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ABSTRACT
Vaccination at age-appropriate intervals increases protection against morbidity and mortality; however, compliance rates among children remain low partly due to a complicated vaccination schedule. Use of combination vaccines reduces the number of injections per visit; however, there is limited evidence quantifying the effect of combination vaccines on vaccination rates. To examine how combination vaccines impact childhood completion (receipt of recommended doses) and compliance (receipt of age-appropriate vaccinations) rates, this study analyzed vaccination data from the 2012 National Immunization Survey (NIS), a nationally representative cross-sectional survey of caregivers of children aged 24 to 35 months in the United States. Vaccines were categorized as combination or single antigen. Vaccine completion was measured at ages 8, 18, and 24 months. Vaccine compliance and time undervaccinated were measured at 24 months. Children who received at least 1 combination vaccine (86%) had a higher completion rate (69%) and compliance with the full vaccine series (4:3:1:3:3:1:4 series) at 24 months (24%) than those who received only single-antigen vaccines (50% and 13%, respectively). Receipt of combination vaccine was associated with an increased likelihood of completing all recommended vaccinations at 24 months (odds ratio [OR] = 2.5; P < 0.001), receiving all vaccinations at age-appropriate times (OR = 2.2; P < 0.001), and less than 7 months undervaccinated (OR = 2.4; P < 0.001). Combination vaccines were associated with improved completion and compliance and should be encouraged among children who are undervaccinated or who received single-antigen vaccines only.
Trademark statements
Rotarix is a trademark of the GSK group of companies. RotaTeq is a trademark of Merck & Co., Inc.
Prior presentation
Parts of this study were presented as abstract and oral presentation at the 18th Annual Conference on Vaccine Research of the National Foundation for Infectious Diseases, Bethesda, MD, April 13–15, 2015.
Note
The analyses, interpretations and conclusions presented here do not necessarily reflect the views or opinions of the National Center for Health Statistics, which is responsible only for the initial data.
Abbreviations
| ACIP | = | Advisory Committee on Immunization Practices |
| DTaP | = | diphtheria, tetanus toxoid, and acellular pertussis vaccine |
| HepB | = | hepatitis B vaccine |
| Hib | = | Haemophilus influenzae type b vaccine |
| IPV | = | inactivated poliovirus vaccine |
| IRB | = | institutional review board |
| LCL | = | lower confidence limit |
| MMR | = | measles, mumps, and rubella vaccine |
| MMR-V | = | measles, mumps, rubella, and varicella vaccine |
| NIS | = | National Immunization Survey |
| PCV | = | pneumococcal conjugate vaccine |
| SCHIP | = | State Children's Health Insurance Program |
| SE | = | standard error of the mean |
| UCL | = | upper confidence limit |
| US | = | United States |
Disclosure of potential conflicts of interest
GlaxoSmithKline Biologicals SA funded this research (GSK study identifier: HO-14–14321) and was involved together with RTI Health Solutions in all stages of study conduct, including management, analysis of the data and interpretation of the data. GlaxoSmithKline Biologicals SA took in charge all costs associated with the development and publication of this manuscript. GK was used by the GSK group of companies at the time of study conduct and during the development of the manuscript. GK is now used by CSL Behring. GK also reports ownership of stock options/restricted shares from the GSK group of companies and CSL Behring. SKK and KLD are employees of RTI Health Solutions, a contract research organization that received funding from the GSK group of companies to conduct the analysis described in this manuscript. Although RTI Health Solutions was contracted to complete the research study described herein, neither SKK nor KLD were compensated for their contributions as authors on this manuscript. SKK has also received funding from Merck & Co., Inc., Otsuka America Pharmaceutical, Inc., Novartis Pharmaceuticals, Pfizer, Bristol-Myers Squibb, and Eli Lilly for contract research. KLD has also received funding from AstraZeneca, Eli Lilly, Millennium Pharmaceuticals, Inc., Novartis Pharmaceuticals, Pfizer and Shire Pharmaceuticals for contract research.
Acknowledgments
Samantha Kurosky had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The authors are grateful to Ning Wu (former employee of GSK) for her contribution to development of the study design, analytic plan, and interpretation of the results. Mayank Ajmera (RTI Health Solutions) drafted the manuscript based on the study report. Editorial support was provided by Heather Santiago (GSK Vaccines), Jenny Andersson (CROMSOURCE Ltd) and Marie Cloes (Business & Decision Life Sciences) on behalf of GSK, and Daniel Siepert (RTI Health Solutions).
Contributors
All authors contributed to method selection and development and provided substantial scientific input to the study report. All authors also reviewed critically the study report and assessed the robustness of the results. KLD and SKK acquired the data, supervised the study and acquired the funding. SKK verified the data, conducted the statistical analyses, reviewed the literature and drafted the study report. KLD provided statistical support for the analysis and reporting of the data. GK populated the models and determined the model settings. All authors had full access to the data, reviewed and provided important intellectual contribution to the content of the manuscript and gave their final approval before submission.