Do Missed Opportunities Stay Missed? A 6-Month Follow-up of Missed Vaccine Opportunities in Inner City Milwaukee Children

Abstract

ABSTRACT. Objectives. To determine 1) the frequency of missed vaccine opportunities (VOs) in inner city children <3 years of age; 2) whether the recommended vaccine(s) were given within 6 months of the missed opportunity (MO); 3) whether these vaccinations were ageappropriate according to the guidelines of the Advisory Committee on Immunization Practices; and 4) variables associated with MOs.Design. Retrospective chart review with a nested retrospective cohort of children with MOs.Setting. Two inner city practice settings in Milwaukee: a community health center and an academic continuity care practice.Patients/Selection Procedure. A consecutive sample of 710 visits of inner city children <3 years of age with VOs, seen between January 1 and March 31, 1995. A VO was defined as any encounter when the child was vaccine-eligible according to Advisory Committee on Immunization Practices guidelines.Results. MOs occurred in 47% (330/710) of the VOs. Only 40% of the children with MOs received age-appropriate immunizations within 6 months; 30% received the vaccinations beyond the age-appropriate time. The remaining 30% either did not return or were not vaccinated on return. The variables significantly associated with MOs were 1) age: children with MOs were older than those without, with a mean age of 15.5 months vs 10.9 months; 2) minor febrile illness; 3) moderate/severe illness; 4) acute illness encounters; and 5) patient's being seen at the community health center. Only 15.5% of all MOs were justified by the presence of moderate/severe illness.Conclusions. VOs are frequently missed in inner city children. Most of the MOs were not justified by the valid contraindication of moderate/severe illness. Sixty percent of the children with MOs did not receive age-appropriate immunizations within 6 months. These children are vulnerable to vaccine-preventable diseases such as measles and pertussis. Pediatrics 1998;101(5). URL: http://www. pediatrics.org/cgi/content/full/101/5/e5; immunization, vaccination, missed opportunities, children, pre-school.ABBREVIATIONS. DTP/DTaP, diphtheria, tetanus and pertussis/acellular pertussis vaccines; OPV/IPV, oral polio vaccine/ inactivated polio vaccine; MMR, measles, mumps, and rubella vaccine; VO, vaccine opportunities; MO, missed opportunities; Hib, Haemophilus influenzae type B vaccine; CI, confidence interval; SBI, serious bacterial illness.

Effect of Provider Prompts on Adolescent Immunization Rates: A Randomized Trial

“…11,12,[21][22][23][24] We conducted a randomized controlled trial in 2 practice-based research networks (PBRNs), an upstate New York network and a national network of pediatric continuity clinics, to evaluate the impact of provider prompts on adolescent immunization rates. We used communitybased participatory research methods for practitioners to reach a consensus on the intervention to be studied, which converged on provider prompts, and then conducted the intervention in both PBRNs.…”

Frequent Vaccination Missed Opportunities at Primary Care Encounters Contribute to Underimmunization

“…In the mid-1990s, several studies demonstrated that pediatric practice missed opportunities to administer indicated vaccines at roughly 50% of the encounters. 6,[12][13][14] Our literature search did not yield any studies describing the frequency of vaccination MOs subsequent to the wide dissemination of the NVAC and CDC recommendations.…”

“…Two studies from the 1990s each found that MOs occurred at roughly one-half of all early childhood health care encounters. 6,12 Two additional studies from the same era found that 50%-75% of children experienced at least one MO by the time they were 24 months old. 13,14 Although the frequencies of MOs reported in the earlier studies are in the same range as our own, the previously reported frequencies are slightly lower likely in part because those studies examined only 3 or 4 vaccine series (vs the 7 in our study) and had relatively low thresholds for valid medical contraindication to vaccination (eg, low-grade fever, history of fever in the last week, mild respiratory illness, sinusitis, and the need for follow up within 48 hours) reflecting the recommendations of the time.…”

Adherencia a las inmunizaciones en niños con necesidades de cuidado médico especial

“…Las causas argumentadas por los padres para los atrasos o no inmunización tienen las limitaciones propias del uso de una anamnesis remota; no hay, sin embargo, otra forma de rescatar esta información y es un método usado en numerosos estudios sobre adherencia a vacunación 12,13,[15][16][17]27 .…”