PharmacoEconomics & Outcomes News 567 - 29 Nov 2008 Room for improvement in childhood vaccination According to two studies published recently in Pediatrics, there is room for significant improvement in the rates of immunisation among children and adolescents. The first study aimed to determine national estimates of the proportions of parents with indicators of vaccine doubt, identify factors associated with those parents, identify specific vaccines prompting doubt and describe the main reasons for parents changing their minds about delaying or refusing a vaccine for their child. 1 Using data from the National Immunisation Survey, conducted by the Centers for Disease Control and Prevention, researchers found that, of 3924 responding parents, 28.3% responded yes to ≥ 1 of the three questions about vaccine doubt indicators. From separate analyses, vaccine safety concern was found to be a predictor for unsure, refused and delayed parents. The largest proportions of unsure and refused parents cited the varicella vaccine as being the one to prompt their concern. Most parents who delayed vaccines for their child did so for reasons related to a child’s illness. Interestingly, the largest proportion of parents who changed their minds about delaying or not getting a vaccination for their child cited "information or assurances from healthcare provider" as the main reason. Clearly parents who show doubts about immunisations are not all the same, and the researchers note that children’s healthcare providers should solicit questions regarding vaccination, establish a good relationship and provide appropriate educational materials to parents. In the second study, researchers assessed immunisation rates for tetanus-diphtheria, hepatitis B, and measles-mumps-rubella in 13-year-old adolescents, identified missed opportunities and evaluated the association between preventive care use and tetanus- diphtheria immunisation. 2 The records of a total of 23 987 adolescents were included in the study (1997–2004) and were divided into two cohorts - those born 1986–1988 and 1989–1991. Results showed that 3%, 20% and 28% of children had received the full series of tetanus, diphtheria, hepatitis B and measles-mumps- rubella vaccines, respectively by 10 years of age, compared with 72%, 67% and 32% by 13 years of age. When the analysis was restricted to those with ≥ 1 vaccine received before 2 years of age, 92%, 82% and 85% were up to date for tetanus-diphtheria, hepatitis B and measles-mumps-rubella, respectively. Missed opportunities for tetanus-diphtheria immunisation occurred at 84% of all healthcare visits. Again, the researchers conclude that additional strategies need to be implemented to enable providers to vaccinate at every opportunity. 1. Gust DA, et al. Parents with doubts about vaccines: which vaccines and reasons why. Pediatrics 122: 718-725, No. 4, Oct 2008. 2. Lee GM, et al. Adolescent immunizations: missed opportunities for prevention. Pediatrics 122: 711-717, No. 4, Oct 2008. 801108228 1 PharmacoEconomics & Outcomes News 29 Nov 2008 No. 567 1173-5503/10/0567-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Room for improvement in childhood vaccination

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PharmacoEconomics & Outcomes News 567 - 29 Nov 2008

Room for improvement inchildhood vaccination

According to two studies published recently inPediatrics, there is room for significant improvement inthe rates of immunisation among children andadolescents.

The first study aimed to determine national estimatesof the proportions of parents with indicators of vaccinedoubt, identify factors associated with those parents,identify specific vaccines prompting doubt and describethe main reasons for parents changing their minds aboutdelaying or refusing a vaccine for their child.1 Using datafrom the National Immunisation Survey, conducted bythe Centers for Disease Control and Prevention,researchers found that, of 3924 responding parents,28.3% responded yes to ≥ 1 of the three questions aboutvaccine doubt indicators. From separate analyses,vaccine safety concern was found to be a predictor forunsure, refused and delayed parents. The largestproportions of unsure and refused parents cited thevaricella vaccine as being the one to prompt theirconcern. Most parents who delayed vaccines for theirchild did so for reasons related to a child’s illness.Interestingly, the largest proportion of parents whochanged their minds about delaying or not getting avaccination for their child cited "information orassurances from healthcare provider" as the mainreason. Clearly parents who show doubts aboutimmunisations are not all the same, and the researchersnote that children’s healthcare providers should solicitquestions regarding vaccination, establish a goodrelationship and provide appropriate educationalmaterials to parents.

In the second study, researchers assessedimmunisation rates for tetanus-diphtheria, hepatitis B,and measles-mumps-rubella in 13-year-old adolescents,identified missed opportunities and evaluated theassociation between preventive care use and tetanus-diphtheria immunisation.2 The records of a total of23 987 adolescents were included in the study(1997–2004) and were divided into two cohorts - thoseborn 1986–1988 and 1989–1991. Results showed that3%, 20% and 28% of children had received the full seriesof tetanus, diphtheria, hepatitis B and measles-mumps-rubella vaccines, respectively by 10 years of age,compared with 72%, 67% and 32% by 13 years of age.When the analysis was restricted to those with≥ 1 vaccine received before 2 years of age, 92%, 82%and 85% were up to date for tetanus-diphtheria,hepatitis B and measles-mumps-rubella, respectively.Missed opportunities for tetanus-diphtheriaimmunisation occurred at 84% of all healthcare visits.Again, the researchers conclude that additionalstrategies need to be implemented to enable providersto vaccinate at every opportunity.1. Gust DA, et al. Parents with doubts about vaccines: which vaccines and reasons

why. Pediatrics 122: 718-725, No. 4, Oct 2008.2. Lee GM, et al. Adolescent immunizations: missed opportunities for prevention.

Pediatrics 122: 711-717, No. 4, Oct 2008.801108228