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Determinants of under-immunization and cumulative time spent under-immunized in a Quebec cohort |
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| Institution: | 1. Department of Epidemiology, Biostatistics & Occupational Health, McGill University, 1020 Pine Ave., West Montreal, QC H3A 1A2, Canada;2. Research Institute of the McGill University Health Centre, 1001 Decarie Boul., Montreal, QC H4A 3J1, Canada;3. Infection Prevention & Control Unit, Department of Medical Microbiology, CHU Sainte-Justine, University of Montreal, 3175 Cote Sainte-Catherine, Montreal, QC H3T 1C5, Canada;4. Direction des risques biologiques et de la santé au travail, Institut de santé publique du Québec, 945 Avenue Wolfe, Québec, QC G1V 5B3, Canada;5. Division of Paediatric Infectious Diseases, CHU Sainte-Justine, University of Montreal, 3175 Cote Sainte-Catherine, Montreal, QC H3T 1C5, Canada;6. Department of Paediatrics, University of Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC J1H 5N4, Canada;7. Department of Microbiology, Infectious Diseases and Immunology, University of Montreal, C.P. 6128, succ. Centre-ville, Montréal, Québec H3C 3J7, Canada;1. Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau;2. Dept. of Endocrinology, Odense University Hospital, Denmark;3. Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institute, Copenhagen, Denmark;4. OPEN, University of Southern Denmark/Odense University Hospital, Denmark;1. National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands;2. European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden;3. National Institute for Public Health and the Environment, Vaccine Supply and Prevention Programs, Bilthoven, The Netherlands;1. Vaccinology and Immunology Research Trials Unit, Women''s and Children''s Hospital, North Adelaide, South Australia 5006, Australia;2. School of Medicine, University of Adelaide, South Australia 5006, Australia;3. Previously employed at Vaccinology and Immunology Research Trials Unit, Women''s and Children''s Hospital, North Adelaide, South Australia 5006, Australia;4. School of Public Health, University of Adelaide, South Australia 5005, Australia;5. Robinson Research Institute, University of Adelaide, South Australia 5006, Australia;1. Department of Primary and Community Care, Radboudumc, 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands;2. Municipal Health Service Utrecht Region, P.O. Box 51, 3700 AB Zeist, The Netherlands;3. Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;4. Scientific Institute for Quality of Healthcare, IQ Healthcare, Radboudumc, 114 IQ, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands |
| Abstract: | BackgroundUnder-immunization refers to a state of sub-optimal protection against vaccine preventable diseases. Vaccine coverage for age may not capture intentional or non-intentional spacing of vaccines in the recommended provincial immunization guidelines. We aimed to identify factors associated with coverage and under-immunization and to determine the number of days during which children were under-immunized during their first 24 months of life.MethodsSecondary analysis of children ≤3 years recruited through active surveillance for gastroenteritis from three Quebec pediatric emergency departments from 2012 to 2014. Vaccination status for children at least 24 months of age was determined using provincial immunization guidelines. Cumulative days under-immunized were calculated for DTaP-VPI-Hib, PCV, MMR, and Men-C-C. Factors associated with up-to-date (UTD) status at 24 months of life and for under-immunization ≥6 months were analyzed using logistic regression.ResultsOf 246 eligible children, 180 (73%) were UTD by 24 months of life. The mean cumulative days under-immunized for MMR was 107 days, for PCV 209 days, for Men-C-C 145 days, and for DTaP-VPI-Hib 227 days. Overall, 149 children (60%) experienced delay for at least 1 vaccine. Factors associated with both an UTD status at 24 months and concurrently associated with being under-immunization ≥6 months, included timely initiation of immunization (OR = 5.85; 95% CI: 2.80–12.22) and (OR = 0.13; 95% CI: 0.07–0.24), failure to co-administer 18-month vaccines (OR = 0.15; 95% CI: 0.10–0.21) and (OR = 3.29; 95% CI: 2.47–4.39), and having a household with ≥3 children under 18 years ((OR = 0.50; 0.28–0.86) and (OR = 2.99; 1.45–6.22), respectively.ConclusionPaired with an unexpected low level of coverage at 24 months of life, the majority of our cohort also experienced a state of under-immunization for a least one vaccine. Estimates of coverage do not capture intentional or non-intentional gaps in protection from vaccine preventable illnesses. Timely preventive care should be prioritized. |
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