Assessment of Missed Opportunities for Hepatitis A Vaccination, National Immunization Survey Child Open Access

Abstract

Objective: Quantify the number of missed opportunities for vaccination (MOV) with Hepatitis A vaccine (HAV) in children and assess the association of HAV MOV with covariates of interest.

Study Subjects: Weighted data from the 2013 National Immunization Survey of U.S. children aged 19-35 months, were used. Analysis was restricted to children with provider verified vaccination history (n=13,460).

Methods: MOV were quantified by determining the number of medical visits a child made when another vaccine was administered during eligibility for HAV vaccine, but HAV was not administered. Bivariate and multivariate polytomous logistic regression was used to assess the association of MOV with child and maternal demographic, socio-economic and geographic covariates.

Results:In 2013, 85% of children in our study population had initiated the HAV vaccine series, and 60% received two or more doses. Children with 2+ MOV initiated the vaccine series 6 months later than children with zero. Children who received zero doses of HAV vaccine had an average of 1.77 MOV compared to 0.43 MOV in those with two doses. Children who were younger, had younger mothers, had ever received WIC benefits, lived below the poverty line or lived in a state with childcare or school entry mandates were independently associated with a reduced odds for MOV; children with more educated mothers or married parents were at an increased odds.

Conclusions: MOV may contribute to the poor coverage for HAV vaccination in children, and it is important to understand why children are not having the vaccine administered when eligible.

Table of Contents

Chapter I

Background.............................................................................................1

Hepatitis A virus..................................................................................... 1

Importance in the U.S. and globally...........................................................2

Vaccination development and recommendations........................................6

Missed opportunities for vaccination & gaps in the current literature...........8

Chapter II

Introduction...........................................................................................13

Methods.................................................................................................14

Data Sources & Recruitment....................................................................14

Study Subjects........................................................................................15

Study variable measurements..................................................................15

Data analysis..........................................................................................16

Ethics.....................................................................................................17

Results...................................................................................................17

Study population.....................................................................................17

Administration of vaccine.........................................................................17

Missed opportunities for vaccination.........................................................18

Discussion...............................................................................................19

Strengths & limitations............................................................................22

Conclusions.............................................................................................23

Tables and Figures....................................................................................23

Chapter III

Summary..................................................................................................28

Public Health Implications.........................................................................28

Possible Future Directions.........................................................................28

References................................................................................................30

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Medicine and Surgery Health Sciences, Epidemiology
Keyword	NIS-Child United States pediatrics vaccination immunization children hepatitis A primary care National Immunization Survey Child missed opportunities
Committee Chair / Thesis Advisor	Bednarczyk, Robert A, Emory University

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