Immunization Completion in Infants Born at Low Birth Weight

Nestander, Matt; Dintaman, Jay; Susi, Apryl; Gorman, Gregory; Hisle-Gorman, Elizabeth

doi:10.1093/jpids/pix079

Cited by 15 publications

(18 citation statements)

References 39 publications

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“…13 Authors of a more recent study conducted in the military health care system demonstrated that infants with low birth weight and preterm infants, identified by using International Classification of Diseases, Ninth Revision codes, had lower odds of vaccine receipt by 24 months of age. 11 In the current study, preterm infants did not catch up to term/ postterm infants by 36 months of age. Authors of an earlier study reported that differences in up-to-date vaccination status by birth weight remained over time, 14 whereas authors of other studies observed a persistent discrepancy only among infants with extremely low birth weight.…”

Section: Discussioncontrasting

confidence: 48%

“…These findings extend previous work indicating undervaccination among not only the highest-risk infants but also infants born with a low birth weight or infants born moderately to late preterm. 11,14 In our study, these preterm groups had comparably low coverage levels for most individual vaccines, except rotavirus, hepatitis B, and influenza vaccines. Lower rotavirus vaccination coverage among early preterm infants likely reflects the ACIP recommendation to delay receipt of the first dose until hospital discharge.…”

Section: Discussionmentioning

confidence: 54%

“…10 Despite these recommendations, earlier studies have revealed that preterm infants and infants with low birth weight are at an increased risk for delayed vaccination and undervaccination. [11][12][13][14][15][16] There are limited studies in which timely receipt of all recommended vaccines has been assessed in this high-risk population.…”

Section: Approximately 1 In Every 10 Unitedmentioning

confidence: 99%

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Early Childhood Vaccination Status of Preterm Infants

et al. 2019

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BACKGROUND: Preterm infants are at increased risk for vaccine-preventable infections and associated complications. Limited studies describe timely vaccination of these vulnerable infants. METHODS: This retrospective cohort study included Washington State infants with birth hospitalizations at an urban academic medical center between 2008 and 2013. Demographic, clinical, and visit data from electronic health records were linked to vaccine data from the Washington State Immunization Information System. Completion of the recommended 7vaccine series by 19 months of age was compared between preterm infants (born at ,37 weeks' gestation) and term/postterm infants (born at 37-43 weeks' gestation) by using Pearson's x 2 test and multivariable logistic regression. Secondary outcomes included 7vaccine series completion by 36 months of age and receipt of individual vaccines in the series. Rotavirus, hepatitis A, and influenza vaccination was also assessed. RESULTS: Of study infants (n = 10 367), 19.3% were born prematurely. Preterm infants had lower 7-vaccine series completion compared with term/postterm infants by 19 months (47.5% vs 54.0%; adjusted odds ratio 0.77 [95% confidence interval 0.65-0.90]) and 36 months (63.6% vs 71.3%; adjusted odds ratio 0.73 [95% confidence interval 0.61-0.87]). Early preterm (23-33 weeks' gestation) and late preterm (34-36 weeks' gestation) infants had a lower rate of 7-vaccine series completion compared with term/postterm infants. Full influenza vaccination coverage by 19 months also differed between groups (early preterm: 47.7%; late preterm: 41.5%; term/postterm: 44.7%; P = .02). CONCLUSIONS: Over half of preterm infants were undervaccinated at 19 months; one-third failed to catch up by 36 months. Strategies to improve vaccination of these high-risk infants are needed. WHAT'S KNOWN ON THIS SUBJECT: Preterm infants are at an increased risk for vaccine-preventable infections and associated complications. Earlier work reveals that they may also be at risk for undervaccination, yet studies in which timely receipt of all currently recommended vaccines is examined in this population are lacking. WHAT THIS STUDY ADDS: This study revealed that fewer preterm infants completed the recommended 7-vaccine series by 19 months of age compared with term/postterm infants. These high-risk infants continued to lag behind in vaccination coverage at 36 months of age.

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Section: Discussioncontrasting

confidence: 48%

Section: Discussionmentioning

confidence: 54%

Section: Approximately 1 In Every 10 Unitedmentioning

confidence: 99%

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Early Childhood Vaccination Status of Preterm Infants

et al. 2019

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“…26 Nestander et al showed immunization completion to be significantly decreased at 24 months in LBW infants. 30 Hofstetter et al found preterm infants less likely to have completed all doses of the "7-vaccine series" by age the age of 19 months. 51 The finding that preterm infants have completed catch up at 24 months in Israel may be attributed to the organization of provision of vaccination and accessibility.…”

Section: Discussionmentioning

confidence: 99%

“…Medical conditions associated with preterm birth such as chronic lung disease and health provider change have also been associated with immunization non-completion. [26][27][28][29][30][31][32] Targeted preterm vaccination intervention programs have reported favorable results in Ireland and Italy. 33,34 Delay of vaccination in preterm and LBW infants may most likely stem from inappropriate knowledge and perceptions of both parents and health-care providers regarding the safety and efficacy of timely routine childhood vaccinations.…”

Section: Introductionmentioning

confidence: 99%

Vaccination timeliness and completeness among preterm and low birthweight infants: a national cohort study

Bary-Weisberg

Stein‐Zamir

2020

Human Vaccines & Immunotherapeutics

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Vaccinating premature and low birthweight (LBW) infants according to chronological age has been found safe and effective. Although these infants are susceptible to infections, vaccinations are often delayed. We estimated vaccination coverage (VC) in preterm and LBW infants compared to term infants in a cohort study (2016 Israel birth cohort, n = 181,543) using the National Immunization Registry. Vaccinations included Hepatitis B, Diphtheria-Tetanus-acellular Pertussis-IPV-Haemophilus influenzae B, Oral Polio Bivalent, Rotavirus, Pneumococcal Conjugate, Measles-Mumps-Rubella-Varicella and Hepatitis A. Inclusion criteria: (1) born in Israel; (2) having a unique identifier (allowing data matching); and (3) surviving to 24 months. VC at 24 months and timeliness of vaccine doses were evaluated according to infants’ birthweight (BW) and gestational age (GA). Preterm infants (GA < 37 weeks) comprised 7.0% (n = 12,264); LBW infants (BW< 2500 g) were 7.7% (n = 13,950); BW was 1500–2499 g in 6.8%, 1000–1499 g in 0.6% and below 1000 g in 0.3%. Compared to normal birthweight (NBW) infants (BW≥2500 g), LBW infants showed delayed initiation of vaccinations. Odds ratio (OR) for delay: DTaP-IPV-Hib 1 OR = 1.26 [95%CI 1.19–1.33]; Rota 1, OR = 1.22 [95%CI 1.16–1.29]. Vaccination delay rates were higher among smaller new-borns (below 1000 g). At 24 months there was no significant difference regarding vaccination status. This national cohort VC analysis focused on preterm/LBW infants. Vaccinating preterm and LBW infants according to the recommended schedule induces protection against life-threatening infectious diseases. Vaccination initiation among LBW infants showed considerable delay. Health practitioners and parents should cooperate to improve timely vaccination initiation.

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