Impact of the change in polio vaccination schedule on immunization coverage rates: A study in two large health maintenance organizations

Robert L. Davis, Tracy A. Lieu, Loren K. Mell, Angela M. Capra, Ann Zavitkovsky, Charles P. Quesenberry, Steven B. Black, Henry R. Shinefield, Robert S. Thompson, Lance E. Rodewald

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective. In January 1997, one of the most significant changes to United States vaccine policy occurred when polio immunization guidelines changed to recommend a schedule containing inactivated polio vaccine (IPV). There were concerns that parent or physician reluctance to accept IPV into the routine childhood immunization schedule would lead to lowered coverage. We determined whether adoption of an IPV schedule had a negative impact on immunization coverage. Design. A cohort study of 2 large health maintenance organizations (HMOs), Group Health Cooperative and Kaiser Permanente Northern California, was conducted. For analysis at 12 months of age, children who were born between October 1, 1996, and December 31, 1997, and were commercially insured and covered by Medicaid were continuously enrolled; for analysis at 24 months of age, children who were born between October 1, 1996, and June 30, 1997, and were commercially insured and covered by Medicaid were continuously enrolled. The 3 measures of immunization status at 12 and 24 months of age were up-to-date status, cumulative time spent up-to-date, and the number of missed opportunity visits. Results. At both HMOs, children who received IPV were as likely to be up to date at 12 months as were children who received oral poliovirus vaccine (OPV), whereas at Group Health, children who received IPV were slightly more likely to be up to date at 24 months (relative risk: 1.12; 95% confidence interval [CI]: 1.05, 1.19). These findings were consistent for children who were covered by Medicaid. At Kaiser Permanente, children who received IPV spent ∼3 fewer days up to date in the first year of life, but this difference did not persist at 2 years of age. At Group Health, children who received IPV were no different from those who received OPV in terms of days spent up to date by 1 or 2 years of age. At Group Health, children who received IPV were less likely to have a missed opportunity by 12 months old (odds ratio [OR] 0.46; 95% CI: 0.31, 0.70), but this finding did not persist at 24 months of age. At Kaiser Permanente, children who received IPV were more likely to have a missed opportunity by 12 months (OR 2.06; 95% CI: 1.84, 2.30), and 24 months of age (OR 1.50; 95% CI: 1.36, 1.67). Conclusions. The changeover from an all-OPV schedule to one containing IPV had little if any negative impact on vaccine coverage. Use of IPV was associated with a small increase in the likelihood of being up to date at 2 years of age at one of the HMOs and conversely was associated with a small increase in the likelihood of having a missed-opportunity visit in the other HMO.

Original languageEnglish (US)
Pages (from-to)671-676
Number of pages6
JournalPediatrics
Volume107
Issue number4 I
DOIs
StatePublished - Apr 17 2001

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Immunization Schedule
Health Maintenance Organizations
Inactivated Vaccines
Poliomyelitis
Vaccination
Oral Poliovirus Vaccine
Medicaid
Confidence Intervals
Immunization
Appointments and Schedules
Odds Ratio
Health
Vaccines

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

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Impact of the change in polio vaccination schedule on immunization coverage rates : A study in two large health maintenance organizations. / Davis, Robert L.; Lieu, Tracy A.; Mell, Loren K.; Capra, Angela M.; Zavitkovsky, Ann; Quesenberry, Charles P.; Black, Steven B.; Shinefield, Henry R.; Thompson, Robert S.; Rodewald, Lance E.

In: Pediatrics, Vol. 107, No. 4 I, 17.04.2001, p. 671-676.

Research output: Contribution to journalArticle

Davis, RL, Lieu, TA, Mell, LK, Capra, AM, Zavitkovsky, A, Quesenberry, CP, Black, SB, Shinefield, HR, Thompson, RS & Rodewald, LE 2001, 'Impact of the change in polio vaccination schedule on immunization coverage rates: A study in two large health maintenance organizations', Pediatrics, vol. 107, no. 4 I, pp. 671-676. https://doi.org/10.1542/peds.107.4.671
Davis, Robert L. ; Lieu, Tracy A. ; Mell, Loren K. ; Capra, Angela M. ; Zavitkovsky, Ann ; Quesenberry, Charles P. ; Black, Steven B. ; Shinefield, Henry R. ; Thompson, Robert S. ; Rodewald, Lance E. / Impact of the change in polio vaccination schedule on immunization coverage rates : A study in two large health maintenance organizations. In: Pediatrics. 2001 ; Vol. 107, No. 4 I. pp. 671-676.
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title = "Impact of the change in polio vaccination schedule on immunization coverage rates: A study in two large health maintenance organizations",
abstract = "Objective. In January 1997, one of the most significant changes to United States vaccine policy occurred when polio immunization guidelines changed to recommend a schedule containing inactivated polio vaccine (IPV). There were concerns that parent or physician reluctance to accept IPV into the routine childhood immunization schedule would lead to lowered coverage. We determined whether adoption of an IPV schedule had a negative impact on immunization coverage. Design. A cohort study of 2 large health maintenance organizations (HMOs), Group Health Cooperative and Kaiser Permanente Northern California, was conducted. For analysis at 12 months of age, children who were born between October 1, 1996, and December 31, 1997, and were commercially insured and covered by Medicaid were continuously enrolled; for analysis at 24 months of age, children who were born between October 1, 1996, and June 30, 1997, and were commercially insured and covered by Medicaid were continuously enrolled. The 3 measures of immunization status at 12 and 24 months of age were up-to-date status, cumulative time spent up-to-date, and the number of missed opportunity visits. Results. At both HMOs, children who received IPV were as likely to be up to date at 12 months as were children who received oral poliovirus vaccine (OPV), whereas at Group Health, children who received IPV were slightly more likely to be up to date at 24 months (relative risk: 1.12; 95{\%} confidence interval [CI]: 1.05, 1.19). These findings were consistent for children who were covered by Medicaid. At Kaiser Permanente, children who received IPV spent ∼3 fewer days up to date in the first year of life, but this difference did not persist at 2 years of age. At Group Health, children who received IPV were no different from those who received OPV in terms of days spent up to date by 1 or 2 years of age. At Group Health, children who received IPV were less likely to have a missed opportunity by 12 months old (odds ratio [OR] 0.46; 95{\%} CI: 0.31, 0.70), but this finding did not persist at 24 months of age. At Kaiser Permanente, children who received IPV were more likely to have a missed opportunity by 12 months (OR 2.06; 95{\%} CI: 1.84, 2.30), and 24 months of age (OR 1.50; 95{\%} CI: 1.36, 1.67). Conclusions. The changeover from an all-OPV schedule to one containing IPV had little if any negative impact on vaccine coverage. Use of IPV was associated with a small increase in the likelihood of being up to date at 2 years of age at one of the HMOs and conversely was associated with a small increase in the likelihood of having a missed-opportunity visit in the other HMO.",
author = "Davis, {Robert L.} and Lieu, {Tracy A.} and Mell, {Loren K.} and Capra, {Angela M.} and Ann Zavitkovsky and Quesenberry, {Charles P.} and Black, {Steven B.} and Shinefield, {Henry R.} and Thompson, {Robert S.} and Rodewald, {Lance E.}",
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T1 - Impact of the change in polio vaccination schedule on immunization coverage rates

T2 - A study in two large health maintenance organizations

AU - Davis, Robert L.

AU - Lieu, Tracy A.

AU - Mell, Loren K.

AU - Capra, Angela M.

AU - Zavitkovsky, Ann

AU - Quesenberry, Charles P.

AU - Black, Steven B.

AU - Shinefield, Henry R.

AU - Thompson, Robert S.

AU - Rodewald, Lance E.

PY - 2001/4/17

Y1 - 2001/4/17

N2 - Objective. In January 1997, one of the most significant changes to United States vaccine policy occurred when polio immunization guidelines changed to recommend a schedule containing inactivated polio vaccine (IPV). There were concerns that parent or physician reluctance to accept IPV into the routine childhood immunization schedule would lead to lowered coverage. We determined whether adoption of an IPV schedule had a negative impact on immunization coverage. Design. A cohort study of 2 large health maintenance organizations (HMOs), Group Health Cooperative and Kaiser Permanente Northern California, was conducted. For analysis at 12 months of age, children who were born between October 1, 1996, and December 31, 1997, and were commercially insured and covered by Medicaid were continuously enrolled; for analysis at 24 months of age, children who were born between October 1, 1996, and June 30, 1997, and were commercially insured and covered by Medicaid were continuously enrolled. The 3 measures of immunization status at 12 and 24 months of age were up-to-date status, cumulative time spent up-to-date, and the number of missed opportunity visits. Results. At both HMOs, children who received IPV were as likely to be up to date at 12 months as were children who received oral poliovirus vaccine (OPV), whereas at Group Health, children who received IPV were slightly more likely to be up to date at 24 months (relative risk: 1.12; 95% confidence interval [CI]: 1.05, 1.19). These findings were consistent for children who were covered by Medicaid. At Kaiser Permanente, children who received IPV spent ∼3 fewer days up to date in the first year of life, but this difference did not persist at 2 years of age. At Group Health, children who received IPV were no different from those who received OPV in terms of days spent up to date by 1 or 2 years of age. At Group Health, children who received IPV were less likely to have a missed opportunity by 12 months old (odds ratio [OR] 0.46; 95% CI: 0.31, 0.70), but this finding did not persist at 24 months of age. At Kaiser Permanente, children who received IPV were more likely to have a missed opportunity by 12 months (OR 2.06; 95% CI: 1.84, 2.30), and 24 months of age (OR 1.50; 95% CI: 1.36, 1.67). Conclusions. The changeover from an all-OPV schedule to one containing IPV had little if any negative impact on vaccine coverage. Use of IPV was associated with a small increase in the likelihood of being up to date at 2 years of age at one of the HMOs and conversely was associated with a small increase in the likelihood of having a missed-opportunity visit in the other HMO.

AB - Objective. In January 1997, one of the most significant changes to United States vaccine policy occurred when polio immunization guidelines changed to recommend a schedule containing inactivated polio vaccine (IPV). There were concerns that parent or physician reluctance to accept IPV into the routine childhood immunization schedule would lead to lowered coverage. We determined whether adoption of an IPV schedule had a negative impact on immunization coverage. Design. A cohort study of 2 large health maintenance organizations (HMOs), Group Health Cooperative and Kaiser Permanente Northern California, was conducted. For analysis at 12 months of age, children who were born between October 1, 1996, and December 31, 1997, and were commercially insured and covered by Medicaid were continuously enrolled; for analysis at 24 months of age, children who were born between October 1, 1996, and June 30, 1997, and were commercially insured and covered by Medicaid were continuously enrolled. The 3 measures of immunization status at 12 and 24 months of age were up-to-date status, cumulative time spent up-to-date, and the number of missed opportunity visits. Results. At both HMOs, children who received IPV were as likely to be up to date at 12 months as were children who received oral poliovirus vaccine (OPV), whereas at Group Health, children who received IPV were slightly more likely to be up to date at 24 months (relative risk: 1.12; 95% confidence interval [CI]: 1.05, 1.19). These findings were consistent for children who were covered by Medicaid. At Kaiser Permanente, children who received IPV spent ∼3 fewer days up to date in the first year of life, but this difference did not persist at 2 years of age. At Group Health, children who received IPV were no different from those who received OPV in terms of days spent up to date by 1 or 2 years of age. At Group Health, children who received IPV were less likely to have a missed opportunity by 12 months old (odds ratio [OR] 0.46; 95% CI: 0.31, 0.70), but this finding did not persist at 24 months of age. At Kaiser Permanente, children who received IPV were more likely to have a missed opportunity by 12 months (OR 2.06; 95% CI: 1.84, 2.30), and 24 months of age (OR 1.50; 95% CI: 1.36, 1.67). Conclusions. The changeover from an all-OPV schedule to one containing IPV had little if any negative impact on vaccine coverage. Use of IPV was associated with a small increase in the likelihood of being up to date at 2 years of age at one of the HMOs and conversely was associated with a small increase in the likelihood of having a missed-opportunity visit in the other HMO.

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