Immunization levels among premature and low-birth-weight infants and risk factors for delayed up-to-date immunization status

Robert Davis, David Rubanowice, Henry R. Shinefield, Ned Lewis, David Gu, Steven B. Black, Frank DeStefano, Paul Gargiullo, John P. Mullooly, Robert S. Thompson, Robert T. Chen

Research output: Contribution to journalArticle

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Abstract

Context: Studies have noted that health care professionals may not conform to proper immunization schedules for premature and low-birth-weight infants in the United States. Little is known about the success of current efforts to immunize these high-risk infants. Objective: To describe current immunization practices for premature and low-birthweight infants and ascertain risk factors for poor immunization status, using large population- based data sources. Design and Setting: Cohort and case-control analyses of immunization data tracked from March 1991 through March 1997 for 3 large health maintenance organizations (HMOs) participating in the Centers for Disease Control and Prevention's Vaccine Safety Datalink project. Participants: A total of 11 580 low-birth-weight and premature infants were enrolled from birth to age 2 months; 6832 of these were continuously enrolled from birth to age 24 months. At age 2 months, there were 173 373 full-term, norma-birthweight infants enrolled as controls; at age 24 months, there were 103 324. Main Outcome Measures Age-specific immunization status by prematurity and birth weight (<1500 g, 1500-2500 g, born at <38 weeks' gestation with birth weight of >2500 g, or full-term with normal birth weight) and patient characteristics associated with up-to-date status. Results: At each age, infants weighing less than 1500 g at birth had lower up-to-date immunization levels than other infants. At age 6 months, 52 % to 65% of infants weighing less than 1500 g were up-to-date at each of the 3 HMOs compared with 69% to 73% of those weighing 1500 to 2500 g, 66% to 80% of premature infants weighing more than 2500g, and 65% to 76% of full-term, normal-birth-weight infants. By age 24 months 78% to 86% of infants weighing less than 1500 g were up-to-date, significantly less than heavier infants, who had levels of 84% to 89%. Well-child preventive care strongly predicted immunization status, while concomitant pulmonary disease did not. Conclusions: Our data suggest that infants born prematurely are vaccinated at levels approaching that of the general population, but levels of vaccination for very low-birth-weight infants lag slightly behind.

Original languageEnglish (US)
Pages (from-to)547-553
Number of pages7
JournalJournal of the American Medical Association
Volume282
Issue number6
DOIs
StatePublished - Aug 11 1999

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Premature Birth
Low Birth Weight Infant
Immunization
Birth Weight
Health Maintenance Organizations
Parturition
Premature Infants
Term Birth
Immunization Schedule
Very Low Birth Weight Infant
Preventive Medicine
Information Storage and Retrieval
Centers for Disease Control and Prevention (U.S.)
Child Care
Population
Lung Diseases
Vaccination
Vaccines
Outcome Assessment (Health Care)
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Immunization levels among premature and low-birth-weight infants and risk factors for delayed up-to-date immunization status. / Davis, Robert; Rubanowice, David; Shinefield, Henry R.; Lewis, Ned; Gu, David; Black, Steven B.; DeStefano, Frank; Gargiullo, Paul; Mullooly, John P.; Thompson, Robert S.; Chen, Robert T.

In: Journal of the American Medical Association, Vol. 282, No. 6, 11.08.1999, p. 547-553.

Research output: Contribution to journalArticle

Davis, R, Rubanowice, D, Shinefield, HR, Lewis, N, Gu, D, Black, SB, DeStefano, F, Gargiullo, P, Mullooly, JP, Thompson, RS & Chen, RT 1999, 'Immunization levels among premature and low-birth-weight infants and risk factors for delayed up-to-date immunization status', Journal of the American Medical Association, vol. 282, no. 6, pp. 547-553. https://doi.org/10.1001/jama.282.6.547
Davis, Robert ; Rubanowice, David ; Shinefield, Henry R. ; Lewis, Ned ; Gu, David ; Black, Steven B. ; DeStefano, Frank ; Gargiullo, Paul ; Mullooly, John P. ; Thompson, Robert S. ; Chen, Robert T. / Immunization levels among premature and low-birth-weight infants and risk factors for delayed up-to-date immunization status. In: Journal of the American Medical Association. 1999 ; Vol. 282, No. 6. pp. 547-553.
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abstract = "Context: Studies have noted that health care professionals may not conform to proper immunization schedules for premature and low-birth-weight infants in the United States. Little is known about the success of current efforts to immunize these high-risk infants. Objective: To describe current immunization practices for premature and low-birthweight infants and ascertain risk factors for poor immunization status, using large population- based data sources. Design and Setting: Cohort and case-control analyses of immunization data tracked from March 1991 through March 1997 for 3 large health maintenance organizations (HMOs) participating in the Centers for Disease Control and Prevention's Vaccine Safety Datalink project. Participants: A total of 11 580 low-birth-weight and premature infants were enrolled from birth to age 2 months; 6832 of these were continuously enrolled from birth to age 24 months. At age 2 months, there were 173 373 full-term, norma-birthweight infants enrolled as controls; at age 24 months, there were 103 324. Main Outcome Measures Age-specific immunization status by prematurity and birth weight (<1500 g, 1500-2500 g, born at <38 weeks' gestation with birth weight of >2500 g, or full-term with normal birth weight) and patient characteristics associated with up-to-date status. Results: At each age, infants weighing less than 1500 g at birth had lower up-to-date immunization levels than other infants. At age 6 months, 52 {\%} to 65{\%} of infants weighing less than 1500 g were up-to-date at each of the 3 HMOs compared with 69{\%} to 73{\%} of those weighing 1500 to 2500 g, 66{\%} to 80{\%} of premature infants weighing more than 2500g, and 65{\%} to 76{\%} of full-term, normal-birth-weight infants. By age 24 months 78{\%} to 86{\%} of infants weighing less than 1500 g were up-to-date, significantly less than heavier infants, who had levels of 84{\%} to 89{\%}. Well-child preventive care strongly predicted immunization status, while concomitant pulmonary disease did not. Conclusions: Our data suggest that infants born prematurely are vaccinated at levels approaching that of the general population, but levels of vaccination for very low-birth-weight infants lag slightly behind.",
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AU - Lewis, Ned

AU - Gu, David

AU - Black, Steven B.

AU - DeStefano, Frank

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AU - Chen, Robert T.

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N2 - Context: Studies have noted that health care professionals may not conform to proper immunization schedules for premature and low-birth-weight infants in the United States. Little is known about the success of current efforts to immunize these high-risk infants. Objective: To describe current immunization practices for premature and low-birthweight infants and ascertain risk factors for poor immunization status, using large population- based data sources. Design and Setting: Cohort and case-control analyses of immunization data tracked from March 1991 through March 1997 for 3 large health maintenance organizations (HMOs) participating in the Centers for Disease Control and Prevention's Vaccine Safety Datalink project. Participants: A total of 11 580 low-birth-weight and premature infants were enrolled from birth to age 2 months; 6832 of these were continuously enrolled from birth to age 24 months. At age 2 months, there were 173 373 full-term, norma-birthweight infants enrolled as controls; at age 24 months, there were 103 324. Main Outcome Measures Age-specific immunization status by prematurity and birth weight (<1500 g, 1500-2500 g, born at <38 weeks' gestation with birth weight of >2500 g, or full-term with normal birth weight) and patient characteristics associated with up-to-date status. Results: At each age, infants weighing less than 1500 g at birth had lower up-to-date immunization levels than other infants. At age 6 months, 52 % to 65% of infants weighing less than 1500 g were up-to-date at each of the 3 HMOs compared with 69% to 73% of those weighing 1500 to 2500 g, 66% to 80% of premature infants weighing more than 2500g, and 65% to 76% of full-term, normal-birth-weight infants. By age 24 months 78% to 86% of infants weighing less than 1500 g were up-to-date, significantly less than heavier infants, who had levels of 84% to 89%. Well-child preventive care strongly predicted immunization status, while concomitant pulmonary disease did not. Conclusions: Our data suggest that infants born prematurely are vaccinated at levels approaching that of the general population, but levels of vaccination for very low-birth-weight infants lag slightly behind.

AB - Context: Studies have noted that health care professionals may not conform to proper immunization schedules for premature and low-birth-weight infants in the United States. Little is known about the success of current efforts to immunize these high-risk infants. Objective: To describe current immunization practices for premature and low-birthweight infants and ascertain risk factors for poor immunization status, using large population- based data sources. Design and Setting: Cohort and case-control analyses of immunization data tracked from March 1991 through March 1997 for 3 large health maintenance organizations (HMOs) participating in the Centers for Disease Control and Prevention's Vaccine Safety Datalink project. Participants: A total of 11 580 low-birth-weight and premature infants were enrolled from birth to age 2 months; 6832 of these were continuously enrolled from birth to age 24 months. At age 2 months, there were 173 373 full-term, norma-birthweight infants enrolled as controls; at age 24 months, there were 103 324. Main Outcome Measures Age-specific immunization status by prematurity and birth weight (<1500 g, 1500-2500 g, born at <38 weeks' gestation with birth weight of >2500 g, or full-term with normal birth weight) and patient characteristics associated with up-to-date status. Results: At each age, infants weighing less than 1500 g at birth had lower up-to-date immunization levels than other infants. At age 6 months, 52 % to 65% of infants weighing less than 1500 g were up-to-date at each of the 3 HMOs compared with 69% to 73% of those weighing 1500 to 2500 g, 66% to 80% of premature infants weighing more than 2500g, and 65% to 76% of full-term, normal-birth-weight infants. By age 24 months 78% to 86% of infants weighing less than 1500 g were up-to-date, significantly less than heavier infants, who had levels of 84% to 89%. Well-child preventive care strongly predicted immunization status, while concomitant pulmonary disease did not. Conclusions: Our data suggest that infants born prematurely are vaccinated at levels approaching that of the general population, but levels of vaccination for very low-birth-weight infants lag slightly behind.

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