Abstract
OBJECTIVES: Assessing timeliness and completeness of vaccine administration is important for evaluating the effectiveness of immunization programs. Few studies have reported timeliness, particularly in Canada. The objective of this study was to examine timeliness of the receipt of vaccination for each routine childhood recommended vaccine by 24 months of age among children in a community-based pregnancy cohort in Calgary, Alberta.
METHODS: Survey data from a community-based pregnancy cohort in Alberta were linked to Public Health vaccination records of children (n = 2763). The proportion of children receiving early, timely, delayed, or no vaccination was calculated. A dose was considered early if it was administered before the recommended age in days as per the vaccination schedule, timely if administered at any time from start of recommended age in days to age in days when delay counts were initiated, and delayed if it was administered on or after age in days when delay counts were initiated. Series completion rates were also calculated.
RESULTS: For multi-dose vaccines, over 80% of children had timely doses at 2, 4 and 6 months. By 12 months, this proportion decreased to 65% (95% CI: 63%–66%) for meningococcal conjugate group C, 61% (95% CI: 59%–62%) for measles antigen-containing vaccines and 64% (95% CI: 62%–65%) for varicella antigen-containing vaccines. At 18 months, only 55% (95% CI: 53%–56%) of the children had a timely 4th dose of diphtheria, acellular pertussis, tetanus, polio, and Haemophilus influenzae type b vaccine. Eventual series completion rate for all recommended vaccines was 77% (95% CI: 75%–79%).
CONCLUSION: The timeliness and completeness of routine childhood vaccination in preschool children in this community-based pregnancy cohort is lower than provincial targets. Data on timeliness of vaccination can inform further work on barriers and enablers to vaccination in order to meet provincial targets.
Key Words: Vaccination, immunization, timeliness, completeness, child
Résumé
OBJECTIFS: Il est important de déterminer l’opportunité et l’intégralité de l’administration des vaccins pour évaluer l’efficacité des programmes d’immunisation. Peu d’études abordent l’opportunité, particulièrement au Canada. Notre objectif était donc d’examiner l’opportunité des vaccinations reçues pour chacun des vaccins systématiquement recommandés aux enfants avant l’âge de 24 mois dans une cohorte communautaire de grossesses de Calgary (Alberta).
MÉTHODE: Les données d’enquête d’une cohorte communautaire de grossesses en Alberta ont été liées aux dossiers de santé publique sur la vaccination des enfants (n = 2 763). Nous avons calculé la proportion d’enfants ayant reçu leurs vaccins tôt, à temps, en retard ou pas du tout. Une dose était jugée avoir été administrée tôt si elle l’avait été avant l’âge recommandé en jours dans le calendrier de vaccination, à temps si elle avait été administrée entre le début de l’âge recommandé en jours et l’âge en jours où l’on a commencé la comptabilisation des retards, et en retard si elle avait été administrée à l’âge ou après l’âge en jours où l’on a commencé la comptabilisation des retards. Nous avons aussi calculé les taux d’achèvement des séries vaccinales.
RÉSULTATS: Pour les vaccins à doses multiples, plus de 80 % des enfants avaient reçu leurs doses à temps à 2, 4 et 6 mois. À 12 mois, cette proportion baissait à 65 % (IC de 95 %: 63 %–66 %) pour le vaccin conjugué contre le méningocoque du groupe C, à 61 % (IC de 95 %: 59 %–62 %) pour les vaccins contenant un antigène contre la rougeole et à 64 % (IC de 95 %: 62 %–65 %) pour les vaccins contenant un antigène contre la varicelle. À 18 mois, seulement 55 % (IC de 95 %: 53 %–56 %) des enfants avaient reçu à temps la 4e dose du vaccin contre la diphtérie, la coqueluche acellulaire, le tétanos, la polio et l’Haemophilus influenzae de type b. Le taux d’achèvement éventuel des séries pour tous les vaccins recommandés était de 77 % (IC de 95 %: 75 %–79 %).
CONCLUSION: L’opportunité et l’intégralité de la vaccination systématique des enfants d’âge préscolaire dans cette cohorte communautaire de grossesses sont inférieures aux cibles provinciales. Les données sur l’opportunité de la vaccination peuvent éclairer d’autres travaux sur les obstacles et les incitateurs à la vaccination afin de respecter les cibles provinciales.
Mots Clés: vaccination, immunisation, opportunité, intégralité, enfant
Footnotes
Conflict of Interest: None to declare.
References
- 1.Hull BP, McIntyre PB. Timeliness of childhood immunisation in Australia. Vaccine. 2006;24(20):4403–8. doi: 10.1016/j.vaccine.2006.02.049. [DOI] [PubMed] [Google Scholar]
- 2.Seither R, Calhoun K, Knighton CL, Mellerson J, Meador S, Tippins A, et al. Vaccination coverage among children in kindergarten–United States, 2014–15 school year. MMWR Morb Mortal Wkly Rep. 2015;64(33):897–904. doi: 10.15585/mmwr.mm6433a2. [DOI] [PubMed] [Google Scholar]
- 3.Public Health Agency of Canada. Vaccine Coverage in Canadian Children: Highlights from the 2013 Childhood National Immunization Coverage Survey (cNICS) Ottawa, ON: PHAC; 2015. [Google Scholar]
- 4.Hull BP, Dey A, Beard FH, Menzies RI, Brotherton JM, McIntyre PB. Annual Immunisation Coverage Report 2013. Canberra, Australia: National Centre for Immunisation Research & Surveillance; 2013. [Google Scholar]
- 5.World Health Organization. WHO Vaccine-Preventable Diseases: Monitoring System, 2016 Global Summary. Geneva, Switzerland: The Department of Immunization, Vaccines and Biologicals, WHO; 2016. [Google Scholar]
- 6.Public Health Agency of Canada. Canadian Immunization Guide. Ottawa, ON: PHAC; 2014. [Google Scholar]
- 7.Luman ET, Barker LE, Shaw KM, McCauley MM, Buehler JW, Pickering LK. Timeliness of childhood vaccinations in the United States: Days undervaccinated and number of vaccines delayed. JAMA. 2005;293(10):1204–11. doi: 10.1001/jama.293.10.1204. [DOI] [PubMed] [Google Scholar]
- 8.Kurosky SK, Davis KL, Krishnarajah G. Completion and compliance of childhood vaccinations in the United States. Vaccine. 2016;34(3):387–94. doi: 10.1016/j.vaccine.2015.11.011. [DOI] [PubMed] [Google Scholar]
- 9.Kroger AT, Sumaya CV, Pickering LK, Atkinson WL. General recommendations on immunization–Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Recomm Rep. 2011;60(2):1–64. [PubMed] [Google Scholar]
- 10.Luman ET, Mason McCauley M, Stokley S, Chu SY, Pickering LK. Timeliness of childhood immunizations. Pediatrics. 2002;110(5):935–39. doi: 10.1542/peds.110.5.935. [DOI] [PubMed] [Google Scholar]
- 11.Strine TW, Luman ET, Okoro C M, McCauley M, Barker LE. Predictors of age-appropriate receipt of DTaP dose 4. Am J Prev Med. 2003;25(1):45–49. doi: 10.1016/S0749-3797(03)00093-X. [DOI] [PubMed] [Google Scholar]
- 12.Dombkowski KJ, Lantz PM, Freed GL T n f s o d i a-a immunization. Am J Prev Med. 2002;23(1):36–42. doi: 10.1016/S0749-3797(02)00442-7. [DOI] [PubMed] [Google Scholar]
- 13.Dannetun E, Tegnell A, Hermansson G, Törner A, Giesecke J. Timeliness of MMR vaccination–Influence on vaccination coverage. Vaccine. 2004;22(31–32):4228–32. doi: 10.1016/j.vaccine.2004.04.018. [DOI] [PubMed] [Google Scholar]
- 14.Lernout T, Theeten H, Hens N, Braeckman T, Roelants M, Hoppenbrouwers K, Van Damme P. Timeliness of infant vaccination and factors related with delay in Flanders, Belgium. Vaccine. 2014;32(2):284–89. doi: 10.1016/j.vaccine.2013.10.084. [DOI] [PubMed] [Google Scholar]
- 15.Akmatov MK, Kretzschmar M, Krämer A, Mikolajczyk RT. Timeliness of vaccination and its effects on fraction of vaccinated population. Vaccine. 2008;26(31):3805–11. doi: 10.1016/j.vaccine.2008.05.031. [DOI] [PubMed] [Google Scholar]
- 16.Dummer TJ, Cui Y, Strang R, Parker L. Immunization completeness of children under two years of age in Nova Scotia, Canada. Can J Public Health. 2012;103(5):e363–67. doi: 10.1007/BF03404442. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.McDonald SW, Lyon AW, Benzies KM, McNeil DA, Lye SJ, Dolan SM, et al. The All Our Babies pregnancy cohort: Design, methods, and participant characteristics. BMC Pregnancy Childbirth. 2013;13(Suppl1):S2. doi: 10.1186/1471-2393-13-S1-S2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Alberta HealthWellness. Alberta Immunization Strategy 2007–2017. Edmonton, AB: Alberta Health and Wellness; 2007. [Google Scholar]
- 19.Public Health Agency of Canada. Canadian National Reports on Immunization, 2006. Can Commun Dis Rep. 2006;32S3:1–44. [Google Scholar]
- 20.Ministry of HealthLong-Term Care. Immunization 2020: Modernizing Ontario’s Publicly Funded Immunization Program. Toronto, ON: Government of Ontario; 2015. [Google Scholar]
- 21.Ministry of Health. ImmunizeBC: A Strategic Framework for Immunization in B.C. Vancouver, BC: Government of British Columbia; 2007. [Google Scholar]
- 22.Canadian Immunization Registry Network. National Standards for Immunization Coverage Assessment: Recommendations from the Canadian Immunization Registry Network. Ottawa, ON: Government of Canada; 2015. [PubMed] [Google Scholar]
- 23.Kershaw T, Suttorp V, Simmonds K St, Jean T. Outbreak of measles in a non-immunizing population, Alberta 2013. Can Commun Dis Rep. 2014;40(12):219–26. doi: 10.14745/ccdr.v40i12a04. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.The Canadian Press. Whooping Cough Outbreak Slow to Leave Central Alberta. Calgary, AB: Herald 9 January; 2015. [Google Scholar]
- 25.Bell CA, Simmonds KA, MacDonald SE. Exploring the heterogeneity among partially vaccinated children in a population-based cohort. Vaccine. 2015;33(36):4572–78. doi: 10.1016/j.vaccine.2015.07.004. [DOI] [PubMed] [Google Scholar]
- 26.Hill HA, Elam-Evans LD, Yankey D, Singleton JA, Kolasa M. National, state, and selected local area vaccination coverage among children aged 19–35 months–United States, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(33):889–96. doi: 10.15585/mmwr.mm6433a1. [DOI] [PubMed] [Google Scholar]