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Delays in Immunization Have Potentially Serious Health Consequences

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Abstract

When children are not administered vaccinations according to the recommended schedule, they not only fail to receive timely protection from preventable diseases at a time when they are most vulnerable, but also increase their risk of never fully completing the vaccination course. Both outcomes compromise a successful childhood immunization program. Although current data suggest that vaccination rates are near 95% for school-aged children in the US, the rate of timely vaccination is much lower. A number of large studies have found that the majority of children are not currently vaccinated on schedule. Moreover, immunization levels for 2- to 3-year-old children have reached a plateau.

It is essential to recognize that low overall rates of the targeted diseases mask the persistent threat they pose if adherence to vaccination schedules declines. A delay in one vaccine will produce a domino effect if catch-up adjustments in scheduled visits are not implemented aggressively. Published reports have demonstrated that failure to adhere to scheduled booster immunizations, not just the initial inoculation, results in resurgence of disease. Children fall off the vaccination schedule for a variety of reasons. Although many studies suggest that inadequate availability to healthcare is not a major determinant of delayed immunization, it still factors into parental decisions. Parents should be reminded of available healthcare options. From the clinician’s end, computerization of healthcare records should allow for the generation of reminders. It is vital for clinicians to be aware that there are few contraindications to vaccination. They should also be prepared to address parental concerns regarding the safety of vaccines and should not hesitate to use topical analgesics or distraction techniques to facilitate inoculation.

With the anticipation of several novel vaccines being added to the childhood and adolescent immunization schedule in the future, pediatricians face new challenges to not only provide every vaccination, but to do so in a timely manner. A lack of willingness on the part of the parent, or, occasionally, on the part of the clinician, to have multiple vaccines administered to the child during a single visit has been shown to be a significant cause of delayed vaccination. Since combination vaccines reduce the number of shots that need to be administered, the use of combination vaccines may provide the best opportunity to simplify the immunization schedule, increasing adherence in the process. Improved adherence to established schedules may present a major opportunity to further protect children from disease.

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References

  1. CDC. Coverage estimates for school entry vaccinations [online]. Available from URL: http://www2.cdc.gov/nip/schoolsurv/nationalAvg.asp [Accessed 2007 Feb 16]

  2. CDC. Vaccination coverage among children entering 2003–04 school year in the United States. MMWR Morb Mortal Wkly Rep 2004; 53: 1041–4

    Google Scholar 

  3. CDC. Special report: 50 years of immunization success. CDC annual reports 2005 [online]. Available from URL: http://www.cdc.gov/nip/webutil/about/annual-rpts/ar205/special-report-2005.pdf [Accessed 2005 Dec 16]

    Google Scholar 

  4. Gerberding J. Rubella no longer a major health threat. National Immunization Conference; 2005 Mar 21; Washington, DC

  5. CDC. Notifiable diseases/deaths in selected cities weekly information. MMWR Morb Mortal Wkly Rep 2006; 55: 1396

    Google Scholar 

  6. Mell LK, Ogren DS, Davis RL, et al. Compliance with national immunization guidelines for children younger than 2 years, 1996–1999. Pediatrics 2005; 115: 461–7

    Article  PubMed  Google Scholar 

  7. Barker L, Luman E, Zhao Z, et al. National, state, and urban area vaccination coverage levels among children aged 19–35 months: United States, 2001. MMWR Morb Mortal Wkly Rep 2002; 51: 664–6

    PubMed  CAS  Google Scholar 

  8. Luman ET, Barker LE, McCauley MM, et al. Timeliness of childhood immunizations: a state-specific analysis. Am J Public Health 2005; 95: 1367–74

    Article  PubMed  Google Scholar 

  9. Kenyon TS, Izurieta H, Shulman ST, et al. Large outbreak of pertussis among young children in Chicago, 1993: investigation of potential contributing factors and estimation of vaccine effectiveness. Pediatr Infect Dis J 1996; 15: 655–61

    Article  PubMed  CAS  Google Scholar 

  10. Farizo KM, Cochi SL, Zell ER, et al. Epidemiological features of pertussis in the United States, 1980–1989. Clin Infect Dis 1992; 14: 708–19

    Article  PubMed  CAS  Google Scholar 

  11. National Vaccine Advisory Committee. The measles epidemic: the problems, barriers, and recommendations. JAMA 1991; 266: 1547–52

    Article  Google Scholar 

  12. Scheifele D, Halperin S, Law B, et al. Invasive Haemophilus influenzae type b infections in vaccinated and unvaccinated children in Canada, 2001–2003. CMAJ 2005; 172: 53–6

    Article  PubMed  Google Scholar 

  13. Wood D, Halfon N, Pereyra M, et al. Knowledge of the childhood immunization schedule and of contraindications to vaccinate by private and public providers in Los Angeles. Pediatr Infect Dis J 1996; 15: 140–5

    Article  PubMed  CAS  Google Scholar 

  14. Bolton P, Hussain A, Hadpawat A, et al. Deficiencies in current childhood immunization indicators. Public Health Reports 1998; 113: 527–32

    PubMed  CAS  Google Scholar 

  15. Dominguez SR, Parrott JS, Lauderdale DS, et al. On-time immunization rates among children who enter Chicago public schools. Pediatrics 2004; 114: 741–7

    Article  Google Scholar 

  16. Santoli JM, Huet NJ, Smith PJ, et al. Insurance status and vaccination coverage among US preschool children. Pediatrics 2004; 113: 1959–64

    PubMed  Google Scholar 

  17. Luman ET, Barker LE, Shaw KM, et al. Timeliness of childhood vaccinations in the United States. JAMA 2005; 283: 1204–11

    Article  Google Scholar 

  18. CDC. National, state, and urban area vaccination coverage levels among children aged 19–35 months: United States, 2000. MMWR Morb Mortal Wkly Rep 2001; 50: 637–41

    Google Scholar 

  19. Dombkowski KJ, Lantz PM, Freed GL. The need for surveillance of delay in age-appropriate immunization. Am J Prev Med 2002; 23: 36–42

    Article  PubMed  Google Scholar 

  20. Grant CC, Roberts M, Scragg R, et al. Delayed immunisation and risk of pertussis in infants: unmatched case-control study. BMJ 2003; 326: 852–3

    Article  PubMed  Google Scholar 

  21. Izurieta HS, Kenyon TA, Strebel PM, et al. Risk factors for pertussis in young infants during an outbreak in Chicago in 1993. Clin Infect Dis 1996; 22: 503–7

    Article  PubMed  CAS  Google Scholar 

  22. Wood DL, Brunell PA. Measles control in the United States: problems of the past and challenges for the future. Clin Microbiol Rev 1995; 8: 260–7

    PubMed  CAS  Google Scholar 

  23. CDC. Preventable measles among U.S. residents, 2001–2004. MMWR 2005; 54: 817–20

    Google Scholar 

  24. Salmon DA, Haber M, Gangarosa EJ, et al. Health consequences of religious and philosophical exemptions from immunization laws. JAMA 1999; 282: 47–53

    Article  PubMed  CAS  Google Scholar 

  25. Marshall GS, Happe LE. Impact of first-year DTaP doses on the timeliness of the fourth dose of DTaP among children in a state Medicaid population [poster no. 269]. 40th National Immunization Conference; 2006 Mar 6–9; Atlanta (GA)

  26. Irigoyen M, Findley SE, Chen S, et al. Early continuity of care and immunization coverage. Ambul Pediatr 2004; 4: 199–203

    Article  PubMed  Google Scholar 

  27. Heath PT, McVernon J. The UK Hib vaccine experience. Arch Dis Child 2002; 86: 393–9

    Article  Google Scholar 

  28. Lieu TA, Black SB, Sorel ME, et al. Would better adherence to guidelines improve childhood immunization rates? Pediatrics 1996; 98: 1062–8

    PubMed  CAS  Google Scholar 

  29. Bardenheier BH, Yusuf HR, Rosenthal J, et al. Factors associated with underim-munization at 3 months of age in four medically underserved areas. Public Health Rep 2004; 119: 479–85

    Article  PubMed  Google Scholar 

  30. Daniels D, Jiles RB, Klevens RM, et al. Undervaccinated African-American preschoolers: a case of missed opportunities. Am J Prev Med 2001; 20 (4 Suppl.): 61–8

    Article  PubMed  CAS  Google Scholar 

  31. John TJ, Samuel R. Herd immunity and herd effect: new insights and definitions. Eur J Epidemiol 2000; 16: 601–6

    Article  PubMed  CAS  Google Scholar 

  32. Davis RM, Whitman EE, Orenstein WA, et al. A persistent outbreak of measles despite appropriate prevention and control measures. Am J Epidemiol 1987; 126: 438–49

    PubMed  CAS  Google Scholar 

  33. Gustafson TL, Lievens AW, Brunell PA, et al. Measles outbreak in a fully immunized secondary-school population. N Engl J Med 1987; 316: 771–4

    Article  PubMed  CAS  Google Scholar 

  34. Kuter BJ, Weibel RE, Guess HA. Oka/Merck varicella vaccine in healthy children: final report of a 2-year efficacy study and 7-year follow-up studies. Vaccine 1991; 9: 643–7

    Article  PubMed  CAS  Google Scholar 

  35. Weibel RE, Neff BJ, Kuter BJ. Live attenuated varicella vaccine: efficacy trial in healthy children. N Engl J Med 1984; 310: 1409–15

    Article  PubMed  CAS  Google Scholar 

  36. Omer SB, Pan WK, Halsey NA, et al. Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence. JAMA 2006; 296: 1757–63

    Article  PubMed  CAS  Google Scholar 

  37. Hinman AR, Orenstein WA, Williamson DE, et al. Childhood immunization: laws that work. J Law Med Ethics 2002; 30 (3 Suppl.): 122–7

    PubMed  Google Scholar 

  38. Feikin DR, Lezotte DC, Hamman RF, et al. Individual and community risks of measles and pertussis associated with personal exemptions to immunization. JAMA 2000; 284: 3145–50

    Article  PubMed  CAS  Google Scholar 

  39. Global Polio Eradication Initiative [online]. Available from URL: http://www.polioeradication.org/casecount.asp [Accessed 2007 Feb 16]

  40. Aberle JH, Aberle SW, Pracher E, et al. Single versus dual respiratory virus infections in hospitalized infants: impact on clinical course of disease and interferon-gamma response. Pediatr Infect Dis J 2005; 24: 605–10

    Article  PubMed  Google Scholar 

  41. Meyeroff A, Jacobs RJ, Greenberg DP, et al. Clinician satisfaction with vaccination visits and the role of multiple injections, results from the COVISE study. Clin Pediatr 2004; 43: 87–93

    Article  Google Scholar 

  42. Committee on Community Health Services and Committee on Practice and Ambulatory Medicine. Increasing immunization coverage. Pediatrics 2003; 112: 993–6

    Article  Google Scholar 

  43. Randolph GD, Murray M, Swanson JA, et al. Behind schedule: improving access to care for children one practice at a time. Pediatrics 2004; 113: 230–7

    Article  Google Scholar 

  44. O’Brien L, Taddio A, Ipp M, et al. Topical 4% amethocaine gel reduces the pain of subcutaneous measles-mumps-rubella vaccination. Pediatrics 2004; 114: e720–4

    Article  PubMed  Google Scholar 

  45. Cohen LL, Blount RL, Cohen RJ, et al. Comparative study of distraction versus topical anesthesia for pediatric pain management during immunizations. Health Psychol 1999; 18: 591–8

    Article  PubMed  CAS  Google Scholar 

  46. Koslap-Petraco MB, Parsons T. Communicating the benefits of combination vaccines to parents and health care providers. J Pediatr Health Care 2003; 17: 53–7

    Article  PubMed  Google Scholar 

  47. Gust DA, Strine TW, Maurice E, et al. Underimmunization among children: effects of vaccine safety concerns on immunization status. Pediatrics 2004; 114: 16–22

    Article  Google Scholar 

  48. Gregson AL, Edelman R. Does antigenic overload exist? The role of multiple immunizations in infants. Immunol Allergy Clin North Am 2003; 23: 649–64

    Article  PubMed  Google Scholar 

  49. Gangarosa EJ, Galazka AM, Wolfe CR, et al. Impact of anti-vaccine movements on pertussis control: the untold story. Lancet 1998; 351: 356–61

    Article  PubMed  CAS  Google Scholar 

  50. CDC. ACIP VFC vaccine resolutions [online]. Available from URL: http://www.cdc.gov/nip/vfc/acip_vfc_resolutions.htm. [Accessed 2006 Mar 6]

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Acknowledgements

BioCentric, Inc. provided editorial assistance. Funding for these services was provided to BioCentric, Inc. by GlaxoSmithKline. The author has received no compensation associated with this article.

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Authors and Affiliations

  1. San Antonio Metropolitan Health District, 332 West Commerce, Suite 307, San Antonio, Texas, 78205-2489, USA

    Fernando A. Guerra (Director of Health)

  2. Department of Pediatrics, University of Texas Health Science Center, San Antonio, Texas, USA

    Fernando A. Guerra (Director of Health)

  3. Department of Public Health, Air Force School of Aerospace Medicine, Brooks Air Force Base, San Antonio, Texas, USA

    Fernando A. Guerra (Director of Health)

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  1. Fernando A. Guerra
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Correspondence to Fernando A. Guerra.

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Guerra, F.A. Delays in Immunization Have Potentially Serious Health Consequences. Pediatr-Drugs 9, 143–148 (2007). https://doi.org/10.2165/00148581-200709030-00002

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