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PEDIATRICS Vol. 101 No. 5 May 1998, p. e5

ELECTRONIC ARTICLE:
Do Missed Opportunities Stay Missed? A 6-Month Follow-up of Missed Vaccine Opportunities in Inner City Milwaukee Children

Received Aug 14, 1997; accepted Dec 31, 1997.

Svapna S. Sabnis, Albert J. Pomeranz, Patricia S. Lye, and Margaret M. Amateau

From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.

Objectives. To determine 1) the frequency of missed vaccine opportunities (VOs) in inner city children <= 3 years of age; 2) whether the recommended vaccine(s) were given within 6 months of the missed opportunity (MO); 3) whether these vaccinations were age-appropriate according to the guidelines of the Advisory Committee on Immunization Practices; and 4) variables associated with MOs.

Design.  Retrospective chart review with a nested retrospective cohort of children with MOs.

Setting.  Two inner city practice settings in Milwaukee: a community health center and an academic continuity care practice.

Patients/Selection Procedure.  A consecutive sample of 710 visits of inner city children <= 3 years of age with VOs, seen between January 1 and March 31, 1995. A VO was defined as any encounter when the child was vaccine-eligible according to Advisory Committee on Immunization Practices guidelines.

Results.  MOs occurred in 47% (330/710) of the VOs. Only 40% of the children with MOs received age-appropriate immunizations within 6 months; 30% received the vaccinations beyond the age-appropriate time. The remaining 30% either did not return or were not vaccinated on return. The variables significantly associated with MOs were 1) age: children with MOs were older than those without, with a mean age of 15.5 months vs 10.9 months; 2) minor febrile illness; 3) moderate/severe illness; 4) acute illness encounters; and 5) patient's being seen at the community health center. Only 15.5% of all MOs were justified by the presence of moderate/severe illness.

Conclusions.  VOs are frequently missed in inner city children. Most of the MOs were not justified by the valid contraindication of moderate/severe illness. Sixty percent of the children with MOs did not receive age-appropriate immunizations within 6 months. These children are vulnerable to vaccine-preventable diseases such as measles and pertussis.

Key words: immunization, vaccination, missed opportunities, children, pre-school.