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Timing of Monovalent Vaccine Administration in Infants Receiving DTaP-based Combination Vaccines in the United States
Gary S Marshall1, Tanaz Petigara2, Zhiwen Liu2
1From the Norton Children's and University of Louisville School of Medicine, Louisville, Kentucky.
Insights
Most infants received timely diphtheria, tetanus, acellular pertussis (DTaP), inactivated poliovirus (IPV), Haemophilus influenzae type b (Hib), and hepatitis B virus (HepB) vaccines. However, some infants experienced delays in completing the HepB vaccine series.
Area of Science:
- Pediatric infectious diseases
- Vaccinology
- Public health
Background:
- The US infant immunization schedule recommends diphtheria, tetanus, acellular pertussis (DTaP), inactivated poliovirus (IPV), Haemophilus influenzae type b (Hib), and hepatitis B virus (HepB) vaccines within the first six months of life.
- Limited data exist on the timing of complementary monovalent vaccine administration alongside DTaP-based pentavalent combination vaccines in infants.
Purpose of the Study:
- To analyze vaccine administration patterns for DTaP-IPV/Hib and hepatitis B virus (HepB) monovalent vaccines in US infants.
- To identify factors associated with the coadministration of HepB doses with DTaP-IPV/Hib combination vaccines.
Main Methods:
- Retrospective cohort study utilizing the US MarketScan commercial claims and encounters database (July 1, 2010 - June 30, 2018).
- Descriptive statistics were employed to assess vaccine administration patterns.
- Multivariate logistic regression was used to explore factors influencing the coadministration of DTaP-IPV/Hib and HepB vaccines.
Main Results:
- Among infants receiving DTaP-HepB-IPV, over 93% received at least two Hib doses, mostly on the same day as the combination vaccine.
- Among infants receiving DTaP-IPV/Hib, over 95% received at least two HepB doses.
- However, only 59.2% received the second HepB dose and 44.6% received the third HepB dose on the same day as the DTaP-IPV/Hib doses, leading to potential delays in HepB series completion.
Conclusions:
- While nearly all infants received the recommended complementary monovalent vaccine series, there was notable variability in the timing of hepatitis B virus (HepB) vaccine doses relative to diphtheria, tetanus, acellular pertussis (DTaP)-IPV/Hib doses.
- A significant proportion of infants did not complete the HepB vaccine series until nine months of age, indicating potential scheduling inefficiencies.
Background:
The recommended US infant immunization schedule includes doses of diphtheria, tetanus, acellular pertussis (DTaP), inactivated poliovirus (IPV), Haemophilus influenzae type b (Hib) and hepatitis B virus (HepB) during the first 6 months of life. Little information is available about the timing of associated, complementary monovalent vaccine administration in infants receiving DTaP-based pentavalent combination vaccines.
Methods:
This was a retrospective cohort study of infants born between July 1, 2010, and June 30, 2018, in the US MarketScan commercial claims and encounters database. Descriptive statistics were used to assess vaccine administration patterns. Multivariate logistic regression was performed to explore factors associated with coadministration of DTaP-IPV/Hib and HepB.
Results:
Among infants who received DTaP-HepB-IPV (n = 129,885), 93.7% had claims for at least 2 Hib doses; most (91.5%-98.3%) of these doses were administered on the same day as DTaP-HepB-IPV doses. Among infants who received DTaP-IPV/Hib (n=214,172), 95.3% had claims for ≥2 doses of HepB. Although coverage was high, 59.2% received the second HepB dose on the same day as the first DTaP-IPV/Hib dose, and 44.6% received the third dose of HepB on the same day as the third DTaP-IPV/Hib dose. Differences in coadministration of the second and third HepB doses with DTaP-IPV/Hib were associated with the region of residence, provider type, health plan type and coadministration of pneumococcal conjugate vaccine and rotavirus vaccine.
Conclusions:
Almost all infants received the appropriate, complementary monovalent vaccine series. However, this study found variability in the timing of HepB doses in relation to DTaP-IPV/Hib doses with many infants not completing the HepB series until 9 months of age.
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