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Sick-visit immunizations and delayed well-baby visits
1Immunization Program, Oregon Health Authority, Portland, OR, USA. steve.g.robison@state.or.us
Insights
Giving immunizations during sick visits for acute otitis media does not impact overall immunization or well-baby visit rates. However, delaying immunizations increases the risk of missed follow-up well-baby visits, potentially delaying overall immunization status.
Area of Science:
- Pediatric Health
- Immunization Practices
- Preventive Medicine
Background:
- The American Academy of Pediatrics recommends immunizations during sick visits for minor illnesses.
- A 2010 policy addition questioned if this practice discourages making up missed well-baby visits.
- This study evaluates the tradeoff between sick-visit immunizations and well-baby visit attendance.
Purpose of the Study:
- To quantify the impact of administering immunizations during sick visits on subsequent well-baby visit attendance.
- To assess the potential tradeoff between sick-visit immunizations and timely well-baby care.
- To analyze immunization and well-baby visit rates through 24 months of age.
Main Methods:
- Retrospective cohort analysis with a case-control component.
- Study included infants with sick visits for acute otitis media at 2, 4, or 6 months, supplanting well-baby visits.
- Infants were stratified based on receiving immunizations during sick visits, having quick makeup visits, or neither.
Main Results:
- No significant difference in overall immunization or well-baby visit rates through 24 months was found between groups.
- 39% of infants not immunized during a sick visit failed to return for a makeup well-baby visit.
- Infants who missed makeup visits were less likely to be up-to-date on immunizations (RR: 0.66) and had fewer well-baby visits (3.8 vs. 4.7).
Conclusions:
- The risk of infants not returning for timely makeup well-baby visits after a sick visit is substantial.
- This risk should be considered when deciding whether to delay immunizations.
- Administering immunizations during sick visits does not appear to negatively impact long-term immunization or well-baby visit rates.
Objective:
Giving recommended immunizations during sick visits for minor and acute illness such as acute otitis media has long been an American Academy of Pediatrics/Advisory Committee on Immunization Practice recommendation. An addition to the American Academy of Pediatrics policy in 2010 advised considering whether giving immunizations at the sick visit would discourage making up missed well-baby visits. This study quantifies the potential tradeoff between sick-visit immunizations and well-baby visits.
Methods:
This study was a retrospective cohort analysis with a case-control component of sick visits for acute otitis media that supplanted normal well-baby visits at age 2, 4, or 6 months. Infants were stratified for sick-visit immunization, no sick-visit immunization but quick makeup well-baby visits, or no sick-visit immunizations or quick makeup visits. Immunization rates and well-baby visit rates were assessed through 24 months of age.
Results:
For 1060 study cases, no significant difference was detected in immunization rates or well-baby visits through 24 months of age between those with or without sick-visit immunizations. Thirty-nine percent of infants without a sick-visit shot failed to return for a quick makeup well-baby visit; this delayed group was significantly less likely to be up-to-date for immunizations (relative risk: 0.66) and had fewer well-baby visits (mean: 3.8) from 2 through 24 months of age compared with those with sick-visit shots (mean: 4.7).
Conclusions:
The substantial risk that infants will not return for a timely makeup well-baby visit after a sick visit should be included in any consideration of whether to delay immunizations.
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