LAUSR

Key Points Question What are the patterns among children who missed the first dose of the diphtheria-tetanus-pertussis vaccine in India from 1993 to 2021? Findings In this cross-sectional study of 125 619 children aged 12 to 23 months in India, the prevalence of children who did not receive a single dose of the diphtheria-tetanus-pertussis vaccine decreased from 33.4% to 6.6% between 1993 and 2021, with Uttar Pradesh, Bihar, and Maharashtra accounting for 53.0% of the burden. While interstate inequalities converged notably toward lower prevalence levels, states like Punjab, Telangana, and Andhra Pradesh experienced an increase in prevalence from 2016 to 2021. Meaning These findings suggest that sustained efforts are warranted to target high-burden states in India; prioritizing small administrative units will be important to achieving the Immunization Agenda 2030 goals endorsed by the World Health Organization.