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Home vaccination for children behind in their immunisation schedule: a randomised controlled trial
L M Bond1, T M Nolan, R A Lester
1Department of Paediatrics, University of Melbourne, Royal Children's Hospital, VIC. bond@cryptic.rch.unimelb.edu.au
Objective:
To ascertain the effectiveness of a home vaccination service for children behind in their vaccination schedule.
Design:
Randomised controlled trial of nurse-administered vaccination at home. Children were allocated at random to the intervention or the control group before any contact with the parents was made.
Setting:
10 council areas in north-west metropolitan Melbourne defined by 56 postcode zones. Six-week intervention period from November 1996.
Participants:
405 children--all those in the study area (n = 2610) 90 days late (age 9 months) for their third diphtheria-tetanus-pertussis/poliomyelitis/Haemophilus influenzae type B (DTP/OPV/Hib) vaccination, or 120 days late (age 16 months) for their measles-mumps-rubella (MMR) vaccination, according to the Australia Childhood Immunisation Register.
Main Outcome Measures:
Number of children completing DTP/OPV/Hib or MMR during the intervention period, and number up to date before intervention.
Results:
Verification of vaccination status with the parents revealed that 123 (60%) of the children in the intervention group and 113 (56%) of those in the control group were up to date with their vaccinations, leaving a study population of 81 (intervention group) and 88 (control group). Vaccination was achieved in 46 (57%) intervention children and 24 (27%) control children (risk ratio [RR], 2.08; 95% CI, 1.4-3.1; P < 0.001). For DTP/OPV/Hib, 18/32 (56%) intervention children and 12/36 (33%) control children were vaccinated, (P = 0.06). For MMR, 28/49 (57%) and 12/52 (23%) children were vaccinated, respectively (P < 0.001). Home vaccinations were completed with 26 families (including five siblings). The average cost per child vaccinated as a result of the home program was $92.52.
Conclusion:
Home vaccination for children behind in their immunisation schedule is an effective, acceptable and relatively cheap method of completing recommended vaccinations. We recommend that a home vaccination program be widely implemented and made available, particularly for disadvantaged families.