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Predictors of age-appropriate receipt of DTaP dose 4
Tara W Strine1, Elizabeth T Luman, Catherine A Okoro
1Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA tws2@cdc.gov
Insights
Timeliness of the third DTaP vaccine dose impacts completion of the four-dose series. Children receiving the third dose late are more likely to miss or receive the fourth DTaP dose late.
Area of Science:
- Pediatrics
- Immunology
- Public Health
Background:
- The national immunization schedule recommends four doses of DTaP (diphtheria and tetanus toxoids and acellular pertussis) vaccine for children.
- The fourth DTaP dose is frequently missed by inadequately immunized children.
Purpose of the Study:
- To assess the impact of the timeliness of the first three DTaP doses on the completion of the four-dose series.
- To identify children at risk for delayed or missed DTaP Dose 4.
Main Methods:
- Analysis of the 2001 National Immunization Survey data.
- Evaluation of the association between the timing of DTaP Doses 1-3 and the completion of the four-dose series by age 24 months.
Main Results:
- Children receiving DTaP Dose 3 late (but before 16 months) were more likely to miss Dose 4 (24% vs. 10%).
- Late receipt of DTaP Dose 3 (before 9 months) was associated with higher rates of late or missed Dose 4 (39% vs. 22%).
- Invalid DTaP Dose 4 administration was more common in children with late or no timely DTaP Dose 3.
Conclusions:
- Assessing the timeliness of DTaP Dose 3 can identify children at risk for incomplete DTaP vaccination.
- Healthcare providers should implement strategies to ensure timely DTaP Dose 4 administration for at-risk children.
Background:
In the United States, the national childhood immunization schedule calls for children to receive four doses of DTaP (diphtheria and tetanus toxoids and acellular pertussis) vaccine administered at 2, 4, 6, and 15 to 18 months. Dose 4 of DTaP is among the most frequently missed vaccines for children who are not adequately immunized.
Methods:
Using the 2001 National Immunization Survey, the effect of the timeliness of the first three DTaP doses was assessed on completion of the four-dose series by age 24 months and on time by age 12 to 18 months.
Results:
Missing Dose 4 was more prevalent among children who received Dose 3 late (but <16 months) than among children who received Dose 3 on time (24% vs 10%). Similarly, receiving Dose 4 late (or not at all) was more prevalent among children who received Dose 3 late (but <9 months) (39% vs 22%). An invalid Dose 4 was administered to 4.6% of those with Dose 3 late but before 9 months and to 10.6% of those with no Dose 3 before 9 months, compared to 1.2% of those with Dose 3 on time.
Conclusions:
Physicians and staff can identify children at risk for missing the fourth DTaP dose or receiving it late by assessing timeliness of receipt of DTaP Dose 3 and implementing steps to ensure that at-risk children receive Dose 4 as recommended.
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