1887. Factors Affecting  Compliance with 13-valent Pneumococcal Conjugate Catch-up Vaccination in Children 
Session: Poster Abstract Session: Vaccines: PCV
Saturday, October 10, 2015
Room: Poster Hall
Background:

Immunization Information Systems (IIS) are recommended for reviewing and updating childhood vaccinations. Automated reminders are useful to ensure on-time immunization, particularly when new vaccines are added to the recommended vaccine schedule. In April 2010 a new 13-valent pneumococcal conjugate vaccine (PCV-13) was introduced, and a single dose was recommended for children who had already completed the primary series with 7-valent vaccine. This study examined compliance with PCV-13 for children receiving well-child care at two military treatment facilities with differing immunization protocols. The objective was to evaluate factors impacting compliance with PCV-13, with a focus on availability and utilization of an IIS.

Methods:

Immunization records were reviewed for subjects aged 18-59 months between Jun 2010 and Dec 2012. Outcome measures included compliance with PCV-13 within one month of well-child visit. Clinic site was included as a potential risk factor. Clinic A had no reliable IIS and required provider order for immunization. Clinic B used a nearby immunization clinic where technicians reviewed IIS and administered vaccines.  Other variables included provider level of training, subject age ≥4 years (4 year old well visit), and time. Unconditional logistic regression was performed to evaluate vaccination rates after adjustment for clinic site and clinic parameters.

Results:

Data for 2841 encounters were analyzed. Overall compliance with PCV-13 catch-up was low (15.2%), but significantly higher in subjects seen at the clinic using an IIS (table 1).  Factors which significantly increased odds of compliance included clinic with IIS, subject age>=4 years and staff physician. Compliance with PCV-13 significantly increased over time.

Conclusion s:

Compliance with new immunization recommendations may be influenced by several variables. Consistent use of an Immunization Information Systems at each well-child encounter is likely to result in improved compliance with new vaccines.

TABLE 1: Odds ratios and 95% confidence intervals Overall PCV-13 vaccine compliance

Univariate Model

Multivariate Model

Parameters

OR (95% CI)

p-value; AUC: R2

OR (95% CI)

p-value; AUC: R2

Clinic

Clinic A

1.0 (--)

--

1.0 (--)

--

Clinic B

1.93 (1.54-2.41)

0.001; 0.575; 0.012

7.74 (5.55-10.82)

0.001

Age

< 4 years

1.0 (--)

--

1.0 (--)

--

≥ 4 years

4.49 (3.56-5.67)

0.001; 0.673; 0.062

3.92 (3.02-5.11)

0.001

Provider Type

Pediatric Nurse Practitioner

1.0 (--)

--

1.0 (--)

--

Pediatric Resident

1.11 (0.81-1.51)

0.535

1.28 (0.88-1.84)

0.188

Staff physician

1.52 (1.18-1.20)

0.002; 0.055; 0.005

1.46 (1.08-1.97)

0.015

Time (Study Quarter)

1.54 (1.47-1.61)

0.001; 0.811; 0.128

1.73 (1.63-1.83)

0.001

 

 

 

 

0.001; 0.855; 0.213

Note. ORs and 95% CI in multivariate models are adjusted for all other terms in table.

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Figure 1: Proportion of well child encounters with PCV-13 administration within one month of clinic visit

Deena Sutter, MD, San Antonio Military Medical Center, Fort Sam Houston, TX, Scott Barnett, PhD, James A. Haley Veterans Medical Center, Tampa, FL, Joshua Anchan, MD, Nellis AFB, Nellis AFB, NV and Ashley M. Maranich, M.D., San Antonio Military Medical Center, JBSA Fort Sam Houston, TX

Disclosures:

D. Sutter, None

S. Barnett, None

J. Anchan, None

A. M. Maranich, None

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