INTRODUCTION: Delays in vaccination can stymie the development of herd immunity, 
and a large proportion of children in the U.S. are known not to receive vaccines 
on time. This study quantifies delays in vaccination, compares vaccination 
timeliness to the proportion of children vaccinated, and evaluates the impact of 
combination vaccine use and timely administration of hepatitis B vaccine birth 
dose on vaccine timeliness among Michigan children.
METHODS: This retrospective cohort study used data from the Michigan Care 
Improvement Registry-the state immunization information system-for children born 
2006-2010. Children aged 24 months as of December 31, 2012, were included. The 
proportion of children with timely administration of vaccine doses was 
calculated, and the mean days of vaccination delay with SD were reported.
RESULTS: Among 620,592 Michigan children, 42.2% had received all vaccines, but 
only 13.2% were vaccinated on time by age 24 months. Children's vaccinations 
were delayed an average of 59.2 (SD=91.2) days by age 24 months for all 
recommended vaccine doses. Children who received a timely hepatitis B vaccine 
birth dose or who received a combination vaccine had less delay in vaccination.
CONCLUSIONS: Michigan children have high vaccination coverage based on standard 
measures but few receive these vaccines on time. Promoting use of combination 
vaccines may improve parental compliance with timely vaccination of children.