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Early Vaccine Delays Strongly Predict Missed MMR by Age 2, Large U.S. Study Finds

The EHR analysis identifies missed infant shots as an early warning for MMR gaps, prompting calls for pediatric counseling in the first months.

Overview

  • Researchers analyzed Truveta electronic health records for more than 321,000 children in routine care from 2018 through April 2025 to assess timing of the first MMR dose.
  • Delays in the recommended 2- and 4-month vaccines were the strongest predictors of receiving no MMR by age 2, flagging the earliest well visits as critical intervention points.
  • On-time MMR coverage rose to 79.9% in 2021 then declined to 76.9% in 2024, as the share unvaccinated by age 2 increased from 5.3% in 2020 to 7.7% in 2024.
  • Across the full period, 78.4% received MMR on time, 13.9% were delayed, and 6.7% had not received the vaccine by age 2.
  • Boys, white non-Hispanic children, and those in rural areas had higher odds of no MMR despite regular care, and experts urge earlier engagement as CDC reports a recent measles surge surpassing 2,000 cases.