Evaluation of potentially achievable vaccination coverage with simultaneous administration of vaccines among children in the United States

Abstract

Background: Routine administration of all age-appropriate doses of vaccines during the same visit is recommended for children by the National Vaccine Advisory Committee (NVAC) and the Advisory Committee on Immunization Practices (ACIP).

Methods: Evaluate the potentially achievable vaccination coverage for ≥4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine (4+DTaP), ≥4 doses of pneumococcal conjugate vaccine (4+PCV), and the full series of Haemophilus influenzae type b vaccine (Hib-FS) with simultaneous administration of all recommended childhood vaccines. Compare the potentially achievable vaccination coverage to the reported vaccination coverage for calendar years 2001 through 2013; by state in the United States and by selected socio-demographic factors in 2013. The potentially achievable vaccination coverage was defined as the coverage possible for the recommended 4+DTaP, 4+PCV, and Hib-FS if missed opportunities for simultaneous administration of all age-appropriate doses of vaccines for children had been eliminated.

Results: Compared to the reported vaccination coverage, the potentially achievable vaccination coverage for 4+DTaP, 4+PCV, and Hib-FS could have increased significantly (P<0.001), the vaccination coverage would have achieved the 90% target of Healthy People 2020 for the three vaccines beginning in 2005, 2008, and 2011 respectively. In 2013, the potentially achievable vaccination coverage increased significantly across all selected socio-demographic factors, potentially achievable vaccination coverage would have reached the 90% target for more than 51% of the states in the United States.

Conclusions: The findings in this study suggest that fully utilization of all opportunities for simultaneous administration of all age-eligible childhood doses of vaccines during the same vaccination visit is a critical strategy for achieving the vaccination coverage target of Healthy People 2020. Encouraging providers to deliver all recommended vaccines that are due at each visit by implementing client reminder and recall systems might decrease missed opportunities for simultaneous administration of childhood vaccines.

Keywords: Age appropriate; Childhood vaccines; Healthy People 2020 target; Potentially achievable; Simultaneous administration; Vaccination coverage.

Fig. 1.

Potentially achievable vs. reported vaccination coverage and 95% confidence interval for 4+DTaP*, 4+HPV^†, Hib-FS^§, National Immunization Survey, United States, 2001–2013. *≥4 doses of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. ^† ≥4 doses of pneumococcal conjugate vaccine (PCV). ^§ Full series Haemophilus influenzae type b (Hib) vaccine: ≥3 or ≥4 doses of Haemophilus influenzae type b (Hib-FS) vaccine depending on product type received (includes primary series plus the booster dose). Footnote for (B): Because of the pneumococcal conjugate vaccine shortages during 2001–2004 in the United States, children included in the 2001–2004 samples were affected by the deferring of the fourth dose of PCV, therefore the data from NIS 2005–2013 were included for the PCV vaccination study. Footnote for (C): Hib data were limited to 2011–2013 because a shortage of Hib vaccine occurred in the United States during December 2007 to September 2009, children were affected by the temporary recommendation to suspend the booster dose of Hib for Hib-FS vaccine.

Fig. 2.

Potentially achievable vs. reported vaccination coverage and 95% confidence interval for the 4+DTaP*, 4+PCV^†, Hib-FS^§, by State in the United States, National Immunization Survey, 2013. * ≥4 doses of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. ^† ≥4 doses of pneumococcal conjugate vaccine (PCV). ^§ Full series Haemophilus influenzae type b (Hib) vaccine: ≥3 or ≥4 doses of Haemophilus influenzae type b (Hib-FS) vaccine depending on product type received (includes primary series plus the booster dose).