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Published on: August 7, 2017
Patterns of childhood immunization and all-cause mortality
Natalie L McCarthy1, Lakshmi Sukumaran1, Sophia Newcomer2
1Immunization Safety Office (VSD), Centers for Disease Control and Prevention, Atlanta, Georgia.
Insights
This study found no difference in all-cause mortality between fully vaccinated and undervaccinated children. These findings support the safety of the recommended childhood immunization schedule.
Area of Science:
- Pediatric Health
- Immunization Safety
- Public Health
Background:
- Childhood immunization schedules are generally safe, but parental vaccine hesitancy is rising.
- All-cause mortality is a key outcome for evaluating immunization schedule safety.
- Further research is needed to address parental concerns about vaccine delays.
Purpose of the Study:
- To investigate the association between childhood vaccination status and all-cause mortality.
- To evaluate the safety of the recommended immunization schedule concerning mortality risks.
- To provide evidence-based information for parents considering vaccination schedules.
Main Methods:
- A cohort study of over 300,000 children from the Vaccine Safety Datalink (VSD) was conducted.
- Vaccination patterns were assessed up to 18 months, and mortality was tracked until 48 months.
- Cox proportional hazards models were used to compare mortality rates between vaccinated and undervaccinated children, adjusting for confounders.
Main Results:
- No significant difference in all-cause mortality rates was observed between children vaccinated on schedule and those undervaccinated.
- Mortality rates were 2.28 per 100,000 person-years for scheduled vaccination and 2.57 for undervaccination.
- The incidence rate ratio (IRR) for mortality was not statistically significant in either analysis (with or without unknown causes of death).
Conclusions:
- The study findings do not suggest an increased risk of all-cause mortality associated with undervaccination compared to the recommended immunization schedule.
- Current evidence supports the safety of the established childhood immunization schedule regarding all-cause mortality.
- These results can help inform discussions about vaccine safety and address parental concerns.
Background:
Evidence supports the safety of the recommended childhood immunization schedule as a whole. However, additional research is warranted as parents' refusing or delaying vaccinations has increased in recent years. All-cause mortality has been identified as a priority outcome to study in the context of the recommended immunization schedule.
Methods:
We included children born January 1, 2004 through December 31, 2009, enrolled in the Vaccine Safety Datalink (VSD) from birth through 18 months of age. We examined vaccination patterns during the first 18 months of life among 8 vaccines, and identified deaths occurring between 19 and 48 months of age. We excluded children with complex chronic conditions, contraindications to vaccination, and deaths due to injuries, congenital anomalies, or diseases with onset prior to 19 months of age. We calculated mortality rates among children with different patterns of immunization, and incidence rate ratios (IRR) using the Cox proportional hazards model for children vaccinated according to the schedule versus undervaccinated children, adjusting for outpatient healthcare utilization, influenza vaccination, sex, and VSD site.
Results:
Among 312,388 children in the study, 199,661 (64%) were vaccinated according to the schedule, and 112,727 (36%) were delayed or not vaccinated for at least one vaccine dose. Of 18 deaths eligible for analysis, 11 occurred in children following the schedule (2.28 per 100,000 person-years), and seven occurred in undervaccinated children (2.57 per 100,000 person-years). Mortality rates among children following the schedule were not significantly different from those of undervaccinated children when excluding deaths with unknown causes (IRR = 1.29, 95% CI = 0.33-4.99), as well as when including deaths with unknown causes (IRR = 0.84, 95% CI = 0.32-2.99).
Conclusion:
Although there were few deaths, our results do not indicate a difference in risk of all-cause mortality among fully vaccinated versus undervaccinated children. Our findings support the safety of the currently recommended immunization schedule with regard to all-cause mortality.
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