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Incomplete Early Childhood Immunization Series and Missing Fourth DTaP Immunizations; Missed Opportunities or Missed
1Immunization Program, State of Oregon, Oregon Health Authority, 800 NE Oregon Street, Suite 370, Portland, OR 97232, USA.
Insights
Many children miss their fourth DTaP vaccine, crucial for early care quality. This study reveals that missed visits, not just missed immunizations, contribute to incomplete childhood vaccination schedules.
Area of Science:
- Pediatric Health
- Public Health Policy
- Immunization Programs
Background:
- Childhood immunizations are key indicators of early care quality.
- Up-to-date (UTD) rates assess combined immunization series, but often mask specific missed vaccines.
- The fourth DTaP (diphtheria/tetanus/pertussis) vaccine at 15-18 months is frequently missed, impacting UTD rates.
Purpose of the Study:
- To differentiate reasons for missing the fourth DTaP vaccine.
- To analyze the relationship between provider visits and DTaP immunization completion.
- To inform strategies for improving childhood vaccination coverage.
Main Methods:
- Compared immunization records (Oregon ALERT IIS) with medical encounter data (Oregon Health Plan).
- Focused on two-year-olds with three DTaP doses by nine months.
- Analyzed visit frequency for children who did and did not receive the fourth DTaP.
Main Results:
- 31.6% of children missed their timely fourth DTaP vaccine.
- Among those missing the fourth DTaP, 42.1% had no provider visits between 15-18 months.
- Children receiving the fourth DTaP had slightly more encounters (2.45) than those with visits but without the fourth DTaP (2.23).
Conclusions:
- Lack of provider visits is a significant factor in incomplete DTaP vaccination.
- Distinguishing between missed visits and missed immunizations is vital for targeted interventions.
- Improving access to timely healthcare visits can enhance childhood immunization rates.
Abstract:
The successful completion of early childhood immunizations is a proxy for overall quality of early care. Immunization statuses are usually assessed by up-to-date (UTD) rates covering combined series of different immunizations. However, series UTD rates often only bear on which single immunization is missing, rather than the success of all immunizations. In the US, most series UTD rates are limited by missing fourth DTaP-containing immunizations (diphtheria/tetanus/pertussis) due at 15 to 18 months of age. Missing 4th DTaP immunizations are associated either with a lack of visits at 15 to 18 months of age, or to visits without immunizations. Typical immunization data however cannot distinguish between these two reasons. This study compared immunization records from the Oregon ALERT IIS with medical encounter records for two-year olds in the Oregon Health Plan. Among those with 3 valid DTaPs by 9 months of age, 31.6% failed to receive a timely 4th DTaP; of those without a 4th DTaP, 42.1% did not have any provider visits from 15 through 18 months of age, while 57.9% had at least one provider visit. Those with a 4th DTaP averaged 2.45 encounters, while those with encounters but without 4th DTaPs averaged 2.23 encounters.
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