11.7) †â€Region 7 23,355 43.7 HO (±1.9) 815 40.9 (±9.7) 1,204 36.3 W (±6.6) 921 35.2 W (±6.7)Region 7 23,355 43.7 HO (±1.9) 815 40.9 (±9.7) 1,204 36.3 W (±6.6) 921 35.2 W (±6.7)Iowa 4,176 51.0 BH (±3.0) 83 22.0 W (±11.3) †† 182 24.6 W (±9.6) 112 41.2 (±16.0) ††Iowa 4,176 51.0 BH (±3.0) 83 22.0 W (±11.3) ††182 24.6 W (±9.6) 112 41.2 (±16.0) †â€Kansas 8,091 43.4 B (±2.1) 365 33.8 W (±8.1) 525 34.1 (±9.4) 416 36.4 (±8.1)Kansas 8,091 43.4 B (±2.1) 365 33.8 W (±8.1) 525 34.1 (±9.4) 416 36.4 (±8.1)Missouri 2,963 38.2 (±3.9) 266 43.2 (±14.0) †† 110 40.5 (±16.7) †† 165 33.1 (±13.2) ††Missouri 2,963 38.2 (±3.9) 266 43.2 (±14.0) ††110 40.5 (±16.7) ††165 33.1 (±13.2) †â€Nebraska 8,125 48.5 O (±2.5) 101 54.4 O (±17.1) †† 387 45.1 (±16.0) †† 228 31.0 WB (±11.8) ††Nebraska 8,125 48.5 O (±2.5) 101 54.4 O (±17.1) ††387 45.1 (±16.0) ††228 31.0 WB (±11.8) †â€Region 8 22,870 42.8 B (±1.8) 202 30.6 W (±10.7) †† 1,486 38.4 (±6.3) 1,701 40.7 (±5.9)Region 8 22,870 42.8 B (±1.8) 202 30.6 W (±10.7) ††1,486 38.4 (±6.3) 1,701 40.7 (±5.9)Colorado ¶¶ 4,328 43.6 B (±3.3) 96 26.0 WHO (±12.9) †† 713 41.6 B (±8.2) 223 44.8 B (±11.8) ††Colorado ¶¶ 4,328 43.6 B (±3.3) 96 26.0 WHO (±12.9) ††713 41.6 B (±8.2) 223 44.8 B (±11.8) †â€Montana 4,131 38.2 (±2.8) --- §§ --- §§ --- §§ 102 --- §§ --- §§ 545 32.9 (±6.8)Montana 4,131 38.2 (±2.8) --- §§ --- §§ --- §§ 102 --- §§ --- §§ 545 32.9 (±6.8)North Dakota 3,323 44.9 (±3.2) --- §§ --- §§ --- §§ 61 33.6 (±19.5) †† 214 39.7 (±21.6) ††North Dakota 3,323 44.9 (±3.2) --- §§ --- §§ --- §§ 61 33.6 (±19.5) ††214 39.7 (±21.6) †â€South Dakota 3,464 54.3 (±4.0) --- §§ --- §§ --- §§ 69 37.4 (±17.8) †† 447 47.4 (±10.1) ††South Dakota 3,464 54.3 (±4.0) --- §§ --- §§ --- §§ 69 37.4 (±17.8) ††447 47.4 (±10.1) †â€Utah 3,450 39.8 (±3.8) --- §§ --- §§ --- §§ 250 30.6 (±11.1) †† 119 33.8 (±12.3) ††Utah 3,450 39.8 (±3.8) --- §§ --- §§ --- §§ 250 30.6 (±11.1) ††119 33.8 (±12.3) †â€Wyoming 4,174 39.8 (±3.0) --- §§ --- §§ --- §§ 291 30.8 (±11.7) †† 153 45.2 (±20.5) ††Wyoming 4,174 39.8 (±3.0) --- §§ --- §§ --- §§ 291 30.8 (±11.7) ††153 45.2 (±20.5) †â€Region 9 11,503 40.7 H (±3.0) 594 42.2 (±11.2) †† 3,751 30.4 WO (±5.2) 4,535 40.2 H (±5.1)Region 9 11,503 40.7 H (±3.0) 594 42.2 (±11.2) ††3,751 30.4 WO (±5.2) 4,535 40.2 H (±5.1)Arizona 2,547 42.3 (±5.3) 86 28.4 O (±16.1) †† 655 35.1 O (±10.4) †† 298 54.7 BH (±14.0) ††Arizona 2,547 42.3 (±5.3) 86 28.4 O (±16.1) ††655 35.1 O (±10.4) ††298 54.7 BH (±14.0) †â€California 4,233 40.6 H (±3.8) 274 45.0 H (±13.4) †† 1,999 30.1 WB (±6.0) 710 36.8 (±6.3)California 4,233 40.6 H (±3.8) 274 45.0 H (±13.4) ††1,999 30.1 WB (±6.0) 710 36.8 (±6.3)Hawaii 1,675 49.8 O (±4.7) 57 63.4 (±24.8) †† 455 51.0 (±10.5) †† 3,175 56.4 W (±4.1)Hawaii 1,675 49.8 O (±4.7) 57 63.4 (±24.8) ††455 51.0 (±10.5) ††3,175 56.4 W (±4.1)Nevada 3,048 35.5 BH (±3.4) 177 22.1 W (±10.2) †† 642 20.5 W (±8.4) 352 31.4 (±10.2) ††Nevada 3,048 35.5 BH (±3.4) 177 22.1 W (±10.2) ††642 20.5 W (±8.4) 352 31.4 (±10.2) †â€TABLE 2. (Continued) Estimated seasonal influenza vaccination coverage among persons aged ≥6 months,* by U.S. Department of Health and Human Services (HHS) region, state, and racial/ethnic group --- United States, Behavioral Risk Factor Surveillance System (BRFSS) and National 2009 H1N1 Flu Survey (NHFS), end of January 2010 †TABLE 2. (Continued) Estimated seasonal influenza vaccination coverage among persons aged ≥6 months,* by U.S. Department of Health and Human Services (HHS) region, state, and racial/ethnic group --- United States, Behavioral Risk Factor Surveillance System (BRFSS) and National 2009 H1N1 Flu Survey (NHFS), end of January 2010 â€HHS region and state/area Non-Hispanic white persons aged ≥6 mos Non-Hispanic black persons aged ≥6 mos Hispanic persons aged ≥6 mos Persons of other race/ethnicity aged ≥6 mosHHS region and state/area Non-Hispanic white persons aged ≥6 mos Non-Hispanic black persons aged ≥6 mos Hispanic persons aged ≥6 mos Persons of other race/ethnicity aged ≥6 mosNo. §¶ % (95% CI**) No. % (95% CI) No. % (95% CI) No. % (95% CI)No. §¶ % (95% CI**) No. % (95% CI) No. % (95% CI) No. % (95% CI)Region 10 17,191 38.9 (±1.6) 263 30.2 (±11.1) †† 1,266 36.3 (±6.4) 2,022 40.1 (±5.1)Region 10 17,191 38.9 (±1.6) 263 30.2 (±11.1) ††1,266 36.3 (±6.4) 2,022 40.1 (±5.1)Alaska 1,760 39.3 (±6.3) 59 --- §§ --- §§ 110 30.9 (±15.5) †† 645 34.6 (±9.0)Alaska 1,760 39.3 (±6.3) 59 --- §§ --- §§ 110 30.9 (±15.5) ††645 34.6 (±9.0)Idaho 3,541 33.4 (±2.7) --- §§ --- §§ --- §§ 257 32.2 (±12.7) †† 156 46.3 (±14.8) ††Idaho 3,541 33.4 (±2.7) --- §§ --- §§ --- §§ 257 32.2 (±12.7) ††156 46.3 (±14.8) †â€Oregon 3,727 38.9 (±3.2) 39 --- §§ --- §§ 269 40.7 (±13.7) †† 469 32.7 (±7.7)Oregon 3,727 38.9 (±3.2) 39 --- §§ --- §§ 269 40.7 (±13.7) ††469 32.7 (±7.7)Washington 8,163 40.4 (±2.3) 141 35.7 (±15.6) †† 630 34.7 (±8.2) 752 43.5 (±7.7)Washington 8,163 40.4 (±2.3) 141 35.7 (±15.6) ††630 34.7 (±8.2) 752 43.5 (±7.7)Median*** 3,653 42.8 499 32.2 248 37.3 233 39.9Median*** 3,653 42.8 499 32.2 248 37.3 233 39.9Range*** 1,307--8,474 33.4--54.3 57--2,093 22.0--63.4 59--3,069 20.5--51.0 97--3,175 26.0--71.6Range*** 1,307--8,474 33.4--54.3 57--2,093 22.0--63.4 59--3,069 20.5--51.0 97--3,175 26.0--71.6U.S. territories ††† 185 31.6 BH (±8.0) 559 14.5 W (±3.9) 1,775 10.9 W (±2.9) 38 --- §§ --- §§U.S. territories †††185 31.6 BH (±8.0) 559 14.5 W (±3.9) 1,775 10.9 W (±2.9) 38 --- §§ --- §§Guam §§§ --- --- --- --- --- --- --- --- --- --- --- ---Guam §§§ --- --- --- --- --- --- --- --- --- --- --- ---Puerto Rico --- §§ --- §§ --- §§ --- §§ --- §§ --- §§ 1,684 10.8 (±3.1) --- §§ --- §§ --- §§Puerto Rico --- §§ --- §§ --- §§ --- §§ --- §§ --- §§ 1,684 10.8 (±3.1) --- §§ --- §§ --- §§U.S. Virgin Islands ¶¶¶ 185 31.6 B (±8.0) 559 14.5 W (±3.9) 91 --- §§ --- §§ 38 --- §§ --- §§U.S. Virgin Islands ¶¶¶ 185 31.6 B (±8.0) 559 14.5 W (±3.9) 91 --- §§ --- §§ 38 --- §§ --- §§NOTE: Superscripted letters indicate that the value was significantly different (p<0.05) than the value for another race/ethnic group (W = non-Hispanic white, B = non-Hispanic black, H = Hispanic, O = other race/ethnicity).* Coverage estimates are for persons with reported vaccination during August 2009--January 2010 who were interviewed during October 2009--February 2010.† Percentages are weighted to the U.S. population.†Percentages are weighted to the U.S. population.§ Respondents with missing vaccination information were excluded; the missing rates are 7.5% from BRFSS and 2.8% from NHFS.§ Respondents with missing vaccination information were excluded; the missing rates are 7.5% from BRFSS and 2.8% from NHFS.¶ Unweighted sample size.¶ Unweighted sample size.** Confidence interval.†† Estimates might be unreliable because confidence interval half-width is >10.††Estimates might be unreliable because confidence interval half-width is >10.§§ Estimates might be unreliable because relative standard error >0.30.§§ Estimates might be unreliable because relative standard error >0.30.¶¶ Includes adult data from BRFSS, but no child BRFSS data were collected.¶¶ Includes adult data from BRFSS, but no child BRFSS data were collected.*** Excludes U.S. territories.††† Estimates for U.S territories are from BRFSS only†††Estimates for U.S territories are from BRFSS only§§§ Guam did not collect BRFSS data in 2009 and 2010.§§§ Guam did not collect BRFSS data in 2009 and 2010.¶¶¶ Estimates are limited to persons aged ≥18 years.¶¶¶ Estimates are limited to persons aged ≥18 years.FIGURE 2. Estimated monthly number of persons reporting vaccination for seasonal influenza --- Behavioral Risk Factor Surveillance System (BRFSS) and National 2009 H1N1 Flu Survey (NHFS) combined, United States, 2008--09* and 2009--10 influenza seasons* Based on data from 19 states reporting, weighted to the U.S. population. Survey was conducted to measure vaccination during August--December only.† For persons aged ≥6 months, 95% confidence intervals for the monthly estimates of the two seasons do not overlap.†For persons aged ≥6 months, 95% confidence intervals for the monthly estimates of the two seasons do not overlap.Alternate Text: The figure above shows the estimated monthly number of persons reporting vaccination for seasonal influenza for the United States, during the 2008-09 and 2009-10 influenza seasons, from Behavioral Risk Factor Surveillance System (BRFSS) and National 2009 H1N1 Flu Survey (NHFS) combined data. Monthly coverage of 2009-10 seasonal vaccination for persons aged ≥6 months was higher during September and October and lower in November compared with 2008-09.Alternate Text: The figure above shows the estimated monthly number of persons reporting vaccination for seasonal influenza for the United States, during the 2008-09 and 2009-10 influenza seasons, from Behavioral Risk Factor Surveillance System (BRFSS) and National 2009 H1N1 Flu Survey (NHFS) combined data. Monthly coverage of 2009-10 seasonal vaccination for persons aged ≥6 months was higher during September and October and lower in November compared with 2008-09.Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.All MMWR HTML versions of articles are electronic conversions from typeset documents. This conversion might result in character translation or format errors in the HTML version. 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