Published online April 1, 2008
PEDIATRICS
Vol. 121
No. 4
April 2008, pp.
e768-e774
(doi:10.1542/peds.2007-0305)
Vaccination Coverage by Special Health Care Needs Status in Young Children
Kathleen S. O'Connor, MPH and
Matthew D. Bramlett, PhD
Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Interview Statistics, Hyattsville, Maryland
 |
ABSTRACT
|
|---|
OBJECTIVE. The purpose of this study was to compare vaccination coverage among children 19 to 35 months of age with and without special health care needs overall and among demographic subgroups.
METHODS. Data are from the National Survey of Children With Special Health Care Needs, a module of the State and Local Area Integrated Telephone Survey, which was sponsored by the Health Resources and Services Administration Maternal and Child Health Bureau and conducted in 2000–2002 by the Centers for Disease Control and Prevention National Center for Health Statistics. We used data from the National Immunization Survey and the National Survey of Children With Special Health Care Needs to examine immunization coverage rates for individual vaccines and an array of combined series vaccinations. The relationship between special needs and immunization status was analyzed by age, gender, and race or ethnicity of the child; the child's health insurance type; the mother's educational attainment and presence in the household; and household income relative to the federal poverty level.
RESULTS. Overall, there were no significant differences between children with and without special needs for any of the individual antigens or combined immunization series. Some significant differences by special needs status were found within certain demographic subgroups.
CONCLUSIONS. Our results suggest that, generally children with special health care needs have immunization rates that are very similar to typically developing children. There is some evidence that children with special health care needs are at risk for underimmunization if they are non-Hispanic white or live in an affluent household and are more likely to be immunized if they are Hispanic, poor, publicly insured, or if their mothers did not complete high school. These findings may be due to outreach or support programs that target disadvantaged children. However, it is important to note that the majority of comparisons within demographic subgroups show no significant differences between children with special health care needs and children without special health care needs.
Key Words: vaccination • children with special health care needs
Abbreviations: CDC—Centers for Disease Control and Prevention • DTP—diphtheria and tetanus toxoids and pertussis vaccine • DT—diphtheria and tetanus toxoids vaccine • DTaP—diphtheria and tetanus toxoids and acellular pertussis vaccine • 4:3:1—combined series composed of 
4 doses of DTP/DT/DTaP, 3 doses of poliovirus vaccine, and 1 dose of MCV • 4:3:1:3—combined series composed of the 4:3:1 plus 3 doses of Hib vaccine • 4:3:1:3:3: combined series composed of the 4:3:1:3 plus 3 doses of hepatitis B vaccine • CSHCN—children with special health care needs • MCHB—Maternal and Child Health Bureau • NIS—National Immunization Survey • NS-CSHCN—National Survey of Children With Special Health Care Needs • SLAITS—State and Local Area Integrated Telephone Survey • FPL—federal poverty level • MMR—measles, mumps, and rubella vaccine • Hib—Haemophilus influenzae type b • MCV—measles-containing vaccine
Healthy People 2010 goals call for effective vaccination coverage levels of 90% among children 19 to 35 months of age for vaccinations recommended by the Advisory Committee on Immunization Practices.*1,2 According to the Centers for Disease Control and Prevention (CDC), vaccination coverage in 2002 for children 19 to 35 months of age ranged from 40.9% for the pneumococcal conjugate vaccine to 94.9% for 3 doses of the diphtheria and tetanus toxoids and pertussis vaccine (DTP)/diphtheria and tetanus toxoids vaccine (DT)/diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP).3 For the combined series, coverage estimates ranged from 65.5% for the 4:3:1:3:3;1 series to 78.5% for the 4:3:1 series.3 These estimates represent the entire population of children 19 to 35 months of age in the United States and may not reflect vaccination status of an important subgroup: children with special health care needs (CSHCN). Immunization is a significant component of the provision of comprehensive preventive and primary care services for all children, including those with special health care needs.4
CSHCN, as defined by the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration, are children who have or are at risk of a physical, developmental, behavioral, or emotional condition and require health or related services of a type or amount beyond that required by children generally.5 CSHCN are identified by the CSHCN Screener as those children who experience 1 of the following 5 health consequences resulting from a medical condition that has lasted or is expected to last for a period of 12 months: use of prescription medications; use of health care services above the average for a child the same age; limitation in activities that most children the same age can do; use of physical, occupational, or speech therapy; or having a behavioral, emotional, or developmental condition requiring treatment or counseling.6,7 Nationally representative vaccination coverage estimates for CSHCN have heretofore been unavailable because of the lack of a data set that included consistent, valid, and reliable CSHCN screener data and immunization data. We used vaccination coverage data from the National Immunization Survey (NIS) along with data from the National Survey of CSHCN (NS-CSHCN) to present the first nationally representative assessment of the immunization status of young children with and without special health care needs.
|
PREVIOUS RESEARCH
|
|---|
A thorough literature review revealed a small number of studies that characterize the immunization status of chronically ill children. Most are limited to specific subpopulations, vaccines, or diagnoses. Examples include vaccination coverage in children with spina bifida8; pediatric cardiology clinic patients9,10; premature, low, and very low birth weight infants11,12; chronically ill children attending specialty or subspecialty clinics13,14; enrollees in a consortium of 6 community-based clinics15; a mix of medical and surgical subspecialty patients in addition to typically developing preschool-aged children admitted to the hospital for treatment16; children 4 months to 16 years of age being assessed for a liver transplant17; and DTP coverage in neonatal intensive care nursery graduates.18 Additional articles characterize the immunization status of hospitalized preschool-aged children.19–21
The evidence of a relationship between chronic illness and immunization status is inconclusive. Norlin and Hoff14 revealed that pediatric patients with chronic illnesses seen in a subspecialty clinic setting had similar immunization rates compared with the general pediatric population of Utah. When examining CSHCN enrolled in a pediatric group practice consortium, Samuels et al15 found that the rate of vaccination for the 4:3:1 series was 84%, which was slightly lower than the comparable state rate but similar to the national rate. Davis et al12 found that the vaccination coverage level for premature infants came close to the coverage level for the general population but was somewhat lower for very low birth weight infants when compared with the general population. Additional research examining vaccination coverage among children with chronic illness who used medical services in subspecialty clinics or hospitalized preschool-aged children found that a nontrivial proportion was underimmunized on presentation to the clinic or admission to the hospital.8,9,19–21
Some unique characteristics of the CSHCN population may provide context for findings of underimmunization in this population. Children with severe chronic conditions may be more likely to see their subspecialists than primary care providers, and well-child care may be overlooked as the specialist attends to the child's more urgent medical problem.16 Children who see specialists in addition to a primary care provider can potentially receive vaccinations from multiple providers,8 which may contribute to record scattering.22 Physicians may have concerns regarding vaccination adverse effects if the child has a chronic condition that affects a particular system, such as the neurologic system.8 The biological nature of the condition and resulting sequelae, such as a suppressed immunologic system response, may preclude vaccination. For example, routine vaccination with varicella vaccine is not recommended for children with cellular immunodeficiencies such as congenital T-cell abnormalities, leukemia, and lymphoma23; the use of a measles-virus-containing vaccine is not recommended in severely immunocompromised children infected with HIV24; and use of a live vaccine is not recommended in children with certain underlying metabolic disorders linked with a high level of immunodeficiency.25
|
METHODS
|
|---|
Data
We used data from the National Survey of Children with Special Health Care Needs, a module of the State and Local Area Integrated Telephone Survey (SLAITS). The NS-CSHCN was primarily sponsored by MCHB and was conducted by the CDC National Center for Health Statistics from October 2000 through April 2002.7 SLAITS modules, such as the NS-CSHCN, use the sample frame of the NIS, a large, nationally representative, population-based telephone survey that monitors vaccination coverage of children in the United States. The NIS is coconducted by National Center for Health Statistics and the CDC National Center for Infectious and Respiratory Diseases. The NIS uses random-digit dialing to identify households with children 19 to 35 months of age.26,27 After obtaining detailed shot record data for each age-eligible child and verbal permission from the respondent to contact the health care provider(s) that vaccinated the child, a supplemental survey is mailed to each shot provider. This survey, completed by the clinician(s) or (his or her) administrative/medical charts staff, verifies the vaccine(s) given and date(s) of administration. Only provider-verified vaccination data are used to calculate official NIS vaccination estimates.
SLAITS modules are conducted after completion of the NIS interview. NIS-eligible households are those with any children ages 19 to 35 months, whereas NS-CSHCN-eligible households are those with any children under age 18 years. Therefore, for children in the NS-CSHCN who were also age eligible for the NIS, we were able to link the provider-verified vaccination data from the NIS with the corresponding NS-CSHSN data record for the child.
For the NS-CSHCN, 196888 households with children were contacted, and all of the children under age 18 years in those households (a total of 373066 children) were screened for special health care needs.7 One child with special health care needs was randomly selected from each household to be the target of the NS-CSHCN detailed interview.7 One child without special health care needs was randomly selected from each household to be the target of a supplemental interview designed to provide a comparison group of children without special health care needs for analyses of health insurance and selected other topics.
The NS-CSHCN screener file contains data on the full set of children screened for special health care needs (all children in all households). NS-CSHCN data available for all of the children in the household include child's age, gender, race, ethnicity, and special needs status, as well as household income relative to federal poverty level (FPL). Analyses of all of the children by special health care needs status and analyses by age, gender, race or ethnicity, or income relative to FPL were based on this file. The NS-CSHCN insurance file contains data on the 1 child with special health care needs and the 1 child without special health care needs randomly selected from each household. Analyses that involve the child's health insurance, the mother's education, or whether the mother resides in the household could only be analyzed for children with and without special health care needs using the insurance file, which had a smaller sample than the screener file because it did not include all of the children in every household. The screener file and insurance file were separately weighted so that each was representative of all of the children at the national level.
The NS-CSHCN completed detailed interviews for
750 CSHCN in each state and in Washington, DC. In certain states where the NIS sample frame was not large enough to achieve this interview target, extra sample (called "augmentation" sample) was drawn to make up the difference. These are households that participated in the NS-CSHCN but did not participate in the NIS. Because we could not link vaccination data from the NIS to these cases, they were not included in our analyses. Of the 23840 children ages 19 to 35 months in the NS-CSHCN screener file, NIS information was available for 21444. Of these, 17994 (83.9%) had provider-verified immunization data. Of the 14182 children ages 19 to 35 months in the NS-CSHCN insurance file, NIS information was available for 13065. Of these, 11002 (84.2%) had provider-verified immunization data.
Statistical Analyses
The relationship between vaccination coverage and special needs status was analyzed for all of the children and by the following demographic characteristics: the age, race or Hispanic ethnicity, health insurance status, and gender of the child; mother's education; maternal presence in the household; and household poverty level relative to FPL.
Estimates of vaccination coverage rates and associated confidence intervals were calculated by using SUDAAN 9 (Research Triangle Institute, Research Triangle Park, NC), which accounts for the complex survey design using the Taylor Series approximation method.28 The estimates were weighted, and the sampling weights were adjusted to account for noncoverage of nontelephone households.7 The statistical significance of differences between rates for CSHCN and children without special needs was assessed at the .05 level by using 2-tailed t tests of the difference of proportions.
|
RESULTS
|
|---|
Table 1 shows the vaccination coverage rates for each of the individual vaccines and combined series for children with and without special health care needs, based on the analysis sample of 17994 children with provider-verified immunization data. For all of the vaccines and combined series, coverage levels of CSHCN are similar to coverage levels of children without special health care needs. There are no statistically significant differences between children with and without special needs for any of the individual vaccines or combined series in this aggregate comparison.
View this table:
[in this window]
[in a new window]
|
TABLE 1 Vaccination Coverage Rates Among Children 19 to 35 Months of Age by Selected Vaccines, Doses, and Special Health Care Needs Status
|
|
Table 2 shows the distribution of the demographic control variables for children with and without special health care needs. CSHCN were more likely than children without special health care needs to be male or non-Hispanic black or to have public insurance or a combination of private and public insurance and were less likely than children without special needs to be female, Hispanic, or privately insured or to live in households with income 200% to 400% of the FPL (Table 2). Virtually all (>96%) of the households included the mother in residence. This is a function of the way the variable was derived, in that it included biological, adoptive, foster mothers, stepmothers, or female guardians, and these different types of mothers cannot be distinguished. Because the number of CSHCN without any mother type in residence in the household was so small, this variable was not useful for subsequent analysis.
The percentage distributions of CSHCN and children without special health care needs by demographics for all of the children age eligible for the NIS were remarkably similar to distributions based on the sample for whom provider-verified NIS data were available (Table 2). This shows that provider nonresponse to the NIS is not significantly related to these demographic characteristics of the child and household and indicates that our analytic samples are appropriately representative.
Table 3 summarizes significant differences in vaccination coverage by special health care needs status within demographic subpopulations. Subpopulations that showed no significant differences by special needs status for any vaccination or series are omitted (12 of 23 subpopulations) as are vaccinations or series that showed no significant differences by special needs status for any demographic subgroup (2 of 8 vaccinations and 1 of 4 series). Although most comparisons showed no differences across special needs status, Table 3 shows that CSHCN are less likely to be immunized for DTP/DT/DTaP or the 4:3:1 series if they are non-Hispanic white children and less likely to be immunized for combined series 4:3:1, 4:3:1:3, and 4:3:1:3:3 if they live in high-income households. However, CSHCN are more likely to be up to date on some vaccines or series if they are Hispanic (measles, mumps, and rubella vaccine [MMR]), poor (MMR and hepatitis B, 4:3:1:3:3), publicly insured (Haemophilus influenzae type b [Hib] or hepatitis B), or live with a mother whose educational attainment is less than a high school degree (poliovirus, Hib, or hepatitis B, 4:3:1:3:3). The full tables that show the vaccination coverage rates for each vaccine and combined series for children with and without special health care needs in all of the demographic subpopulations, as well as the associated confidence intervals and tests of statistical significance, are available in the online supplemental materials, which are published as Tables 4 to 15 on www.pediatrics.org/content/full/122/4/e768.
View this table:
[in this window]
[in a new window]
|
TABLE 3 Summary of Significant Differences in Vaccination Coverage by Special Health Care Needs Status Within Demographic Subpopulations
|
|
|
DISCUSSION
|
|---|
Most comparisons showed no differences in immunization status by special health care needs. Of the differences that were statistically significant, most suggest that CSHCN had higher coverage rates than children without special needs; the only cases where children with special needs had lower coverage rates were for DT/DTP/DTaP 4 doses and 4:3:1 among non-Hispanic white children and for combined the series 4:3:1, 4:3:1:3, and 4:3:1:3:3 among children who lived in households in the highest income category. It is possible the lower coverage rates may have reflected (in part) parent or provider concerns about vaccinating CSHCN; however, variables to measure these constructs were not included in either survey. In contrast, past research has demonstrated that CSHCN are more likely to have a personal doctor or nurse, get care in a medical home, see their doctors more often, and more often see specialists or other doctors than children without special health care needs (results available on request from the authors or see the data query platform at http://childhealthdata.org). It is possible that CSHCN in certain subgroups are more likely to be immunized because of these factors. However, the overall differences between CSHCN and children without special needs were not significant; it, therefore, seems unlikely that the higher vaccination coverage levels of CSHCN in certain subgroups are the result of factors that may affect all CSHCN.
The findings in Table 3 suggest that CSHCN are at risk of underimmunization only if they live in advantaged households (white or high income) but are more likely to be immunized if they live in disadvantaged or minority households (Hispanic, poor, publicly insured, or with poorly educated mothers). Our results have a similar trend to those of Kim et al,29 who examined up-to-date coverage for the 4:3:1:3 series in all children, although the antigen-specific findings did not match across the 2 studies. They found a higher vaccination rate among young children living in Hispanic and non-Hispanic black families with low income-to-poverty ratios, in families with Hispanic mothers, and in families with mothers with less than a high school education. For the current study, the only significant results in Table 3 that did not follow the pattern were the higher MMR or measles-containing vaccine (MCV) vaccination coverage rates for CSHCN among male children and privately insured children and the lower 4:3:1 series coverage rates for CSHCN among female children and children 19 to 23 months of age. This general pattern could be interpreted as a success story for disadvantaged populations in that outreach efforts or supports may be working for those who need them most. For instance, selected factors identified in past research as being associated with lower vaccination rates among all children include low maternal education,30–34 being black,30,34 and living in poverty.30,34–36 However, it is important to note that, in the current study, the majority of cells in Table 3 show no significant differences between CSHCN and children without special health care needs.
|
LIMITATIONS
|
|---|
The data for both the NIS and the NS-CSHCN were reported by the person most knowledgeable about the health of the child (usually a parent or guardian); however, parent-reported immunization data have been found to be inaccurate in some cases.37–39 Thus, supplemental provider data from the immunization and medical chart were used to verify parent-reported immunization data. However, it is possible that provider records or data transcribed onto the NIS form when submitting provider data could be inaccurate,40 especially among CSHCN who are more likely to see multiple doctors and may have a higher probability of record-keeping errors or record scattering. Errors could be administrative in nature (transcription or data entry error or poor handwriting) or technical (difficulty maintaining current knowledge on the dynamic and complex vaccination schedule for young children).40
The range of chronic conditions captured by the MCHB definition of CSHCN is broad by definition. However, the NS-CSHCN did not collect condition-specific data, so vaccination coverage cannot be studied by condition. It is possible that different results may have been obtained if we stratified CSHCN by severity of special health care need(s). We will examine this in future research.
These surveys are cross-sectional, and the data cannot be used to prove causal relationships. As sample surveys, the NIS and the NS-CSHCN are subject to various forms of nonrandom error, including coverage bias and nonresponse bias.
|
CONCLUSIONS
|
|---|
There were no statistically significant differences between children with and without special needs for any of the individual antigens or combined series in the aggregate comparison. Most antigens and combined series did not show a difference by special health care needs within demographic subpopulations. The majority of the few antigens or series that did show a difference by special needs status within a particular demographic subgroup seemed to follow a pattern of underimmunization for CSHCN in affluent or white households and higher coverage levels for CSHCN in Hispanic, poor, or publicly insured households or for CSHCN whose mothers did not complete high school. This may be related to successful communication outreach or support efforts that target disadvantaged children, but additional research is needed.
Additional vaccination coverage research is of critical importance for CSHCN of all ages. These results can be used to inform policy-makers and enhance appropriate decision-making related to immunization programs for young CSHCN.
|
ACKNOWLEDGMENTS
|
|---|
The National Immunization Survey is funded by the National Center for Infectious and Respiratory Diseases (formerly known as the National Immunization Program), Centers for Disease Control and Prevention. The National Survey of Children With Special Health Care Needs is funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration.
We thank the thousands of families across the country who graciously gave their time and effort to complete the surveys, as well as the project staff who worked on these surveys or interviewed respondents. We also thank Marcie Cynamon, Stephen Blumberg, Jane Gentleman, Jennifer Madans, and James Singleton for their insightful comments, as well as the anonymous reviewers.
|
FOOTNOTES
|
|---|
Accepted Aug 27, 2007.
Address correspondence to Kathleen S. O'Connor, MPH, Centers for Disease Control and Prevention, National Center for Health Statistics, 3311 Toledo Rd, Room 2114, Hyattsville, MD 20782-2003. E-mail: koconnor1{at}cdc.gov
The content of this article reflects the opinions of the authors and not that of the Department of Health and Human Services.
The authors have indicated they have no financial relationships relevant to this article to disclose.
| What's Known on This Subject
Current vaccination estimates represent the entire population of children 19 to 35 months of age in the United States and may not reflect vaccination status of an important subgroup: children with special health care needs.
|
| What This Study Adds
This study presents the first nationally representative assessment of the immunization status of young children with special health care needs.
|
* Vaccinations examined in this report to determine immunization status include the following: diphtheria and tetanus toxoids and pertussis vaccine/diphtheria and tetanus toxoids/diphtheria and tetanus toxoids and acellular pertussis vaccine (DTP/DT/DTaP) 3 doses; DTP/DT/DTaP 4 doses; poliovirus 3 doses; measles/mumps/rubella 1 dose; measles-containing vaccine 1 dose; Haemophilus influenzae type b 3 doses; hepatitis B 3 doses; varicella 1 dose; combined series examined include the following: 4:3:1 (DTP/DT/DTaP 4 doses, poliovirus 3 doses, measles-containing vaccine 1 dose); 4:3:1:3 (4:3:1 series plus Haemophilus influenzae type b 3 doses); 4:3:1:3:3 (4:3:1:3 series plus hepatitis B 3 doses); and combined series composed of the 4:3:1:3:3 plus 1 dose of varicella vaccine. 
|
REFERENCES
|
|---|
- US Department of Health and Human Services.
Healthy People 2010. 2nd ed, 2 vols. Washington, DC: US Government Printing Office; 2000
- Advisory Committee on Immunization Practices. The Advisory Committee on Immunization Practices Page. Available at: www.cdc.gov/nip/ACIP/default.htm. Accessed September 21, 2006
- Centers for Disease Control and Prevention. National, state, and urban area vaccination levels among children aged 19–35 months: United States, 2002.
MMWR Morb Mortal Wkly Rep. 2003;52
(31):728
–732[Medline]
- American Academy of Pediatrics, Medical Homes Initiatives for Children with Special Needs Project Advisory Committee. The medical home.
Pediatrics. 2002;110
(1 pt 1):184
–186[Abstract/Free Full Text]
- McPherson M, Arango P, Fox H, et al. A new definition of children with special health care needs.
Pediatrics. 1998;102
(1 pt 1):137
–140[Free Full Text]
- Bethell CD, Read D, Stein RE, Blumberg SJ, Wells N, Newacheck PW. Identifying children with special health care needs: development and evaluation of a short screening tool.
Ambul Pediatr. 2002;2
(1):38
–48[CrossRef][ISI][Medline]
- Blumberg SJ, Olson L, Frankel M, et al. Design and operation of the National Survey of Children with Special Health Care Needs, 2001.
Vital Health Stat. 2003;1
(41):1
–136.
- Raddish M, Goldmann DA, Kaplan LC, Perrin JM. The immunization status of children with Spina Bifida.
Am J Dis Child. 1993;147
(8):849
–853[Abstract]
- Basco WT Jr, Recknor JC, Darden PM. Who needs an immunization in a pediatric subspecialty clinic?
Arch Pediatr Adolesc Med. 1996;150
(5):508
–511[Abstract]
- Uzark K, Collins J, Meisenhelder K, Dick M, Rosenthal A. Primary preventive health care in children with heart disease.
Pediatr Cardiol. 1983;4
(4):259
–264[CrossRef][ISI][Medline]
- Langkamp DL, Hoshaw-Woodard S, Boye ME, Lemeshow S. Delays in receipt of immunizations in low-birth-weight children: a nationally representative sample.
Arch Pediatr Adolesc Med. 2001;155
(2):167
–172[Abstract/Free Full Text]
- Davis RL, Rubanowice D, Shinefield HR, et al. Immunization levels among premature and low-birth-weight infants and risk factors for delayed up-to-date immunization status.
JAMA. 1999;282
(6):547
–553[Abstract/Free Full Text]
- Fraser, JJ. Immunization status of chronically ill children.
Tex Med. 1990;86
(10):76
–79[Medline]
- Norlin C, Hoff CJ. Immunization in children with chronic illness. Presented at the Pediatric Academic Societies Meeting; May 3–6, 2003; Seattle, WA
- Samuels RC, Liu J, Permut IQ, Sofis LA, Palfrey JS. Immunization rates in children with special health care needs [abstract].
Pediatr Res. 2003;53
(4, Part 2 Suppl S):1442
.
- Tifft CJ, Lederman HM. Immunization status of hospitalized preschool-age children.
Am J Dis Child. 1988;142
(7):719
–720[Abstract]
- Ginsburg C, Andrews W. Orthotopic hepatic transplantation for unimmunized children: a paradox of contemporary medical care.
Pediatr Infect Dis J. 1987;6
(8):764
–765[CrossRef][ISI][Medline]
- Vohr BR, Oh W. Age of diphtheria, tetanus, and pertussis immunization of special care nursery graduates.
Pediatrics. 1986;77
(4):569
–571[Abstract/Free Full Text]
- Kum-Nji P, James D, Herrod HG. Immunization status of hospitalized preschool children: risk factor associated with inadequate immunization.
Pediatrics. 1995;96
(3 pt 1):434
–438[Abstract/Free Full Text]
- Bell LM, Pritchard M, Anderko R, Levenson R. A program to immunize hospitalized preschool-aged children: evaluation and impact.
Pediatrics. 1997;100
(2 pt 1):192
–196[Abstract/Free Full Text]
- Conway SP. Opportunistic immunization in hospital.
Arch Dis Child. 1999;81
(5):422
–425[Abstract/Free Full Text]
- Stokley S, Rodewald LE, Maes EF. The impact of record scattering on the measurement of immunization coverage.
Pediatrics. 2001;107
(1):91
–96[Abstract/Free Full Text]
- American Academy of Pediatrics, Committee on Infectious Diseases. Varicella vaccine update.
Pediatrics. 2000;105
(1 pt 1):136
–141[Abstract/Free Full Text]
- American Academy of Pediatrics. Section 3: summary of infectious diseases: human immunodeficiency virus infection. In: Pickering LK, Baker CJ, Long SS, McMillian JA, eds.
Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:378–401
- Kingsley JD, Varman M, Chatterjee A, Kingsley RA, Roth KS. Immunizations for patients with metabolic disorders.
Pediatrics. 2006;118
(2). Available at: www.pediatrics.org/cgi/content/full/118/2/e460
- Zell ER, Ezzatti-Rice TM, Battaglia MP, Wright RA. National Immunization Survey: the methodology of a vaccination surveillance system.
Public Health Rep. 2000;115
(1):65
–77[CrossRef][ISI][Medline]
- Smith PJ, Battaglia MP, Huggins VJ, et al. Overview of the sampling design and statistical methods used in the National Immunization Survey.
Am J Prev Med. 2001;20
(4 suppl):17
–24[CrossRef][ISI][Medline]
- Research Triangle Institute.
SUDAAN Language Manual, Release 9.0. Research Triangle Park, NC: Research Triangle Institute; 2004
- Kim SS, Frimpong JA, Rivers PA, Kronenfeld JJ. Effects of maternal and provider characteristics on up-to-date immunization status of children aged 19 to 35 months.
Am J Public Health. 2007;97
(2):259
–266[Abstract/Free Full Text]
- Luman ET, McCauley MM, Shefer A, Chu SY. Maternal characteristics associated with vaccination of young children.
Pediatrics. 2003;111
(5 part 2):1215
–1218[Abstract/Free Full Text]
- Miller LA, Hoffman RE, Barón AE, Marine WM, Melinkovich P. Risk factors for delayed immunization against measles, mumps, and rubella in Colorado two-year-olds.
Pediatrics. 1994;94
(2 pt 1):213
–219[Abstract/Free Full Text]
- Bobo JK, Gale JL, Thapa PB, Wassilak SG. Risk factors for delayed immunization in a random sample of 1163 children from Oregon and Washington.
Pediatrics. 1993;91
(2):308
–314[Abstract/Free Full Text]
- Santoli JM, Huet NJ, Smith PJ, et al. Insurance status and vaccination coverage among U.S. preschool children.
Pediatrics. 2004;113
(6 suppl):1959
–1964[Abstract/Free Full Text]
- Smith PJ, Chu SY, Barker LE. Children who have received no vaccines: who are they and where do they live?
Pediatrics. 2004;114
(1):187
–195[Abstract/Free Full Text]
- Bates AS, Wolinsky FD. Personal, financial, and structural barriers to immunization in socioeconomically disadvantaged urban children.
Pediatrics. 1998;101
(4 pt 1):591
–596[Abstract/Free Full Text]
- Klevens RM, Luman ET. U.S. children living in and near poverty: risk of vaccine-preventable diseases.
Am J Prev Med. 2001;20
(4 suppl):41
–46[CrossRef][ISI][Medline]
- McKinney PA, Alexander FE, Nicholson C, Cartwright RA, Carrette J. Mothers' reports of childhood vaccinations and infections and their concordance with general practitioner records.
J Public Health Med. 1991;13
(1):13
–22[Abstract/Free Full Text]
- Zell E, Peak R, Rodewald L, Ezzati-Rice T. Reliability of vaccination cards and parent-derived information for determining immunization status: lessons from the 1994 National Health Interview Survey (NHIS) Provider Record Check (PRC) Study. Poster presented at the American Pediatric Society and the Society for Pediatric Research Meeting; May 2–6, 1997; Washington, DC
- Willis G, Brittingham A, Lee, L, Tourangeau R, Ching P. Response errors in surveys of children's immunizations. National Center for Health Statistics.
Vital Health Stat. 1999;6
(8):1
–56.
- Khare M, Battaglia MP, Huggins VJ, Stokley S, Hoaglin DC, Wright RA, Roden AS. Accuracy of vaccination dates reported by immunization providers in the National Immunization Survey.
Proceedings of the Survey Research Methods Section, American Statistical Association. 2000;665
–670
PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics
TOP
ABSTRACT
PREVIOUS RESEARCH
