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Reifferscheid L, Kiely MS, Lin MSN, Libon J, Kennedy M, MacDonald SE. Effectiveness of hospital-based strategies for improving childhood immunization coverage: A systematic review. Vaccine 2023; 41:5233-5244. [PMID: 37500415 DOI: 10.1016/j.vaccine.2023.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Hospital settings represent an opportunity to offer and/or promote childhood vaccination. The purpose of the systematic review was to assess the effectiveness of different hospital-based strategies for improving childhood vaccination coverage. METHODS A systematic search of multiple bibliographic databases, thesis databases, and relevant websites was conducted to identify peer-reviewed articles published up to September 20, 2021. Articles were included if they evaluated the impact of a hospital (inpatient or emergency department)-based intervention on childhood vaccination coverage, were published in English or French, and were conducted in high-income countries. High quality studies were included in a narrative synthesis. RESULTS We included 25 high quality studies out of 7,845 unique citations. Studies focused on routine, outbreak, and influenza vaccines, and interventions included opportunistic vaccination (i.e. vaccination during hospital visit) (n = 7), patient education (n = 2), community connection (n = 2), patient reminders (n = 2), and opportunistic vaccination combined with patient education and/or reminders (n = 12). Opportunistic vaccination interventions were generally successful at improving vaccine coverage, though results ranged from no impact to vaccinating 71 % of eligible children with routine vaccines and 9-61 % of eligible children with influenza vaccines. Interventions that aimed to increase vaccination after hospital discharge (community connection, patient education, reminders) were less successful. CONCLUSIONS Some interventions that provide vaccination to children accessing hospitals improved vaccine coverage; however, the baseline coverage level of the population, as well as implementation strategies used impact success. There is limited evidence that interventions promoting vaccination after hospital discharge are more successful if they are tailored to the individual.
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Affiliation(s)
| | - Marilou S Kiely
- Institut National de Santé Publique du Québec, Québec City, QC, Canada; Faculty of Medicine, Department of Social and Preventive Medicine, Québec City, QC, Canada; Centre de recherche du CHU de Québec, Québec City, QC, Canada
| | | | - Jackie Libon
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Megan Kennedy
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada.
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Blagden S, Newell K, Ghazarians N, Sulaiman S, Tunn L, Odumala M, Isba R, Edge R. Interventions delivered in secondary or tertiary medical care settings to improve routine vaccination uptake in children and young people: a scoping review. BMJ Open 2022; 12:e061749. [PMID: 35918116 PMCID: PMC9351315 DOI: 10.1136/bmjopen-2022-061749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To identify and analyse the interventions delivered opportunistically in secondary or tertiary medical settings, focused on improving routine vaccination uptake in children and young people. DESIGN Scoping review. SEARCH STRATEGY We searched CINAHL, Web of Science, Medline, Embase and Cochrane Database of Systematic Reviews for studies in English published between 1989 and 2021 detailing interventions delivered in secondary or tertiary care that aimed to improve childhood vaccination coverage. Title, abstract and full-text screening were performed by two independent reviewers. RESULTS After deduplication, the search returned 3456 titles. Following screening and discussion between reviewers, 53 studies were included in the review. Most papers were single-centre studies from high-income countries and varied considerably in terms of their study design, population, target vaccination, clinical setting and intervention delivered. To present and analyse the study findings, and to depict the complexity of vaccination interventions in hospital settings, findings were presented and described as a sequential pathway to opportunistic vaccination in secondary and tertiary care comprising the following stages: (1) identify patients eligible for vaccination; (2) take consent and offer immunisations; (3) order/prescribe vaccine; (4) dispense vaccine; (5) administer vaccine; (6) communicate with primary care; and (7) ongoing benefits of vaccination. CONCLUSIONS Most published studies report improved vaccination coverage associated with opportunistic vaccination interventions in secondary and tertiary care. Children attending hospital appear to have lower baseline vaccination coverage and are likely to benefit from vaccination interventions in these settings. Checking immunisation status is challenging, however, and electronic immunisation registers are required to enable this to be done quickly and accurately in hospital settings. Further research is required in this area, particularly multicentre studies and cost-effectiveness analysis of interventions.
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Affiliation(s)
- Sarah Blagden
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
- Health Education England North West Liverpool, Liverpool, UK
| | - Kathryn Newell
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
- Health Education England North West Liverpool, Liverpool, UK
| | - Nareh Ghazarians
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Sabrena Sulaiman
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Lucy Tunn
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Michael Odumala
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Rachel Isba
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Rhiannon Edge
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
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Tampi M, Carrasco-Labra A, O'Brien KK, Velandia-González M, Brignardello-Petersen R. Systematic review on reducing missed opportunities for vaccinations in Latin America. Rev Panam Salud Publica 2022; 46:e65. [PMID: 35747470 PMCID: PMC9211032 DOI: 10.26633/rpsp.2022.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives To estimate the prevalence of missed opportunities for vaccination (MOV) in Latin America and the effect of interventions targeting health systems, health workers, patients, and communities on MOV. Methods Searches were conducted in MEDLINE, EMBASE, CINAHL, and LILACS electronic databases and relevant organizations were contacted, including the Pan American Health Organization (PAHO), to identify studies meeting eligibility criteria. A pair of reviewers identified 27 randomized and non-randomized studies quantifying the effectiveness of any intervention for reducing MOV and 5 studies assessing the rate of MOV in Latin America. Results are reported narratively when criteria to pool results were not met, and the certainty of this evidence was assessed using the GRADE approach. Results Evidence suggests the rate of MOV in Latin America ranged from 5% to 37% with a pooled estimate of 17% (95% CI [9, 32]) (low certainty) and that monetary incentives to healthcare teams, training for healthcare teams on how to communicate with patients, and educational interventions for caregivers probably reduce MOV (moderate to very low certainty). Conclusions There is insufficient evidence supporting the implementation of any intervention as policy based only on the potential reduction of MOV without considering several factors, including costs, feasibility, acceptability, and equity.
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Affiliation(s)
- Malavika Tampi
- University of Michigan School of Dentistry Ann ArborMichigan United States of America University of Michigan School of Dentistry, Ann Arbor, Michigan, United States of America
| | - Alonso Carrasco-Labra
- University of Pennsylvania PhiladelphiaPennsylvania United States of America University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Kelly K O'Brien
- American Dental Association ChicagoIllinois United States of America American Dental Association, Chicago, Illinois, United States of America
| | - Martha Velandia-González
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
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Bryan MA, Hofstetter AM, Opel DJ, Simon TD. Vaccine Administration in Children's Hospitals. Pediatrics 2022; 149:184452. [PMID: 35001100 PMCID: PMC9677936 DOI: 10.1542/peds.2021-053925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To examine inpatient vaccine delivery across a national sample of children's hospitals. METHODS We conducted a retrospective cohort study examining vaccine administration at 49 children's hospitals in the Pediatric Health Information System database. Children <18 years old admitted between July 1, 2017, and June 30, 2019, and age eligible for vaccinations were included. We determined the proportion of hospitalizations with ≥1 dose of any vaccine type administered overall and by hospital, the type of vaccines administered, and the demographic characteristics of children who received vaccines. We calculated adjusted hospital-level rates for each vaccine type by hospital. We used logistic and linear regression models to examine characteristics associated with vaccine administration. RESULTS There were 1 185 667 children and 1 536 340 hospitalizations included. The mean age was 5.5 years; 18% were non-Hispanic Black, and 55% had public insurance. There were ≥1 vaccine doses administered in 12.9% (95% confidence interval: 12.8-12.9) of hospitalizations, ranging from 1% to 45% across hospitals. The most common vaccines administered were hepatitis B and influenza. Vaccine doses other than the hepatitis B birth dose and influenza were administered in 1.9% of hospitalizations. Children had higher odds of receiving a vaccine dose other than the hepatitis B birth dose or influenza if they were <2 months old, had public insurance, were non-Hispanic Black race, were medically complex, or had a length of stay ≥3 days. CONCLUSIONS In this national study, few hospitalizations involved vaccine administration with substantial variability across US children's hospitals. Efforts to standardize inpatient vaccine administration may represent an opportunity to increase childhood vaccine coverage.
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Affiliation(s)
- Mersine A. Bryan
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington,Seattle Children’s Research Institute, Seattle, Washington,Address correspondence to Mersine A. Bryan, MD, MPH, Department of Pediatrics, University of Washington, M/S CURE-4, PO Box 5371, Seattle, WA 98145. E-mail:
| | - Annika M. Hofstetter
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington,Seattle Children’s Research Institute, Seattle, Washington
| | - Douglas J. Opel
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington,Seattle Children’s Research Institute, Seattle, Washington
| | - Tamara D. Simon
- Division of Hospital Medicine, Department of Pediatrics, Keck School of Medicine at University of Southern California, Los Angeles, California,The Saban Research Institute, Children’s Hospital of Los Angeles, Los Angeles, California
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Mihalek AJ, Hall M, Russell CJ, Wu S. Identifying Practices to Promote Inpatient Adolescent and Influenza Vaccine Delivery. Hosp Pediatr 2021:hpeds.2021-005924. [PMID: 34807982 DOI: 10.1542/hpeds.2021-005924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Many hospitalized children are underimmunized. We assessed the association between hospital immunization practices and tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal, human papillomavirus (HPV), and influenza vaccine delivery. METHODS An electronic survey regarding hospital vaccine delivery practices was distributed via the Pediatric Health Information System (PHIS) and Pediatric Research in Inpatient Settings networks to PHIS hospitals. Number of vaccines delivered and total discharges in 2018 were obtained from the PHIS database to determine hospital vaccine delivery rates; patients 11 to 18 years old (adolescent vaccines) and 6 months to 18 years old (influenza vaccine) were included. Vaccine delivery rates were risk adjusted by using generalized linear mixed-effects modeling and compared with survey responses to determine associations between the number or presence of specific practices and vaccine delivery. Adjusted HPV and meningococcal vaccine delivery rates could not be calculated because of low delivery. RESULTS Twenty-nine hospitals completed a survey (57%). 152 499 and 423 046 patient encounters were included for the adolescent and influenza vaccines, respectively. Unadjusted inpatient vaccine delivery rates varied. After adjustment, the number of practices was associated only with influenza vaccine delivery (P = .02). Visual prompts (P = .02), nurse or pharmacist ordering (P = .003), and quality improvement projects (P = .048) were associated with increased influenza vaccine delivery; nurse or pharmacist ordering had the greatest impact. No practices were associated with Tdap vaccine delivery. CONCLUSIONS The number and presence of specific hospital practices may impact influenza vaccine delivery. Further research is needed to identify strategies to augment inpatient adolescent immunization.
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Affiliation(s)
- Alexandra J Mihalek
- Hospitalist Division, Children's Hospital of Orange County, Orange, California
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Christopher J Russell
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Susan Wu
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
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Bryan MA, Hofstetter AM, Ramos D, Ramirez M, Opel DJ. Facilitators and Barriers to Providing Vaccinations During Hospital Visits. Hosp Pediatr 2021; 11:1137-1152. [PMID: 34556537 DOI: 10.1542/hpeds.2020-004655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Many children are undervaccinated at the time of hospital admission. Our objective was to explore the facilitators and barriers to vaccinating during hospitalization. METHODS We conducted qualitative interviews of parents, primary care pediatricians, emergency department (ED) physicians, and pediatric hospitalists. Parents of undervaccinated hospitalized children who were admitted through the ED were invited to participate. We used purposive sampling to identify physician participants. Semistructured interviews querying participants' perspectives on hospital-based vaccination were audiorecorded and transcribed. Parent demographics and physician practice characteristics were collected. Transcripts were analyzed for facilitators and barriers to vaccinating during acute hospital visits by using inductive content analysis. A conceptual framework was developed on the basis of the social ecological model. RESULTS Twenty-one parent interviews and 10 physician interviews were conducted. Of parent participants, 86% were female; 76% were white. Physician participants included 3 primary care pediatricians, 3 ED physicians, and 4 hospitalists. Facilitators and barriers fell under 4 major themes: (1) systems-level factors, (2) physician-level factors, (3) parent-provider interactional factors, and (4) parent- and child-level factors. Parent participants reported a willingness to receive vaccines during hospitalizations, which aligned with physician participants' experiences. Another key facilitator identified by parent and physician participants was the availability of shared immunization data. Identified by parent and physician participants included the availability of shared immunization data. Barriers included being unaware that the child was vaccine-eligible, parental beliefs against vaccination, and ED and inpatient physicians' perceived lack of skills to effectively communicate with vaccine-hesitant parents. CONCLUSIONS Parents and physicians identified several key facilitators and barriers to vaccinating during hospitalization. Efforts to provide inpatient vaccines need to address existing barriers.
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Affiliation(s)
- Mersine A Bryan
- Department of Pediatrics, School of Medicine .,Seattle Children's Research Institute, Seattle, Washington
| | - Annika M Hofstetter
- Department of Pediatrics, School of Medicine.,Seattle Children's Research Institute, Seattle, Washington
| | - Daniela Ramos
- Seattle Children's Research Institute, Seattle, Washington
| | - Magaly Ramirez
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Douglas J Opel
- Department of Pediatrics, School of Medicine.,Seattle Children's Research Institute, Seattle, Washington
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Mihalek AJ, Russell CJ, Hassan A, Yeh MY, Wu S. National Inpatient Immunization Patterns: Variation in Practice and Policy Between Vaccine Types. Hosp Pediatr 2021; 11:462-471. [PMID: 33820809 DOI: 10.1542/hpeds.2020-002634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Many hospitalized children are underimmunized, yet little is known about current systems supporting inpatient vaccination. We aim to describe national pediatric inpatient immunization practices and determine if variation exists among adolescent, childhood, and influenza vaccines. METHODS An electronic survey regarding hospital vaccination practices was sent to physician, nurse, and pharmacy leaders via the Pediatric Research in Inpatient Settings Network in spring 2019. Hospitals reported the presence of various practices to support inpatient vaccination stratified by vaccine type: tetanus, diphtheria, and acellular pertussis, meningococcal, human papillomavirus, childhood series, and influenza. One-way analysis of variance testing compared differences in numbers of practices and χ2 tests compared proportions of sites reporting each practice between vaccine types. Qualitative responses were evaluated via content analysis. RESULTS Fifty-one of 103 eligible hospitals completed the survey (50%). Standardized policies existed in 92% of hospitals for influenza, 41% for childhood, and 29% for adolescent vaccines. Hospitals identified an average of 5.1 practices to deliver influenza vaccines, compared with 1.5 for childhood; 0.9 for tetanus, diphtheria, and acellular pertussis; 0.7 for meningococcal; and 0.6 for human papillomavirus vaccines (P < .001). Standardized screening tools, visual prompts, standing orders, nurse- or pharmacy-driven screening or ordering, staff education, and quality improvement projects were reported more often for influenza vaccines than other vaccine types (P < .01 for all comparisons). Common barriers to delivery included communication difficulties, lack of systems optimization, and parent and provider discomfort with inpatient immunization. CONCLUSIONS Existing hospital infrastructure supports influenza vaccine delivery over other vaccine types, potentially creating missed inpatient vaccination opportunities.
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Affiliation(s)
- Alexandra J Mihalek
- Division of Hospital Medicine and .,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Christopher J Russell
- Division of Hospital Medicine and.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Mei Yu Yeh
- The Saban Research Institute and Southern California Clinical and Translational Science Institute Biostatistics Core, Children's Hospital Los Angeles, Los Angeles, California; and
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Mihalek AJ, Kysh L, Pannaraj PS. Pediatric Inpatient Immunizations: A Literature Review. Hosp Pediatr 2019; 9:550-559. [PMID: 31209128 DOI: 10.1542/hpeds.2019-0026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Timely vaccine uptake in children remains suboptimal. Eliminating missed opportunities is key to increasing childhood immunization rates, and hospitalization offers another potential setting to vaccinate. OBJECTIVE To better understand pediatric inpatient immunization programs, including vaccination rates of inpatients, parental and provider attitudes, barriers to vaccine delivery, and interventions to increase provision of inpatient vaccines. DATA SOURCES A search was conducted of PubMed, Embase, and Web of Science to identify articles and conference abstracts related to pediatric inpatient immunization. STUDY SELECTION Inclusion criteria were studies published in English between January 1990 and January 2019 in which pediatric vaccination in the hospital setting was discussed. Findings from 30 articles and conference abstracts were summarized and organized by topic area. DATA EXTRACTION Abstracts were screened for relevance, articles were read, and themes were identified. RESULTS Children who are hospitalized have been shown to have lower immunization rates compared with the general population, with 27% to 84% of pediatric inpatients due or overdue for vaccines nationally when verified with official records. Unfortunately, little is done to catch up these children once they have been identified. Access to accurate vaccine histories remains a major barrier in inpatient immunization programs because providers frequently under document and parents over recall a child's vaccine status. Strategies identified to increase inpatient vaccination included creation of a multidisciplinary immunization team, educational interventions, visual reminders, catch-up vaccine plans, order sets, and nursing-driven screening. When offered inpatient vaccination, a majority of parents accepted immunizations for their children. CONCLUSIONS Hospitalization may provide an opportunity to augment vaccine uptake. Further research is needed to develop evidence-based strategies to overcome barriers to inpatient vaccination.
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Affiliation(s)
- Alexandra J Mihalek
- Divisions of Hospital Medicine and .,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Lynn Kysh
- Children's Hospital Los Angeles, Los Angeles, California; and
| | - Pia S Pannaraj
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.,Infectious Diseases
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Shanthikumar S, Hauser SEP. Paediatric assessment in a general metropolitan emergency department. J Paediatr Child Health 2013; 49:507-8. [PMID: 23724820 DOI: 10.1111/jpc.12234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shingler S, Hunter K, Romano A, Graham D. Opportunities taken: the need for and effectiveness of secondary care opportunistic immunisation. J Paediatr Child Health 2012; 48:242-6. [PMID: 22077700 DOI: 10.1111/j.1440-1754.2011.02231.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the effectiveness of a formalised opportunistic immunisation (OI) system in a hospital setting. METHODS Pre-post implementation audit of missed immunisation opportunities. RESULTS Of 5583 children in the National Immunisation Register cohort seen in a hospital setting, 1641 (29.4%) were under-immunised, compared with the concurrent regional cohort of 15%. Māori children were less likely to be age-appropriately immunised (36.9% under-immunised, P < 0.0005, χ(2) = 41.4). Of the 1641 under-immunised children, 337 (20.5%) were deemed to have current medical reasons not to be immunised acutely, and of the remaining 1304, 244 (18.7%) declined immunisations. This left 1060 for whom immunisation was possible, and we immunised 880 (83.0%) of these. All children were re-engaged with primary care services. CONCLUSIONS Children in contact with secondary care services have low immunisation rates with ethnic disparity. Appropriately resourced formalised OI is effective, with potential for further improvement. The system we have implemented enhances primary care involvement.
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Way ASC, Durrheim DN, Vally H, Massey PD. Missed immunisation opportunities in emergency departments in northern New South Wales, Australia. J Paediatr Child Health 2012; 48:66-70. [PMID: 21988697 DOI: 10.1111/j.1440-1754.2011.02188.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to determine the proportion of children less than 12 months of age presenting to Hunter New England (HNE) emergency departments (EDs) during 2009 who were overdue for immunisations and identify factors associated with overdue status. METHODS The immunisation status of all children aged between 3 months and 1 year (120-365 days) who presented at an HNE ED between 1 January and 31 December 2009 was determined using Australian Childhood Immunisation Register (ACIR) 30-day overdue reports. The ED dataset and ACIR reports were linked using a deterministic method. RESULTS Six per cent (253/4218) of children who attended an HNE ED in 2009 were overdue for immunisation and 28.1% (71/253) presented multiple times while overdue. There was a median delay of 77 days from their first presentation while overdue until they no longer appeared on the ACIR 30-day overdue report. Children who presented while overdue were more likely to present multiple times to EDs (RR = 1.45; P = 0.0025), be in a life-threatening triage category (P = 0.012) and present at tertiary referral hospitals (P < 0.001). CONCLUSIONS Important missed immunisation opportunities occurred in HNE EDs and may occur in other EDs in Australia. Half of the children who presented to Hunter New England emergency departments while overdue for immunisation remained overdue for greater than 77 days following their presentation. Opportunities exist in EDs and paediatric inpatient wards for ensuring that all children are protected against vaccine-preventable diseases.
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Affiliation(s)
- Andrew S C Way
- National Centre for Epidemiology and Population Health, College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia
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12
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Immunisation coverage in Australian Indigenous children: Time to move the goal posts. Vaccine 2008; 27:307-12. [PMID: 18977263 DOI: 10.1016/j.vaccine.2008.09.096] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Revised: 09/23/2008] [Accepted: 09/30/2008] [Indexed: 11/21/2022]
Abstract
Childhood immunisation coverage reported at 12 to <15 months and 2 years of age, may mask deficiencies in the timeliness of vaccines designed to protect against diseases in infancy. This study aimed to evaluate immunisation timeliness in Indigenous infants in the Northern Territory, Australia. Coverage was analysed at the date children turned 7, 13 and 18 months of age. By 7 months of age, 45.2% of children had completed the recommended schedule, increasing to 49.5% and 81.2% at 13 and 18 months of age, respectively. Immunisation performance benchmarks must focus on improving the timeliness in these children in the first year of life.
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