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This Month in Archives of Pediatrics and Adolescent Medicine
May 04, 2009

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2009;163(5):407. doi:10.1001/archpediatrics.2009.55
Progress in Timely Vaccination Coverage Among Children Living in Low-Income Households

Two ongoing issues with obtaining complete vaccination coverage in all children are obtaining timely vaccination and increasing vaccination levels in children from low-income families. In this study, timely vaccination coverage among low-income children increased during the 13-year period for all vaccines except for Haemophilus influenzae type b. There were substantial disparities in vaccination coverage between children from low-income and those not from low-income households. These disparities decreased for every birth cohort in the study period for measles, mumps, rubella; hepatitis B; and varicella vaccines but increased for the diphtheria, tetanus, pertussis vaccine. Further progress in eliminating these disparities will require multifaceted interventions focused on providers, parents, and financing.

Estimated vaccination coverage by age 19 months for 4 or more doses of the diphtheria, tetanus, pertussis vaccine (DTap-DTP) by annual birth cohort. Asterisk indicates a significantly lower estimated timely vaccination coverage rate for low-income (≤133% FPL) or middle-income (134%-399% FPL) children compared with high-income (≥400% FPL) children for the annual birth cohort designated on the x-axis; FPL, federal poverty level.

Estimated vaccination coverage by age 19 months for 4 or more doses of the diphtheria, tetanus, pertussis vaccine (DTap-DTP) by annual birth cohort. Asterisk indicates a significantly lower estimated timely vaccination coverage rate for low-income (≤133% FPL) or middle-income (134%-399% FPL) children compared with high-income (≥400% FPL) children for the annual birth cohort designated on the x-axis; FPL, federal poverty level.

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Strategies for Vaccination of Close Contacts and Expectant Parents of Infants: The Next Immunization Frontier for Pediatricians

Infants younger than 6 months are particularly susceptible to vaccine-preventable diseases like influenza and pertussis. The source of these infections is usually adult or sibling contacts in the household. One approach has been the vaccination of pregnant women and their partners by their adult providers. However, this approach has resulted in only 30% of pregnant women receiving the influenza vaccine. Shah suggests that to protect the young infant within a “cocoon” of immunity, pediatricians should shoulder the responsibility of immunizing adults in the household. Further examination of this and other strategies are needed to optimize the protection available from our current vaccines.

A schematic view of strategies to immunize contacts of newborns. Expectant parents have multiple opportunities throughout the antepartum and postpartum period to obtain immunization.

A schematic view of strategies to immunize contacts of newborns. Expectant parents have multiple opportunities throughout the antepartum and postpartum period to obtain immunization.

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Potential Impact of Accelerating the Primary Dose of Pneumococcal Conjugate Vaccine in Infants

Although many groups recommend administering the pneumococcal vaccine to infants starting at 2 months of age, it is permissible to start immunization as early as 6 weeks, thereby giving susceptible infants earlier protection. In this decision analysis, the projected rates of invasive pneumococcal disease among infants aged 61 to 90 days would be reduced by 39% to 72% if vaccination began at 6 weeks of age, depending on expected vaccine efficacy. This reduction in particularly devastating diseases like pneumococcal meningitis may be especially important for groups at high risk of such infections. Because other immunizations can also be started at 6 weeks, an accelerated vaccination schedule would not require additional well-child care visits or increased health care use.

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Effects of a Minimum Interval Immunization Schedule for DTaP During a Pertussis Outbreak

During pertussis outbreaks in a community, shortening the minimum interval between doses of diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) to 4 weeks can provide increased protection against pertussis in vulnerable infants. The effect of such an accelerated schedule on other vaccinations is unknown. Analyzing data from a pertussis outbreak in Arizona in 2005, Bronson-Lowe and Anderson found that children immunized according to the minimum interval schedule during the outbreak were more likely to receive 3 doses of DTaP, 3 doses of inactivated polio vaccine, and 3 doses of pneumococcal conjugate vaccine than those immunized on a standard schedule. Based on these findings, implementation of the minimum interval DTaP vaccination schedule should be considered in order to increase vaccination rates among susceptible individuals during a pertussis outbreak.

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