Infant,maternal and demographic predictors of delayed vaccination: A population-based cohort study |
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| Affiliation: | 1. Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia;2. The University of Sydney Northern Clinical School, NSW, Australia;3. National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia;4. School of Public Health and Community Medicine, UNSW Medicine, University of NSW, Sydney, NSW, Australia;5. Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia;6. Communicable Diseases Branch, Health Protection NSW, Sydney, NSW, Australia;7. Perth Children''s Hospital, WA, Australia;8. School of Medicine, University of Western Australia, Perth, WA, Australia;9. Department of Microbiology, PathWest Laboratory Medicine WA, Perth Children''s Hospital, Perth, WA, Australia;10. Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia;11. National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia;12. School of Public Health, Curtin University, Perth, WA, Australia;1. Centre de recherche du CHU de Québec, Axe SP-POS, Québec, Canada;2. Département de médecine sociale et préventive, Université Laval, Québec, Canada;3. Public Health Ontario, Ontario, Canada;4. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada;5. CancerCare Manitoba, Manitoba, Canada;6. University of Manitoba, Manitoba, Canada;7. British Columbia Cancer Agency, British Columbia, Canada;8. Department of Infectious Disease Epidemiology, Imperial College, London, UK;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. Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, South Korea;2. Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea;3. Faculty of Medicine Siriraj Hospital, Bangkok, Thailand;4. Peking University People’s Hospital, Beijing, China;5. Research Institute for Tropical Medicine, Manila, Philippines;6. Institute for Medical Research, Kuala Lumpur, Malaysia;7. Changi General Hospital, Singapore;8. Tan Tock Seng Hospital, Singapore;9. Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, South Korea;1. Alberta Health Surveillance and Assessment, Edmonton, Alberta, Canada;2. School of Public Health, University of Alberta, Edmonton, Alberta, Canada;3. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada;4. Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada;5. Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada |
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| Abstract: | BackgroundReceiving vaccines at or close to their due date (vaccination timeliness) is a now key measure of program performance. However, studies comprehensively examining predictors of delayed infant vaccination are lacking. We aimed to identify predictors of short and longer-term delays in diphtheria-tetanus-pertussis (DTP) vaccination by dose number and ethnicity.MethodsPerinatal, notification, death and immunisation databases were linked for 1.3 million births in 2000–11 from two Australian states (Western Australia and New South Wales), with follow-up data until 2013. Ordinal logistic regression was used to estimate adjusted relative risks (RR) by degree of delay. Separate models were constructed for each vaccine dose and for Aboriginal and non-Aboriginal children.ResultsEach dose-specific cohort included at least 49,000 Aboriginal and 1.1 million non-Aboriginal children. Delayed receipt was more common among Aboriginal than non-Aboriginal children (eg for the first dose of DTP [DTP1] 19.4 v 8.1%). Risk factors for delayed vaccination were strongest for DTP1, and delayed receipt of DTP1 was a key driver of subsequent delays; every week DTP1 was delayed was associated with a 1.6 to 2-fold increased risk of delayed DTP2 receipt. For DTP1, ≥3 previous pregnancies (the only factor more strongly associated with longer than shorter delays; RR ≥5 compared to no previous pregnancies), and children born to mothers <20 years of age (RR ≥2 compared to ≥35 years) were at highest risk of delay. Other independent predictors were prematurity, maternal smoking during pregnancy, and being born in Western Australia (if Aboriginal) or another country in the Oceania region.ConclusionThe sub-populations at risk for delayed vaccination we have identified are likely generalisable to other high-income settings. Measures to improve their dose 1 timeliness, particularly for children with older siblings, are likely to have significant flow-on benefits for timeliness of later doses. |
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| Keywords: | Data linkage Population Vaccine timeliness Diphtheria-tetanus-pertussis vaccine ACIR" },{" #name" :" keyword" ," $" :{" id" :" k0030" }," $$" :[{" #name" :" text" ," _" :" Australian Childhood Immunisation Register DTP" },{" #name" :" keyword" ," $" :{" id" :" k0040" }," $$" :[{" #name" :" text" ," _" :" diphtheria-tetanus-pertussis vaccine NSW" },{" #name" :" keyword" ," $" :{" id" :" k0050" }," $$" :[{" #name" :" text" ," _" :" New South Wales RR" },{" #name" :" keyword" ," $" :{" id" :" k0060" }," $$" :[{" #name" :" text" ," _" :" relative risks WA" },{" #name" :" keyword" ," $" :{" id" :" k0070" }," $$" :[{" #name" :" text" ," _" :" Western Australia |
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