Vaccine Schedule as a Predictor of Up-to-Date Status of Early Childhood Immunizations in the U.S. Pubblico

Abstract

Objectives: To estimate the ability of sociodemographic factors to predict the proportion of American children adhering to the Advisory Council on Immunization Practices (ACIP) recommended vaccination schedule or utilizing alternate schedules, and to estimate the effect of both schedule adherence and sociodemographics on vaccination coverage for all ACIP-recommended early childhood immunizations.

Methods: We classified vaccination schedule adherence as routine, alternate, or other for the 15,059 2014 National Immunization Survey (NIS) 19-35-month-old participants with provider-verified data, and calculated the up-to-date status for participants using all ACIP-recommended immunizations. To determine schedule adherence, we accounted for vaccines received by 5 key time points. We then constructed logistic models using sociodemographic characteristics to predict alternate and other schedule adherence (versus routine schedule). Finally, we constructed a logistic model to estimate the association between schedule adherence and up-to-date status, while also accounting for key sociodemographic characteristics.

Results: Most children followed a routine schedule (63%), while 23% and 14% followed alternate and other schedules, respectively. Most children (68%) were up-to-date for all required immunizations. Alternate and other schedule adherence were strongly associated with not being up-to-date (ORs = 32.7 and 3.9 respectively). Factors including belonging to specific racial/ethnic groups, being below the poverty line, and having moved across state lines since birth were associated both with non-adherence to routine schedules and not being up-to-date.

Conclusion: Vaccination schedule in early childhood is strongly correlated with the likelihood that a child will be up-to-date for recommended immunizations. Understanding characteristics of families with early vaccine delays may be useful for future interventions targeting those at risk for non-adherence to routine immunization.

Table of Contents

Chapter I: Background ………………………………………………………………………… 1

Chapter II: Manuscript ………………………………………………………………………… 8

Abstract …………………………………………………………………………………. 8

Introduction …………………………………….……………………………………….. 9

Methods ……………………………………….………………………………………... 10

Results ……………………………………….…………………………………………. 13

Discussion ………………………………….………………………………………….. 14

References ……………………………………………………………………………... 19

Tables …………………………………………….…………………………………….. 29

Chapter III: Public Health Implications …………………………………………………….... 38

Appendices …………………………………………………………………………………….... 40

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, Epidemiology
Parola chiave	vaccines routine immunization childhood immunizations vaccine schedule National Immunization Survey
Committee Chair / Thesis Advisor	Bednarczyk, Robert A, Emory University
Committee Members	Frew, Paula, Emory University
Partnering Agencies	US (Federal) agency other than CDC

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