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PEDIATRICS Vol. 100 No. 2 August 1997, pp. 192-196

A Program to Immunize Hospitalized Preschool-aged Children: Evaluation and Impact

Received Jun 11, 1995; accepted Feb 15, 1996.

Louis M. Bell*, Dagger , Michele Pritchard*, Rebecca Anderko*, and Robert Levenson§

From the * Divisions of Immunologic and Infectious Diseases, and Dagger  Emergency Medicine, Children's Hospital of Philadelphia, University of Pennsylvania; and § Philadelphia Department of Public Health, Philadelphia, Pennsylvania.

Objective.  The Standards for Pediatric Immunization Practices suggest that hospitalization be viewed as an opportunity to vaccinate children. The purpose of the present study is 1) to determine the immunization status of an urban population of hospitalized preschool-aged children, 2) to study the impact of an immunization program designed to vaccinate hospitalized 0 to 2-year-old children who are underimmunized at admission, and 3) to make immunization a routine part of care for the hospitalized child.

Methods.  Prospective evaluation of the immunization status of hospitalized 0 to 2-year-old residents of Philadelphia admitted to an urban children's hospital was performed. With verification of the child's immunization record through the primary care provider (PCP), needed immunizations were given and records were forwarded to notify the PCP. Educational information was provided to families and health care providers.

Main Outcome Measure.  The percentage of children fully immunized on admission compared with the percentage at the time of discharge.

Results.  Two thousand three hundred twenty-nine children from 0 to 2 years of age were hospitalized during the 22-month study period. Immunization records were verified in 86% (2006), requiring an average of 1.5 phone calls to the PCP. The mean patient age was 10 months. Average hospital length of stay was 4 days. On admission, 49% (980) of the 2006 study patients were fully immunized. The remaining 51% (1026) were eligible for vaccination. Immunizations were delayed greater than or equal to 2 months in 18% (355) of the children. Neither type of health care insurance nor site of primary care affected the immunization status of those evaluated at the time of admission.

Sixty-six percent (N = 674) of eligible patients received at least one vaccination before hospital discharge. Medical contraindications accounted for only 4% of the reasons eligible patients were not immunized. Of the 2006 children evaluated, the percentage of those fully vaccinated for age increased significantly from 44% on admission to 70% on discharge.

Conclusion.  As a result of this program, there was a significant improvement in vaccination percentage at the time of hospital discharge in this group of urban preschool-aged children. The development of an immunization program to vaccinate hospitalized preschool children is an opportunity to immunize in the urban setting where there is a high prevalence of underimmunization.

In addition, it provides an opening for educational programs for families, nurses, and housestaff and linkage to the community PCPs.

Key words: immunization rates, hospitalization, underimmunization, preschool age children.




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