Risk Factors Associated with Children Missing the Fourth Dose of DTaP Vaccination

Area of Science:

• Pediatric infectious diseases
• Vaccinology
• Public health epidemiology

Background:

• Pertussis (whooping cough) cases in the US surged in 2012, reaching levels not seen since 1955.
• This highlights a critical need to understand factors affecting DTaP vaccination coverage.

Purpose of the Study:

• To estimate the prevalence of children missing the fourth DTaP dose.
• To identify risk factors associated with missed DTaP vaccinations, including parental vaccine confidence and provider relationships.
• To evaluate the risk ratios for not receiving the fourth DTaP dose.

Main Methods:

• Analysis of data from 16,919 children aged 19-35 months from the 2011 National Immunization Survey.
• Application of weighted categorical data analysis and multivariable regression for complex sample surveys.
• Assessment of prevalence and identification of independent risk factors for DTaP non-vaccination.

Main Results:

• 14.7% of children missed the fourth DTaP dose.
• Children with delayed third DTaP doses had a 2.48 times higher risk of missing the fourth dose.
• Lower parental confidence in vaccines (RR 1.41) and poorer parent-provider relationships (62% higher risk) were significant factors.

Conclusions:

• Timeliness of DTaP doses 1-3, provider influence, and parental vaccine confidence are key modifiable risk factors for missed fourth DTaP doses.
• Interventions targeting improved parent-provider relationships and vaccine attitudes can enhance pertussis vaccination rates.
• Addressing these factors is crucial for improving overall pertussis immunization coverage.