Related Experiment Videos
Fragmentation of scheduled visits and missed doses among infants receiving multiple injected vaccines
M J Ferson1, K A McKenzie, F Macartney-Bourne
1Public Health Unit, South Eastern Sydney Area Health Service.
Insights
Infant immunisation visits are often split, leading to missed doses, particularly with the hepatitis B vaccine. This fragmentation, often suggested by GPs, delays timely vaccination for infants.
Area of Science:
- Pediatrics
- Public Health
- Immunology
Background:
- Infant immunisation schedules involve multiple vaccines within the first year of life.
- The introduction of the hepatitis B vaccine (HBV) has increased the number of injections per visit.
- Concerns exist regarding the fragmentation of scheduled immunisation visits and potential impact on vaccine uptake.
Purpose of the Study:
- To assess the extent of immunisation visit fragmentation in infants.
- To identify factors associated with visit fragmentation and missed vaccine doses.
- To evaluate the impact of the neonatal hepatitis B vaccination program on immunisation visit timing and completion.
Main Methods:
- Retrospective cohort study of a one-month birth cohort in Sydney.
- Telephone questionnaires collected vaccination dates for diphtheria-tetanus-pertussis (DTP), Haemophilus influenzae type b (Hib), and HBV.
- Analysis compared vaccination timing and visit fragmentation between infants in the neonatal HBV program and those not enrolled.
Main Results:
- 12 infants (8.5%) had 28 (6.9%) scheduled visits fragmented.
- Fragmentation was suggested by general practitioners in all cases.
- Infants in the neonatal HBV program had delayed DTP and Hib vaccine uptake compared to those not enrolled.
- Missed DTP/Hib doses were higher in infants not receiving HBV (7.1%) or in the neonatal HBV program (2.9%).
- Only 29% of infants received the third HBV dose concurrently with DTP doses.
Conclusions:
- Scheduled infant immunisation visits are frequently fragmented, often at the GP's suggestion.
- The neonatal hepatitis B vaccination program may contribute to delayed uptake of other routine infant vaccines.
- Fragmentation and delayed uptake highlight challenges in Australia's current infant immunisation strategy.
- Combination vaccines, including DTP, Hib, and HBV, are needed to streamline infant immunisation.
Abstract:
A retrospective cohort study was used to determine the extent to which immunisation visits due in the first year of life are split into separate visits. A one-month birth cohort of infants registered in early childhood health centres in the former Eastern Sydney Health Area was followed up when the infants were 8 to 11 months of age. A telephone questionnaire sought documented dates of each dose in the primary series of diphtheria-tetanus-pertussis (DTP), Haemophilus influenzae type b (Hib) and hepatitis B (HBV) vaccination. Of the 141 subjects, 130 had received all due doses of DTP and Hib vaccines and 63 (45 per cent) had been enrolled in the neonatal hepatitis B program. Infants in the latter group received the first DTP-Hib dose on average one week later than did those not in the hepatitis B program (DTP, P = 0.016; Hib, P = 0.047). The greatest percentage of missed DTP or Hib doses occurred in infants not receiving HBV vaccination (7.1 per cent of doses) or those high-risk infants enrolled in the neonatal hepatitis B program (2.9 per cent). Overall, 12 infants had 28 (6.9 per cent) of the 404 possible scheduled visits fragmented into two separate visits. In all cases, parents reported that this was at the suggestion of the general practitioner. We found no greater likelihood of fragmentation for infants who had also received hepatitis B vaccine. Only 17 infants (29 per cent) had received the third hepatitis B vaccine and DTP doses at the same visit, as recommended. These findings confirm anecdotal reports of fragmentation of scheduled visits and missed doses for infants due to receive multiple injections, and some delay in uptake among those receiving hepatitis B vaccine. Universal infant hepatitis B immunisation should not be considered until combination vaccines (which should also include a Hib component) become available in Australia.