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Risk Factors Associated with Children Missing the Fourth Dose of DTaP Vaccination
1National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail Stop A19, Atlanta, GA 30333, USA.
Insights
Many children miss the fourth DTaP vaccine dose. Delays in previous doses, poor parent-provider relationships, and low vaccine confidence increase this risk, impacting pertussis (whooping cough) prevention.
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.
Background:
In 2012, reported pertussis reached the highest number of cases (48,277) in the United States since 1955.
Objectives:
Estimate the prevalence of children who missed the fourth dose of DTaP (Diphtheria and Tetanus toxoids and acellular Pertussis vaccine) by parents' confidences in vaccines and influences from providers, the timeliness of the first through the third dose of DTaP, and selected socio-demographic characteristics; identify the significant risk factors for non-receipt of the fourth dose of DTaP; and evaluate the unadjusted and adjusted risk ratios for missing the fourth dose of DTaP.
Methods:
Data from 16,919 children 19-35 months living in the United States included in the 2011 National Immunization Survey were analyzed. Weighted categorical data analysis and multivariable regression in the context of complex sample survey were applied to assess the prevalence and to determine the independent risk factors.
Results:
Overall, 14.7% of children missed the fourth dose of DTaP. Children who were late in receiving the third dose of DTaP had significantly higher risk of missing the fourth dose of DTaP than children who were on-time in receiving the third dose of DTaP (adjusted risk ratio (RR) 2.48; 95%CI (1.92, 3.20)). The risk of missing the fourth dose of DTaP was 62% higher among children whose parents reported they didn't have a good relationship with their child's health-care providers than children whose parents reported having good relationship. Compared with the risk of missing the fourth dose of DTaP among children whose parents were confident in the value of vaccines, the risk was significantly higher for the children whose parents lacked confidence (adjusted RR 1.41; 95%CI (1.05, 1.89)).
Conclusions:
Timeliness in receiving the first through the third dose of DTaP, influences from providers, and parents' confidence in the value of vaccines are the five significant risk factors for missing the fourth dose of DTaP vaccination. They are all modifiable. Future interventions to improve parental relationships with providers and attitudes toward vaccines could help improve pertussis vaccination coverage.
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