title: Do missed opportunities stay missed? A 6-month follow-up of missed vaccine opportunities in inner city Milwaukee children.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective chart review with a nested retrospective cohort of children with MOs.
  
  
  METHODS
  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.
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Sabnis
authors.forename: A J
authors.initials: AJ
authors.lastname: Pomeranz
authors.forename: P S
authors.initials: PS
authors.lastname: Lye
authors.forename: M M
authors.initials: MM
authors.lastname: Amateau
mesh_terms: D002675:Child, Preschool; D000075202:Contraindications; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D016015:Logistic Models; D008910:Minnesota; D011204:Poverty Areas; D012189:Retrospective Studies; D014505:Urban Population; D014611:Vaccination / Q000706:statistics & numerical data*