To assess vaccination status in a cohort of 2 year olds with access to health care at no cost and to delineate factors associated with failure to be fully vaccinated.
Retrospective cross-sectional study. Children not up-to-date on vaccinations by age 2 years compared with children up-to-date by medical record review. A telephone survey was conducted for those without medical records or whose records lacked complete documentation.
Large military tertiary care hospital.
A cohort of 844 children born between August 31, 1988, and September 1, 1989.
Main Outcome Measures:
Timeliness of vaccination, factors associated with undervaccination, number and nature of missed opportunities.
Best estimate of coverage with entire primary vaccination series was 72% by age 2 years. Attendance at military day care was associated with full vaccination (odds ratio [OR]=1.80, confidence interval [CI] =1.12 to 3.24) as was completion of well-baby visits. Increasing number of other visits did not predict full vaccination. Children followed up by family practice were more likely to be up-to-date than children followed up by pediatrics (OR=3.67, CI=1.47 to 9.73). Seventy-two percent of children who were not up-to-date had at least one missed opportunity for vaccination. If vaccinations had been offered at all visits, 93% of children could have been fully vaccinated by age 2 years.
Offering free vaccinations in a "barrierfree" system will not ensure vaccination levels of 90%. Health care providers should offer vaccinations during acute, non-well visits to improve coverage.(Arch Pediatr Adolesc Med. 1995;149:1130-1135)