Pediatric Hospitalizations: Are We Missing an Opportunity to Immunize?

Abstract

Fewer than half of children receive all recommended immunizations on time. Hospitalizations may be opportunities to address delayed immunizations. Our objectives were to assess (1) prevalence of delayed immunizations among hospitalized patients, (2) missed opportunities to administer delayed immunizations, and (3) time to catch up after discharge. METHODS:We conducted a retrospective cohort study investigating immunization status of patients 0 to 21 years of age admitted to an academic children's center from 2012 to 2013 at the time of admission, at discharge, and 18 months postdischarge. Immunization catch-up at 18 months postdischarge was defined as having received immunizations due on discharge per Centers for Disease Control and Prevention recommendations. x 2 and t test analyses compared characteristics among patients caught up and not caught up at 18 months postdischarge. Analysis of variance and logistic regression analyses compared mean number of immunizations needed and odds of immunization catch-up among age groups. Kaplan-Meier and Cox proportional hazards analyses compared catch-up time by age, race, sex, and insurance.RESULTS: Among 166 hospitalized patients, 80 were not up to date on immunizations at admission, and only 1 received catch-up immunizations before discharge. Ninety-nine percent (79 of 80) were not up to date on discharge per Centers for Disease Control and Prevention recommendations. Thirty percent (24 of 79), mostly adolescents, were not caught up at 18 months postdischarge. Median postdischarge catch-up time was 3.5 months (range: 0.03-18.0 months). Patients 0 to 35 months of age were more likely to catch up compared with those of other ages (hazard ratio 5 2.73; P 5 .001), with no differences seen when comparing race, sex, or insurance.CONCLUSIONS: Pediatric hospitalizations provide important opportunities to screen and immunize children.

Effect of Electronic Health Record Reminders for Routine Immunizations and Immunizations Needed for Chronic Medical Conditions

“…2 It is important to identify children with immunization delay and provide catch-up immunizations at every opportunity. 3…”

Vaccine Administration in Children’s Hospitals

“…[10][11][12][13][14] A majority of hospitalized children need only 1 to 2 vaccines to be considered up to date (UTD). 11,12,[14][15][16][17] The Advisory Committee on Immunization Practices (ACIP) recommends vaccinating hospitalized children and improving efforts to ensure vaccine administration during hospitalization. 18 In the era of population-based Immunization Information Systems (IISs) in which individual vaccine records are accessible to hospital-based providers, hospitalization has been increasingly recognized as an opportunity to provide vaccinations for children who are not UTD.…”

“…26,27 Few studies of hospital-based vaccinations have examined baseline vaccine administration rates before implementing interventions to provide vaccines, particularly for routine childhood vaccines other than influenza and the hepatitis B birth dose. 10,16,17,28 Importantly, in studies that examined baseline rates, investigators estimate that <20% of hospitalized children received any needed vaccines. 10,16,17,28 Furthermore, previous studies have been primarily limited to singlecenter studies.…”

“…10,16,17,28 Importantly, in studies that examined baseline rates, investigators estimate that <20% of hospitalized children received any needed vaccines. 10,16,17,28 Furthermore, previous studies have been primarily limited to singlecenter studies. 10,11,13,[19][20][21] Currently, there is a gap in our understanding of vaccine administration during hospitalization across different hospitals.…”