Infant, maternal and demographic predictors of delayed vaccination

A population-based cohort study

Heather F. Gidding, Lloyd K. Flack, S. Sheridan, B. Liu, P. Fathima, V. Sheppeard, P. Richmond, Brynley Hull, C. Blyth, Ross M. Andrews, Thomas L. Snelling, Nicholas de Klerk, Peter B. McIntyre, Hannah C. Moore, H. Gidding, H. Moore, P. McIntyre, N. de Klerk, B. Liu, C. Blyth & 12 others T. Snelling, K. Edmond, L. Jorm, P. Effler, P. Richmond, R. Menzies, R. Andrews, T. Joseph, V. Sheppeard, B. Hull, S. Sheridan, P. Fathima

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Receiving vaccines at or close to their due date (vaccination timeliness) is a now key measure of program performance. However, studies comprehensively examining predictors of delayed infant vaccination are lacking. We aimed to identify predictors of short and longer-term delays in diphtheria-tetanus-pertussis (DTP) vaccination by dose number and ethnicity.

    Methods: Perinatal, notification, death and immunisation databases were linked for 1.3 million births in 2000–11 from two Australian states (Western Australia and New South Wales), with follow-up data until 2013. Ordinal logistic regression was used to estimate adjusted relative risks (RR) by degree of delay. Separate models were constructed for each vaccine dose and for Aboriginal and non-Aboriginal children.

    Results: Each dose-specific cohort included at least 49,000 Aboriginal and 1.1 million non-Aboriginal children. Delayed receipt was more common among Aboriginal than non-Aboriginal children (eg for the first dose of DTP [DTP1] 19.4 v 8.1%). Risk factors for delayed vaccination were strongest for DTP1, and delayed receipt of DTP1 was a key driver of subsequent delays; every week DTP1 was delayed was associated with a 1.6 to 2-fold increased risk of delayed DTP2 receipt. For DTP1, ≥3 previous pregnancies (the only factor more strongly associated with longer than shorter delays; RR ≥5 compared to no previous pregnancies), and children born to mothers <20 years of age (RR ≥2 compared to ≥35 years) were at highest risk of delay. Other independent predictors were prematurity, maternal smoking during pregnancy, and being born in Western Australia (if Aboriginal) or another country in the Oceania region.

    Conclusion: The sub-populations at risk for delayed vaccination we have identified are likely generalisable to other high-income settings. Measures to improve their dose 1 timeliness, particularly for children with older siblings, are likely to have significant flow-on benefits for timeliness of later doses.

    Original languageEnglish
    Pages (from-to)1-8
    Number of pages8
    JournalVaccine
    DOIs
    Publication statusE-pub ahead of print - 15 Oct 2019

    Fingerprint

    cohort studies
    Vaccination
    Cohort Studies
    demographic statistics
    vaccination
    Mothers
    Demography
    relative risk
    dosage
    Western Australia
    Diphtheria
    Whooping Cough
    Population
    Tetanus
    whooping cough
    Pregnancy
    tetanus
    pregnancy
    Vaccines
    Oceania

    Cite this

    Gidding, H. F., Flack, L. K., Sheridan, S., Liu, B., Fathima, P., Sheppeard, V., ... Fathima, P. (2019). Infant, maternal and demographic predictors of delayed vaccination: A population-based cohort study. Vaccine, 1-8. https://doi.org/10.1016/j.vaccine.2019.09.091
    Gidding, Heather F. ; Flack, Lloyd K. ; Sheridan, S. ; Liu, B. ; Fathima, P. ; Sheppeard, V. ; Richmond, P. ; Hull, Brynley ; Blyth, C. ; Andrews, Ross M. ; Snelling, Thomas L. ; de Klerk, Nicholas ; McIntyre, Peter B. ; Moore, Hannah C. ; Gidding, H. ; Moore, H. ; McIntyre, P. ; de Klerk, N. ; Liu, B. ; Blyth, C. ; Snelling, T. ; Edmond, K. ; Jorm, L. ; Effler, P. ; Richmond, P. ; Menzies, R. ; Andrews, R. ; Joseph, T. ; Sheppeard, V. ; Hull, B. ; Sheridan, S. ; Fathima, P. / Infant, maternal and demographic predictors of delayed vaccination : A population-based cohort study. In: Vaccine. 2019 ; pp. 1-8.
    @article{6997936081fa47308c09d50dfa8af0ad,
    title = "Infant, maternal and demographic predictors of delayed vaccination: A population-based cohort study",
    abstract = "Background: Receiving vaccines at or close to their due date (vaccination timeliness) is a now key measure of program performance. However, studies comprehensively examining predictors of delayed infant vaccination are lacking. We aimed to identify predictors of short and longer-term delays in diphtheria-tetanus-pertussis (DTP) vaccination by dose number and ethnicity. Methods: Perinatal, notification, death and immunisation databases were linked for 1.3 million births in 2000–11 from two Australian states (Western Australia and New South Wales), with follow-up data until 2013. Ordinal logistic regression was used to estimate adjusted relative risks (RR) by degree of delay. Separate models were constructed for each vaccine dose and for Aboriginal and non-Aboriginal children. Results: Each dose-specific cohort included at least 49,000 Aboriginal and 1.1 million non-Aboriginal children. Delayed receipt was more common among Aboriginal than non-Aboriginal children (eg for the first dose of DTP [DTP1] 19.4 v 8.1{\%}). Risk factors for delayed vaccination were strongest for DTP1, and delayed receipt of DTP1 was a key driver of subsequent delays; every week DTP1 was delayed was associated with a 1.6 to 2-fold increased risk of delayed DTP2 receipt. For DTP1, ≥3 previous pregnancies (the only factor more strongly associated with longer than shorter delays; RR ≥5 compared to no previous pregnancies), and children born to mothers <20 years of age (RR ≥2 compared to ≥35 years) were at highest risk of delay. Other independent predictors were prematurity, maternal smoking during pregnancy, and being born in Western Australia (if Aboriginal) or another country in the Oceania region. Conclusion: The sub-populations at risk for delayed vaccination we have identified are likely generalisable to other high-income settings. Measures to improve their dose 1 timeliness, particularly for children with older siblings, are likely to have significant flow-on benefits for timeliness of later doses.",
    keywords = "Data linkage, Diphtheria-tetanus-pertussis vaccine, Population, Vaccine timeliness",
    author = "Gidding, {Heather F.} and Flack, {Lloyd K.} and S. Sheridan and B. Liu and P. Fathima and V. Sheppeard and P. Richmond and Brynley Hull and C. Blyth and Andrews, {Ross M.} and Snelling, {Thomas L.} and {de Klerk}, Nicholas and McIntyre, {Peter B.} and Moore, {Hannah C.} and H. Gidding and H. Moore and P. McIntyre and {de Klerk}, N. and B. Liu and C. Blyth and T. Snelling and K. Edmond and L. Jorm and P. Effler and P. Richmond and R. Menzies and R. Andrews and T. Joseph and V. Sheppeard and B. Hull and S. Sheridan and P. Fathima",
    year = "2019",
    month = "10",
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    doi = "10.1016/j.vaccine.2019.09.091",
    language = "English",
    pages = "1--8",
    journal = "Vaccine",
    issn = "0264-410X",
    publisher = "Elsevier",

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    Gidding, HF, Flack, LK, Sheridan, S, Liu, B, Fathima, P, Sheppeard, V, Richmond, P, Hull, B, Blyth, C, Andrews, RM, Snelling, TL, de Klerk, N, McIntyre, PB, Moore, HC, Gidding, H, Moore, H, McIntyre, P, de Klerk, N, Liu, B, Blyth, C, Snelling, T, Edmond, K, Jorm, L, Effler, P, Richmond, P, Menzies, R, Andrews, R, Joseph, T, Sheppeard, V, Hull, B, Sheridan, S & Fathima, P 2019, 'Infant, maternal and demographic predictors of delayed vaccination: A population-based cohort study', Vaccine, pp. 1-8. https://doi.org/10.1016/j.vaccine.2019.09.091

    Infant, maternal and demographic predictors of delayed vaccination : A population-based cohort study. / Gidding, Heather F.; Flack, Lloyd K.; Sheridan, S.; Liu, B.; Fathima, P.; Sheppeard, V.; Richmond, P.; Hull, Brynley; Blyth, C.; Andrews, Ross M.; Snelling, Thomas L.; de Klerk, Nicholas; McIntyre, Peter B.; Moore, Hannah C.; Gidding, H.; Moore, H.; McIntyre, P.; de Klerk, N.; Liu, B.; Blyth, C.; Snelling, T.; Edmond, K.; Jorm, L.; Effler, P.; Richmond, P.; Menzies, R.; Andrews, R.; Joseph, T.; Sheppeard, V.; Hull, B.; Sheridan, S.; Fathima, P.

    In: Vaccine, 15.10.2019, p. 1-8.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Infant, maternal and demographic predictors of delayed vaccination

    T2 - A population-based cohort study

    AU - Gidding, Heather F.

    AU - Flack, Lloyd K.

    AU - Sheridan, S.

    AU - Liu, B.

    AU - Fathima, P.

    AU - Sheppeard, V.

    AU - Richmond, P.

    AU - Hull, Brynley

    AU - Blyth, C.

    AU - Andrews, Ross M.

    AU - Snelling, Thomas L.

    AU - de Klerk, Nicholas

    AU - McIntyre, Peter B.

    AU - Moore, Hannah C.

    AU - Gidding, H.

    AU - Moore, H.

    AU - McIntyre, P.

    AU - de Klerk, N.

    AU - Liu, B.

    AU - Blyth, C.

    AU - Snelling, T.

    AU - Edmond, K.

    AU - Jorm, L.

    AU - Effler, P.

    AU - Richmond, P.

    AU - Menzies, R.

    AU - Andrews, R.

    AU - Joseph, T.

    AU - Sheppeard, V.

    AU - Hull, B.

    AU - Sheridan, S.

    AU - Fathima, P.

    PY - 2019/10/15

    Y1 - 2019/10/15

    N2 - Background: Receiving vaccines at or close to their due date (vaccination timeliness) is a now key measure of program performance. However, studies comprehensively examining predictors of delayed infant vaccination are lacking. We aimed to identify predictors of short and longer-term delays in diphtheria-tetanus-pertussis (DTP) vaccination by dose number and ethnicity. Methods: Perinatal, notification, death and immunisation databases were linked for 1.3 million births in 2000–11 from two Australian states (Western Australia and New South Wales), with follow-up data until 2013. Ordinal logistic regression was used to estimate adjusted relative risks (RR) by degree of delay. Separate models were constructed for each vaccine dose and for Aboriginal and non-Aboriginal children. Results: Each dose-specific cohort included at least 49,000 Aboriginal and 1.1 million non-Aboriginal children. Delayed receipt was more common among Aboriginal than non-Aboriginal children (eg for the first dose of DTP [DTP1] 19.4 v 8.1%). Risk factors for delayed vaccination were strongest for DTP1, and delayed receipt of DTP1 was a key driver of subsequent delays; every week DTP1 was delayed was associated with a 1.6 to 2-fold increased risk of delayed DTP2 receipt. For DTP1, ≥3 previous pregnancies (the only factor more strongly associated with longer than shorter delays; RR ≥5 compared to no previous pregnancies), and children born to mothers <20 years of age (RR ≥2 compared to ≥35 years) were at highest risk of delay. Other independent predictors were prematurity, maternal smoking during pregnancy, and being born in Western Australia (if Aboriginal) or another country in the Oceania region. Conclusion: The sub-populations at risk for delayed vaccination we have identified are likely generalisable to other high-income settings. Measures to improve their dose 1 timeliness, particularly for children with older siblings, are likely to have significant flow-on benefits for timeliness of later doses.

    AB - Background: Receiving vaccines at or close to their due date (vaccination timeliness) is a now key measure of program performance. However, studies comprehensively examining predictors of delayed infant vaccination are lacking. We aimed to identify predictors of short and longer-term delays in diphtheria-tetanus-pertussis (DTP) vaccination by dose number and ethnicity. Methods: Perinatal, notification, death and immunisation databases were linked for 1.3 million births in 2000–11 from two Australian states (Western Australia and New South Wales), with follow-up data until 2013. Ordinal logistic regression was used to estimate adjusted relative risks (RR) by degree of delay. Separate models were constructed for each vaccine dose and for Aboriginal and non-Aboriginal children. Results: Each dose-specific cohort included at least 49,000 Aboriginal and 1.1 million non-Aboriginal children. Delayed receipt was more common among Aboriginal than non-Aboriginal children (eg for the first dose of DTP [DTP1] 19.4 v 8.1%). Risk factors for delayed vaccination were strongest for DTP1, and delayed receipt of DTP1 was a key driver of subsequent delays; every week DTP1 was delayed was associated with a 1.6 to 2-fold increased risk of delayed DTP2 receipt. For DTP1, ≥3 previous pregnancies (the only factor more strongly associated with longer than shorter delays; RR ≥5 compared to no previous pregnancies), and children born to mothers <20 years of age (RR ≥2 compared to ≥35 years) were at highest risk of delay. Other independent predictors were prematurity, maternal smoking during pregnancy, and being born in Western Australia (if Aboriginal) or another country in the Oceania region. Conclusion: The sub-populations at risk for delayed vaccination we have identified are likely generalisable to other high-income settings. Measures to improve their dose 1 timeliness, particularly for children with older siblings, are likely to have significant flow-on benefits for timeliness of later doses.

    KW - Data linkage

    KW - Diphtheria-tetanus-pertussis vaccine

    KW - Population

    KW - Vaccine timeliness

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    U2 - 10.1016/j.vaccine.2019.09.091

    DO - 10.1016/j.vaccine.2019.09.091

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    JO - Vaccine

    JF - Vaccine

    SN - 0264-410X

    ER -