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A Missed Opportunity: Evaluating Immunization Status and Barriers in Hospitalized Children
Brittany Lissinna1, Chelsea Gilbert2, Calla Isaac3
1Departments of Pediatrics.
Insights
Many hospitalized children are not up-to-date on their vaccines, with caregivers reporting more barriers to immunization. Hospital-based strategies are needed to improve childhood vaccination rates.
Area of Science:
- Pediatric medicine
- Public health
- Immunization science
Background:
- Hospitalized children represent a vulnerable population for maintaining up-to-date immunization status.
- Assessing immunization coverage and identifying barriers among hospitalized pediatric patients is crucial for public health initiatives.
Purpose of the Study:
- To determine the proportion of underimmunized or unimmunized children admitted to pediatric inpatient units.
- To identify barriers to immunization faced by families of hospitalized children.
Main Methods:
- Prospective study of children aged 2 months to 18 years admitted to pediatric inpatient units (July 2021-October 2022).
- Immunization status assessed against provincial schedules using electronic medical charts.
- Caregiver surveys collected data on immunization barriers and compared responses between up-to-date and non-up-to-date groups.
Main Results:
- Only 58.2% of hospitalized children (142/244) were up-to-date on all immunizations, indicating a deficit compared to preschool vaccine doses in the general population.
- Caregivers of underimmunized children reported significantly more barriers related to access, concerns, and perceived importance of vaccines.
- A notable disparity exists in immunization status for hospitalized children in Canada compared to national targets and community rates.
Conclusions:
- Hospitalized children in Canada exhibit a significant disparity in immunization status.
- Increased barriers to vaccination are reported by caregivers of underimmunized hospitalized children.
- Implementing hospital-based immunization strategies could enhance vaccination coverage among this pediatric population.
Objective:
Hospitalized children are a potentially underimmunized population. We sought to determine the proportion of patients admitted to our pediatric medicine inpatient units who are underimmunized or unimmunized and to identify barriers to immunization faced by families of children admitted to hospital.
Methods:
We conducted a prospective study of children aged 2 months to 18 years admitted to our pediatric medicine inpatient units between July 2021 and October 2022. Immunization and demographic data were collected from electronic medical charts. Immunization status of each child was categorized as up-to-date if they had received all eligible vaccine doses in accordance with the provincial immunization schedule. Caregivers completed a survey on barriers to immunizations; results were compared between caregivers of children whose vaccines were up-to-date and those who were not.
Results:
Hospitalized children were missing more doses of the preschool vaccines than the general population based on published provincial data. Only 142 of 244 (58.2%) of study patients were up-to-date on all their immunizations. Caregivers of children whose immunizations were not up-to-date reported significantly more barriers to vaccination in all survey categories: access to shots, concerns about shots, and importance of shots.
Conclusions:
There is a disparity in immunization status between children admitted to hospital in a Canadian setting compared with national targets and community immunization rates. Caregivers of underimmunized hospitalized children cited significantly more barriers to immunization when compared with hospitalized children who are up-to-date. Pursuing a hospital-based immunization strategy could lead to improved immunization status for hospitalized children.
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