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Frequency and Cost of Vaccinations Administered Outside Minimum and Maximum Recommended Ages-2014 Data From 6
Loren Rodgers1, Lauren Shaw2, Raymond Strikas1
1National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA; Commissioned Corps, US Public Health Service, Rockville, MD.
Insights
Vaccinations given outside recommended ages are rare, but some errors, like with influenza and DTaP-IPV vaccines, necessitate revaccination, incurring costs. Improving adherence to immunization schedules reduces waste and patient inconvenience.
Area of Science:
- Public Health
- Immunization Practices
- Health Economics
Background:
- Vaccination schedules are crucial for effective disease prevention.
- Adherence to recommended vaccination ages ensures optimal immunity and minimizes revaccination needs.
- Understanding deviations from vaccination schedules is key to improving public health outcomes.
Purpose of the Study:
- To quantify the frequency of vaccinations administered outside recommended minimum and maximum ages.
- To determine the financial costs associated with revaccination due to age-related errors.
- To analyze data from immunization information systems (IIS) for insights into vaccination practices.
Main Methods:
- Analysis of deidentified immunization records from 6 IIS sentinel sites covering 10% of the US population in 2014.
- Quantification of vaccine doses administered outside Advisory Committee on Immunization Practices (ACIP) schedule and prescribing information guidelines.
- Calculation of revaccination costs, focusing on publicly funded doses with consistent lot numbers and vaccine types to minimize bias.
Main Results:
- 0.3% of doses with maximum age recommendations were administered late, with quadrivalent inactivated influenza vaccine (Fluzone Quadrivalent) requiring revaccination at a cost of $111,964.
- 0.1% of doses with minimum age recommendations were administered early, most commonly quadrivalent injectable influenza vaccines and Kinrix (DTaP-IPV).
- Revaccination costs for early administrations (where recommended) totaled $179,179.
Conclusions:
- Vaccine administration outside recommended age parameters is infrequent, indicating general adherence to guidelines.
- Specific vaccines, including certain influenza and DTaP-IPV formulations, showed higher error rates, sometimes mandating revaccination.
- Complexity of vaccine schedules and product similarity may contribute to errors, highlighting the need for error reduction to minimize costs and improve patient experience.
Objective:
To quantify vaccinations administered outside minimum and maximum recommended ages and to determine attendant costs of revaccination by analyzing immunization information system (IIS) records.
Study Design:
We analyzed deidentified records of doses administered during 2014 to persons aged <18 years within 6 IIS sentinel sites (10% of the US population). We quantified doses administered outside of recommended ages according to the Advisory Committee on Immunization Practices childhood immunization schedule and prescribing information in package inserts, and calculated revaccination costs. To minimize misreporting bias, we analyzed publicly funded doses for which reported lot numbers and vaccine types were consistent.
Results:
Among 3 394 047 doses with maximum age recommendations, 9755 (0.3%) were given after the maximum age. One type of maximum age violation required revaccination: 1344 (0.7%) of 194 934 doses of the 0.25-mL prefilled syringe formulation of quadrivalent inactivated influenza vaccine (Fluzone Quadrivalent, Sanofi Pasteur, Swiftwater, PA) were administered at age ≥36 months (revaccination cost, $111 964). We identified a total of 7 529 165 childhood, adolescent, and lifespan doses with minimum age recommendations, 9542 of which (0.1%) were administered before the minimum age. The most common among these violations were quadrivalent injectable influenza vaccines (3835, or 0.7% of 526 110 doses administered before age 36 months) and Kinrix (GlaxoSmithKline Biologicals, Rixensart, Belgium; DTaP-IPV) (2509, or 1.2% of 208 218 doses administered before age 48 months). The cost of revaccination for minimum age violations (where recommended) was $179 179.
Conclusion:
Administration of vaccines outside recommended minimum and maximum ages is rare, reflecting a general adherence to recommendations. Error rates were higher for several vaccines, some requiring revaccination. Vaccine schedule complexity and confusion among similar products might contribute to errors. Minimization of errors reduces wastage, excess cost, and inconvenience for parents and patients.
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