Barriers to and facilitators of early childhood immunization in rural areas of the United States: A systematic review of the literature

•Early childhood vaccination coverage is low in rural areas of the United States.•Reminder-recall & positive family-provider relationships facilitate vaccine uptake.•Parental hesitancy is a barrier to early childhood vaccination in the rural U.S.•Vaccine referrals & distance to providers are also rural-specific barriers.•To increase vaccine coverage, interventions across rural populations are needed. Early childhood vaccination rates are lower in rural areas of the U.S. compared with suburban and urban areas. Our aim was to identify barriers to and facilitators of early childhood immunization in rural U.S. communities. We completed a systematic review of original research conducted in the U.S. between January 1, 2000-July 25, 2021. We searched PubMed, Cumulative Index for Nursing and Allied Health Literature, and Web of Science. We included studies that examined barriers to and facilitators of routine immunizations in children