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Risk factors for delayed immunization in a random sample of 1163 children from Oregon and Washington
J K Bobo1, J L Gale, P B Thapa
1Department of Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha 68198-4350.
Insights
Many US children lack comprehensive vaccine coverage by age two. Later-born children and those with less educated mothers are more likely to be incompletely immunized, highlighting disparities in pediatric vaccination schedules.
Area of Science:
- Pediatric Public Health
- Immunization Science
Background:
- Vaccine safety is well-studied, but comprehensive coverage rates for US infants and toddlers remain unclear.
- Understanding factors influencing timely immunization is crucial for public health initiatives.
Purpose of the Study:
- To assess the comprehensiveness of vaccine coverage in US children younger than 2 years.
- To identify child and family characteristics predicting delayed or missed immunizations.
Main Methods:
- Analysis of provider and parent data from a population-based sample of 1163 children in two states.
- Evaluation of vaccine coverage at three key ages: by 92 days, by 1 year, and by 2 years.
Main Results:
- By age two, only 60% of children received the full series of diphtheria, tetanus toxoids, and pertussis (DTP), oral poliovirus (OPV), and measles, mumps, and rubella (MMR) vaccines.
- Later-born children were 1.7 times more likely to be incompletely immunized by age two.
- Children of more educated mothers showed significantly lower rates of underimmunization.
Conclusions:
- Significant proportions of US children under two do not complete their recommended vaccination schedules.
- Birth order and maternal education are consistent predictors of pediatric immunization status.
- Targeted interventions may be needed to address disparities in vaccine access and adherence.
Abstract:
Despite extensive study of vaccine safety and decades of effort to immunize infants and toddlers, little is known about the comprehensiveness of vaccine coverage in US children younger than 2 years of age. Provider and parent data from a population-based sample of 1163 children from two states were analyzed to assess coverage rates at three ages and to evaluate characteristics of children and their families that predict failure to immunize on schedule. Overall, 78% of the children had received their first dose of diphtheria and tetanus toxoids with pertussis vaccine (DTP) and their first dose of oral poliovirus (OPV) by 92 days of age. Similarly, 77% had received their third dose of DTP and their second dose of OPV by their first birthday. However, by their second birthday only 60% had received the full series of four doses of DTP, three doses of OPV, and one dose of the measles, mumps, and rubella vaccines. When considered singly, several variables including child birth order, family income, maternal education, and marital status significantly predicted failure to immunize on schedule. In multivariate logistic models, only birth order and maternal education consistently predicted vaccine status at each of the three ages. Compared with first-born children, those who were later-born were 1.7 times more likely to be incompletely immunized at 2 years of age (95% confidence interval: 1.2, 2.3). Children of more educated mothers were significantly less likely to be underimmunized at all ages.(ABSTRACT TRUNCATED AT 250 WORDS)