Disturbing findings regarding pediatric vaccination in the US
In view of the current flu epidemic, the Centers for Disease Control and Prevention (CDC) recommends that everyone who is over the age of 6 months should get a flu vaccine. Beyond flu, a number of vaccinations are recommended for children. However, a new study has found that pediatric vaccination in the United States has fallen well short of the mark. The study, conducted by researchers affiliated with the Kaiser Permanente Colorado Institute for Health Research, was published online on January 21 in the journal JAMA Pediatrics.
The current recommended immunization schedule, which includes vaccines for hepatitis B, MMR (measles, mumps, and rubella (German measles)), and DPT (diphtheria, pertussis (whooping cough), and tetanus, was developed by the Advisory Committee for Immunization Practices (ACIP). It describes the ages at which children should receive specific vaccines. Some vaccines are often grouped together and administered all at once during one doctor’s visit.
The researchers conducted a retrospective (backward-looking) study, which had the objective of examining patterns and trends of undervaccination in children aged 2 to 24 months and to compare healthcare utilization rates between undervaccinated and age-appropriately vaccinated children. The study group comprised 323,247 born between 2004 and 2008 who were enrolled in eight managed care organizations. The researchers reviewed record from the Vaccine Safety Datalink to calculate the average number of days children were undervaccinated. The investigators created two matched study groups: (1) Children who were undervaccinated for any reason; and (2) Children who were undervaccinated because of parental choice. For both groups, undervaccinated children were matched to age-appropriately vaccinated children by birth date, managed care organization, and sex. The main outcome measures were the rates of undervaccination, specific patterns of undervaccination, and healthcare utilization rates.
The researchers found that 48.7% of the children were undervaccinated for at least one day before age 24 months. The prevalence of undervaccination and specific patterns of undervaccination increased over time. In a matched cohort analysis, undervaccinated children had lower outpatient visit rates compared with children who were age-appropriately vaccinated. In contrast, undervaccinated children had increased inpatient admission rates compared with age-appropriately vaccinated children. In a second matched cohort analysis, children who were undervaccinated because of parental choice had lower rates of outpatient visits and emergency department encounters than age-appropriately vaccinated children.
The researchers concluded that undervaccination appears to be an increasing trend. In addition, undervaccinated children appear to have different healthcare utilization patterns compared with age-appropriately vaccinated children.
Take home message:
Vaccination has been proven effective to prevent serious illness and death from a variety of childhood diseases. Some parents decline vaccination of their children for a number of reasons, including fear of harm to the child, or religious reasons. Others do not receive regular pediatric care for their children. The low vaccination rate in a managed care setting is surprising because these healthcare organizations stress preventive healthcare. It is likely that pediatric vaccination rates are lower in the general population than that of the managed care population.
Reference: JAMA Pediatrics
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