Timeliness of routine immunization in non-preterm children less than 2 years old using electronic data capture in an ambulatory setting in France in the context of vaccine hesitancy.

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Arch Pediatr. 2019 Jan 9. pii: S0929-693X(18)30259-8. doi: 10.1016/j.arcped.2018.11.011. [Epub ahead of print]

Timeliness of routine immunization in non-preterm children less than 2 years old using electronic data capture in an ambulatory setting in France in the context of vaccine hesitancy.

Rybak A1 Vié le Sage F2 Béchet S3 Werner A2 Thiebault G2 Bakhache P2 Virey B2 Caulin E4 Cohen R5 Levy C6.

Abstract

OBJECTIVES:

The vaccine schedule was changed in 2013 in France which resulted in fewer vaccinations. However to maintain disease protection both vaccine timeliness and high coverage should be respected. In the context of growing vaccine hesitancy we aimed to describe compliance with the immunization program according to the age recommended for each dose for non-preterm children less than 2 years old.

METHODS:

Between May 2013 and April 2016 we used automated electronic data capture of electronic medical records for non-preterm children less than 2 years old. Children were followed up by 92 randomly selected pediatricians from the French ambulatory pediatricians group. Delayed immunization was defined as more than 15 days after the recommended age for the primary series of diphtheria-tetanus-pertussis-polio-Haemophilus influenzae b-hepatitis B (DTaP-IPV-Hib±HB) and 13-valent pneumococcal vaccine (PCV13) 2 months for boosters 1 month for measles-mumps-rubella (MMR)/meningococcal C conjugate (Men-C) and 6 months for the second dose of MMR. An association between delayed first dose and other doses delayed were described with odds ratios (ORs) and their 95% confidence intervals (CIs).

RESULTS:

Data for 22097 children in France with 124702 vaccinations were analyzed: 21.8% 20.4% and 30.7% of children had one or more delayed doses of DTaP-IPV-Hib±HB PCV13 and MMR vaccines respectively. For 47.6% of children the single-dose Men-C vaccination was delayed. A delayed first dose of DTaP-IPV-Hib±HB PCV13 and MMR was associated with a delayed second dose of the same vaccine (OR 7.5 [95% CI 6.6-8.6] 39.0 [34.1-44.8] and 23.5 [19.1-29.0] respectively) and with a third dose of DTaP-IPV-Hib±HB and PCV13 (14.7 [13.3-17.7] and 3.7 [3.1-4.5]).

CONCLUSION:

This large study shows that the proportion of children with delayed vaccination in France was globally high and substantial for Men-C and the first MMR vaccination. Risk of a delayed second and third dose was increased with a delayed first dose which may reflect vaccine hesitancy.

Copyright © 2018 Elsevier Masson SAS. All rights reserved.

KEYWORDS:

Automatic data processing; Schedule; Vaccine; Vaccine delay; Vaccine hesitancy

PMID: 30638762 DOI: 10.1016/j.arcped.2018.11.011