A Rybak1, F Vié le Sage2, S Béchet3, A Werner2, G Thiebault2, P Bakhache2, B Virey2, E Caulin4, R Cohen5, C Levy6. 1. Association française de pédiatrie ambulatoire (AFPA), 78100 Saint-Germain-en-Laye, France; Association Clinique et thérapeutique infantile du Val-de-Marne (ACTIV), 94100 Saint-Maur-des-Fossés, France. 2. Association française de pédiatrie ambulatoire (AFPA), 78100 Saint-Germain-en-Laye, France. 3. Association Clinique et thérapeutique infantile du Val-de-Marne (ACTIV), 94100 Saint-Maur-des-Fossés, France. 4. MSD Vaccins, 69007 Lyon, France. 5. Association française de pédiatrie ambulatoire (AFPA), 78100 Saint-Germain-en-Laye, France; Association Clinique et thérapeutique infantile du Val-de-Marne (ACTIV), 94100 Saint-Maur-des-Fossés, France; Service de néonatologie, unité Court Séjour, Petits Nourrissons, centre hospitalier Intercommunal de Créteil, 94010 Créteil France; Centre de recherche clinique, unité Petits Nourrissons, hôpital Intercommunal de Créteil, 94010 Créteil, France; Université Paris Est, IMRB-GRC GEMINI, 94010 Créteil, France. 6. Association française de pédiatrie ambulatoire (AFPA), 78100 Saint-Germain-en-Laye, France; Association Clinique et thérapeutique infantile du Val-de-Marne (ACTIV), 94100 Saint-Maur-des-Fossés, France; Service de néonatologie, unité Court Séjour, Petits Nourrissons, centre hospitalier Intercommunal de Créteil, 94010 Créteil France; Université Paris Est, IMRB-GRC GEMINI, 94010 Créteil, France. Electronic address: corinne.levy@activ-france.fr.
Abstract
OBJECTIVES: The vaccine schedule was changed in 2013 in France, which resulted in fewer vaccinations. However, to maintain disease protection, both vaccine timeliness and high coverage should be respected. In the context of growing vaccine hesitancy, we aimed to describe compliance with the immunization program according to the age recommended for each dose for non-preterm children less than 2 years old. METHODS: Between May 2013 and April 2016, we used automated electronic data capture of electronic medical records for non-preterm children less than 2 years old. Children were followed up by 92 randomly selected pediatricians from the French ambulatory pediatricians group. Delayed immunization was defined as more than 15 days after the recommended age for the primary series of diphtheria-tetanus-pertussis-polio-Haemophilus influenzae b-hepatitis B (DTaP-IPV-Hib±HB) and 13-valent pneumococcal vaccine (PCV13), 2 months for boosters, 1 month for measles-mumps-rubella (MMR)/meningococcal C conjugate (Men-C), and 6 months for the second dose of MMR. An association between delayed first dose and other doses delayed were described with odds ratios (ORs) and their 95% confidence intervals (CIs). RESULTS: Data for 22,097 children in France with 124,702 vaccinations were analyzed: 21.8%, 20.4%, and 30.7% of children had one or more delayed doses of DTaP-IPV-Hib±HB, PCV13, and MMR vaccines, respectively. For 47.6% of children, the single-dose Men-C vaccination was delayed. A delayed first dose of DTaP-IPV-Hib±HB, PCV13, and MMR was associated with a delayed second dose of the same vaccine (OR 7.5 [95% CI 6.6-8.6], 39.0 [34.1-44.8], and 23.5 [19.1-29.0], respectively) and with a third dose of DTaP-IPV-Hib±HB and PCV13 (14.7 [13.3-17.7] and 3.7 [3.1-4.5]). CONCLUSION: This large study shows that the proportion of children with delayed vaccination in France was globally high and substantial for Men-C and the first MMR vaccination. Risk of a delayed second and third dose was increased with a delayed first dose, which may reflect vaccine hesitancy.
OBJECTIVES: The vaccine schedule was changed in 2013 in France, which resulted in fewer vaccinations. However, to maintain disease protection, both vaccine timeliness and high coverage should be respected. In the context of growing vaccine hesitancy, we aimed to describe compliance with the immunization program according to the age recommended for each dose for non-preterm children less than 2 years old. METHODS: Between May 2013 and April 2016, we used automated electronic data capture of electronic medical records for non-preterm children less than 2 years old. Children were followed up by 92 randomly selected pediatricians from the French ambulatory pediatricians group. Delayed immunization was defined as more than 15 days after the recommended age for the primary series of diphtheria-tetanus-pertussis-polio-Haemophilus influenzae b-hepatitis B (DTaP-IPV-Hib±HB) and 13-valent pneumococcal vaccine (PCV13), 2 months for boosters, 1 month for measles-mumps-rubella (MMR)/meningococcal C conjugate (Men-C), and 6 months for the second dose of MMR. An association between delayed first dose and other doses delayed were described with odds ratios (ORs) and their 95% confidence intervals (CIs). RESULTS: Data for 22,097 children in France with 124,702 vaccinations were analyzed: 21.8%, 20.4%, and 30.7% of children had one or more delayed doses of DTaP-IPV-Hib±HB, PCV13, and MMR vaccines, respectively. For 47.6% of children, the single-dose Men-C vaccination was delayed. A delayed first dose of DTaP-IPV-Hib±HB, PCV13, and MMR was associated with a delayed second dose of the same vaccine (OR 7.5 [95% CI 6.6-8.6], 39.0 [34.1-44.8], and 23.5 [19.1-29.0], respectively) and with a third dose of DTaP-IPV-Hib±HB and PCV13 (14.7 [13.3-17.7] and 3.7 [3.1-4.5]). CONCLUSION: This large study shows that the proportion of children with delayed vaccination in France was globally high and substantial for Men-C and the first MMR vaccination. Risk of a delayed second and third dose was increased with a delayed first dose, which may reflect vaccine hesitancy.