Evaluation of potentially achievable vaccination coverage with simultaneous administration of vaccines among children in the United States☆
Introduction
Routine administration of all age-appropriate doses of childhood vaccines during the same health care provider visit is the standard for childhood immunization practices and has been approved and recommended by the National Vaccine Advisory Committee (NVAC), the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) [1]. Simultaneous administration of childhood vaccines is defined as administering more than one recommended vaccine on the same visit day, at different anatomic sites, and not combined in the same syringe [2]. Simultaneous administration of all vaccines for which a child is eligible is an important strategy for ensuring that vaccinations are received on schedule, and for bringing children who have fallen behind on their vaccines up to date [3]. It is also an important standard crucial to increasing immunization rate, achieving and maintaining the national target of vaccination coverage level among children of 19–35 months for all recommended vaccines [1], [2], [3], [4], [5]. Experimental evidence and extensive clinical experience show that giving all age-appropriate childhood vaccines simultaneously is a safe and efficacious practice [2], [3], [6]. Data from vaccination coverage surveys have indicated that failing to administer all vaccines for which a child is eligible is an important cause of low vaccination coverage [3]. Surveys of vaccination records from 21 selected cities and localities in the United States have shown that each child had many opportunities for the simultaneous administration of vaccines that, if used appropriately, could have potentially raised vaccination coverage levels by 12–22 percentage points with median of 17 percentage points [7]. A recent study from Nebraska has reported that 77% of children who were behind on their vaccinations at 24 months could have been up to date if appropriate vaccines had been given simultaneously [8]. A study from immunization record audits in the State of Georgia has demonstrated that vaccination coverage increased significantly when missed opportunities to administer vaccines simultaneously were reduced [9]. Missed opportunities for simultaneous vaccinations were recognized as one of the two main causes for children falling behind in their vaccination [10].
The studies cited above indicate that simultaneous administration of age-appropriate childhood vaccine could have increased children's vaccination coverage rates significantly, but those results were limited to the selected states and local areas and did not evaluate the vaccination coverage that could be potentially achieved at the national level. Since 1995, the Centers for Disease Control and Prevention (CDC) has been estimating and reporting national, state, and selected local area vaccination coverage among children 19–35 months in the United States [11]. Those reports point out that vaccination coverage levels for most of the routine childhood vaccines have reached the Healthy People 2020 target of 90% [4]. However, vaccination coverage for ≥4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine (4+DTaP), ≥4 doses of pneumococcal conjugate vaccine (4+PCV), and the full series of Haemophilus influenzae type b vaccine (Hib-FS) have not yet reached the 90% target. Therefore, in this current study, we applied the important immunization practice standard, i.e. simultaneous administration of childhood vaccines at the same visit, to the National Immunization Survey (NIS), the largest vaccination survey in the United States. We evaluated the potentially achievable vaccination coverage for 4+DTaP, 4+PCV, and Hib-FS for calendar years 2001 through 2013 in the United States; by 50 U.S. states and DC, and by selected socio-demographic factors in 2013. All potentially achievable vaccination coverage levels were compared to the corresponding reported vaccination coverage levels to assess the impact of simultaneous administration of childhood vaccines on vaccination coverage.
Section snippets
Data sources
National Immunization Survey (NIS) data collected from 2001 through 2013 were analyzed in this study. The NIS is conducted annually by the Centers for Disease Control and Prevention (CDC) to obtain national, state, and selected local area estimates of vaccination coverage for the U.S. non-institutionalized population of children 19–35 months [11]. The NIS is a random-digit-dialed telephone survey of households with age eligible children followed by a mail survey to children's immunization
Potentially achievable vs. reported vaccination coverage for 4+DTaP, 4+PCV, and the full series of Hib (Hib-FS), 2001–2013
If the recommended standards of childhood immunization practices for simultaneous administration of the fourth dose of DTaP vaccine had been implemented fully according to the general ACIP recommended vaccination schedule, compared to the reported vaccination coverage for 4+DTaP, the potentially achievable vaccination coverage for 4+DTaP would have increased significantly each year from 2001 through 2013 (P < 0.001) (Fig. 1(A)). The increases of vaccination coverage ranged from 3.9 percentage
Discussion
Immunization recommendations in the United States currently target 14 vaccine-preventable diseases for children [4], [17], it is very important to achieve the national immunization targets for children outlined in the Healthy People 2020, a nationwide health promotion and disease prevention agenda from the US Department of Health and Human Services. Achieving these objectives will improve the health and welfare of all children as well as the communities in which they live [4]. However, the
Conclusions
The findings in this study suggest that fully utilization of all opportunities for simultaneous administration of all age-eligible childhood doses of vaccines during the same vaccination visit is a critical strategy for achieving the vaccination coverage target of Healthy People 2020. If simultaneous administration of all age-appropriate doses of vaccines had been fully carried out according to the general ACIP recommended vaccination schedule, potentially achievable vaccination coverage for
References (23)
- et al.
When and why children fall behind with vaccinations: missed visits and missed opportunities at milestone ages
Am J Prev Med
(2009) Standards for child and adolescent immunization practices
Pediatrics
(2003)Recommendations of the Advisory Committee on Immunization Practices (ACIP)
MMWR
(2011)- et al.
Simultaneous administration of childhood vaccines: an important public health policy that is safe and efficacious
Pediatr Infect Dis J
(1994) - US Department of Health and Human Services. Healthy people 2020 objectives, immunization and infectious diseases....
Immunization strategies for healthcare practices and providers. Epidemiology and prevention of vaccine-preventable diseases. The pink book: course textbook
(2015)- et al.
Addressing parents’ concerns: do multiple vaccines overwhelm or weaken the infant's immune system?
Pediatrics
(2002) - et al.
Potential impact on vaccination coverage levels by administering vaccines simultaneously and reducing dropout rates
Arch Pediatr Adolesc Med
(1994) Early childhood vaccination in two rural counties: Nebraska, 1991–1992
MMWR
(1992)- et al.
Monitoring progress towards US preschool immunization goal
JAMA
(1992)
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Disclaimer: The findings and conclusions in this article are solely the responsibility of the authors and do not necessarily represent the official view of Centers for Disease Control and Prevention.