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

Abstract

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.

Improving timeliness and completion of infant vaccination among infants in Nigerian urban slums through older women's participation

“…For example, almost all the low birth weight (LBW) infants had both timely and complete vaccinations compared to normal weight infants. This is contrary to earlier reports where there were delayed vaccination of LBW infants ( 48 , 49 ). This is a concern because mortality of LBW infants has the highest contribution to under five mortality and death from VPDs due to delayed vaccination will be an unnecessary and avoidable added cause of mortality among this group of infants.…”

Vaccination timeliness of preterm infants hospitalised in a neonatal intensive care unit in Denmark

“…Studies from other countries have found that infants born most preterm and with the lowest birth weight are less likely to receive vaccinations on time 5,7,13–17,23,28 . This international trend of vaccination delay has been ascribed to parents' and health workers' beliefs regarding preterm and low birth weight infants' frailty 3,23,28,29 . The reason the extremely preterm infants are more likely to receive vaccinations on time in our cohort could be explained by some of them still being hospitalised at the time of vaccination and by the recommendation in Denmark of in‐hospital vaccination for the first childhood vaccination.…”

A retrospective study of hepatitis B vaccination in preterm birth and low birth weight infants born to hepatitis B surface antigen-positive mothers: Time to close the policy-practice gap

“…PTB and LBW were common reasons for delayed vaccination, as parents or doctors perceive preterm and low birth weight infants as medically fragile even after their health has improved and their weight increased. 19 , 26 …”