title: Do too many shots due lead to missed vaccination opportunities? Does it matter?
abstract: BACKGROUND
  Missed childhood vaccination opportunities have been generally described, yet not since the immunization schedule's recent rapid expansion. Little is known about the relationship between the number of vaccine doses due and whether all scheduled doses are administered, and the effect of dose deferral on immunization coverage.
  
  
  METHODS
  32 private pediatrics centers reviewed medical records covering the first 2 years of life for 858 patients. For each visit during ages 2-8 months, we determined the numbers of vaccine doses due versus administered. Logistic regression was used to assess the effect of dose deferral on immunization coverage at ages 1 and 2 years.
  
  
  RESULTS
  Of 2224 visits during ages 2-8 months at which > or =1 dose was administered, > or =1 due dose was deferred at 26%, 34%, and 48% of the visits at which < or =3, 4, and 5 doses were due, respectively. Absence of a deferred dose visit predicted increased coverage at age 1 (adjusted odds ratio: 2.4, 95% confidence interval: 1.8-3.2) and 2 years (2.1, 1.4-3.0).
  
  
  CONCLUSIONS
  Administering some but not all vaccine doses at visits during ages 2-8 months impairs immunization coverage through age 2 years.
authors.affiliation: Capitol Outcomes Research, Inc., 6188 Old Franconia Road, Alexandria, VA 22310, USA. Allen.Meyerhoff@CapitolOutcomesResearch.com
authors.forename: A S
authors.initials: AS
authors.lastname: Meyerhoff
authors.forename: R J
authors.initials: RJ
authors.lastname: Jacobs
mesh_terms: D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D008297:Male; D010349:Patient Compliance; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*