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Identification of Spatial Clusters of Undervaccination Patterns Among Children Aged <24 Months Using Immunization
Sophia R Newcomer1, Jon Graham2, Kayla Irish3
1School of Public and Community Health Sciences and Center for Population Health Research, University of Montana, Missoula, MT, USA.
Insights
Spatial clustering of undervaccination in Montana children under two poses risks for vaccine-preventable diseases. Targeted interventions are crucial for improving childhood vaccination rates in specific geographic areas.
Area of Science:
- Public Health
- Epidemiology
- Immunization Practices
Background:
- Spatial clustering of undervaccination increases vulnerability to vaccine-preventable diseases.
- Identifying geographic patterns of incomplete childhood immunizations is critical for public health interventions.
Purpose of the Study:
- To identify and characterize spatial clusters of undervaccination among children under 24 months in Montana.
- To differentiate undervaccination patterns related to parental hesitancy versus structural barriers.
Main Methods:
- Analysis of deidentified vaccination records from Montana's immunization information system for children born between January 2015 and November 2017.
- Utilized Bernoulli spatial scans with geomasked residential addresses to detect clusters (>=100 children) for three undervaccination outcomes.
- Calculated relative risk for undervaccination within identified spatial clusters.
Main Results:
- Of 31,201 children, 37.5% did not complete the 7-vaccine series by age 24 months, with 5 spatial clusters identified.
- Four clusters of undervaccination linked to parental vaccine hesitancy were found in western Montana, one with a relative risk of 2.3.
- Four clusters of undervaccination linked to structural barriers were identified, predominantly in eastern Montana.
Conclusions:
- Distinct strategies are necessary to increase routine and timely childhood vaccinations across Montana's diverse rural landscape.
- Immunization information system data effectively identifies specific areas requiring targeted vaccination interventions.
Objective:
Spatial clustering of undervaccination leads to increased risk of vaccine-preventable diseases. We identified spatial clustering of undervaccination patterns among children aged <24 months in Montana.
Methods:
We used Montana's immunization information system data to analyze deidentified vaccination records of children aged <24 months born from January 2015 through November 2017. We measured 3 outcomes that were not mutually exclusive: not completing the combined 7-vaccine series by age 24 months, having an undervaccination pattern indicative of parental hesitancy, and having an undervaccination pattern indicative of structural barriers to timely vaccination. Using geomasked residential addresses, we conducted separate Bernoulli spatial scans with a randomization P < .01 to identify spatial clusters consisting of ≥100 children for each outcome and calculated the relative risk of having the undervaccination pattern inside versus outside the cluster.
Results:
Of 31 201 children aged <24 months included in our study, 11 712 (37.5%) had not completed the combined 7-vaccine series by age 24 months, and we identified 5 spatial clusters of this outcome across Montana. We identified 4 clusters of undervaccination patterns indicative of parental vaccine hesitancy, all in western Montana. The cluster with the largest relative risk (2.3) had a radius of 23.7 kilometers (n = 762 children, P < .001). We also identified 4 clusters of undervaccination patterns indicative of structural barriers, with 3 of the largest clusters in eastern Montana.
Conclusion:
In Montana, different strategies to increase routine and timely childhood vaccination are needed in distinct areas of this large and predominantly rural state. Immunization information system data can pinpoint areas where interventions to increase vaccination uptake are needed.
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