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The contribution of missed opportunities to childhood underimmunization in Baltimore
1Department of International Health, Maternal and Child Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Insights
Missed opportunities to vaccinate are common in inner-city children, impacting immunization coverage. Addressing these missed chances at provider visits can significantly boost vaccination rates.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Underimmunization remains a significant public health concern.
- Missed opportunities to vaccinate (MOV) contribute to suboptimal immunization coverage.
- Identifying the incidence and context of MOV is crucial for intervention.
Purpose of the Study:
- To determine the community-wide incidence of missed opportunities to vaccinate (MOV).
- To describe the clinical settings where MOV occur.
- To estimate the impact of MOV on childhood immunization coverage.
Main Methods:
- Retrospective review of outpatient medical records for 502 children aged 2 years in inner-city Baltimore.
- Data collection included vaccine dates, visit dates, diagnoses, and temperatures from 98 provider sites.
- Missed opportunities to vaccinate and up-to-date vaccination status were the primary outcomes.
Main Results:
- 75% of children experienced at least one MOV by 24 months of age.
- Only 55% of children were up-to-date with the 4:3:1 vaccine series.
- MOV occurred at over one-third of eligible visits, including >20% of well-child visits, often during minor illnesses.
Conclusions:
- Missed opportunities to vaccinate are prevalent among inner-city children in Baltimore, significantly contributing to underimmunization.
- Accurate screening at all visits and adherence to vaccination contraindication guidelines can reduce MOV.
- Reducing MOV is a provider-based, low-cost strategy to improve childhood immunization rates.
Objective:
To determine the community-wide incidence of missed opportunities to vaccinate, to describe the clinical settings in which they occur, and to estimate the impact of missed opportunities on immunization coverage.
Design And Methods:
We abstracted outpatient medical records from a random, community-based sample of 2-year-old children whose residence was inner-city Baltimore. The date of each vaccine and the date, diagnoses, and temperature at each visit were collected for 502 children at 98 different provider sites.
Main Outcome Measures:
Missed opportunities to vaccinate and up-to-date vaccination status.
Results:
By 24 months of age, 75% of the children had at least one missed opportunity and only 55% were up-to-date for the 4:3:1 series. Missed opportunities occurred at more than one third of eligible visits for each vaccine, including > 20% of preventative care visits. Diagnoses commonly associated with missed opportunities were "well child," otitis media, upper respiratory infection, gastroenteritis, skin infection, and resolving illness. If no missed opportunities had occurred, 73% of the children would have been up-to-date by 24 months.
Conclusions:
Missed opportunities occurred commonly at providers serving inner-city children in Baltimore and represent a major factor in underimmunization. Reduction of missed opportunities by accurate screening at all visits and adherence to the contraindication guidelines is a provider-based, low-cost method to increase immunization coverage.