title: Impact of the introduction of pneumococcal conjugate vaccine on immunization coverage among infants.
abstract: BACKGROUND
  The introduction of pneumococcal conjugate vaccine (PCV) to the U.S. recommended childhood immunization schedule in the year 2000 added three injections to the number of vaccinations a child is expected to receive during the first year of life. Surveys have suggested that the addition of PCV has led some immunization providers to move other routine childhood vaccinations to later ages, which could increase the possibility of missing these vaccines. The purpose of this study was to evaluate whether introduction of PCV affected immunization coverage for recommended childhood vaccinations among 13-month olds in four large provider groups.
  
  
  METHODS
  In this retrospective cohort study, we analyzed computerized data on vaccinations for 33,319 children in four large provider groups before and after the introduction of PCV. The primary outcome was whether the child was up to date for all non-PCV recommended vaccinations at 13 months of age. Logistic regression was used to evaluate the association between PCV introduction and the primary outcome. The secondary outcome was the number of days spent underimmunized by 13 months. The association between PCV introduction and the secondary outcome was evaluated using a two-part modelling approach using logistic and negative binomial regression.
  
  
  RESULTS
  Overall, 93% of children were up-to-date at 13 months, and 70% received all non-PCV vaccinations without any delay. Among the entire study population, immunization coverage was maintained or slightly increased from the pre-PCV to post-PCV periods. After multivariate adjustment, children born after PCV entered routine use were less likely to be up-to-date at 13 months in one provider group (Group C: OR = 0.5; 95% CI: 0.3-0.8) and were less likely to have received all vaccine doses without any delay in two Groups (Group B: OR = 0.4, 95% CI: 0.3 - 0.6; Group C: OR = 0.5, 95% CI: 0.4-0.7). This represented 3% fewer children in Group C who were up-to-date and 14% (Group C) to 16% (Group B) fewer children who spent no time underimmunized at 13 months after PCV entered routine use compared to the pre-PCV baseline. Some disruptions in immunization delivery were also observed concurrent with temporary recommendations to suspend the birth dose of hepatitis B vaccine, preceding the introduction of PCV.
  
  
  CONCLUSIONS
  These findings suggest that the introduction of PCV did not harm overall immunization coverage rates in populations with good access to primary care. However, we did observe some disruptions in the timely delivery of other vaccines coincident with the introduction of PCV and the suspension of the birth dose of hepatitis B vaccine. This study highlights the need for continued vigilance in coming years as the U.S. introduces new childhood vaccines and policies that may change the timing of existing vaccines.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care, Harvard Medical School, Boston, MA, USA. nlin@stanford.edu
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Lin
authors.forename: Ken
authors.initials: K
authors.lastname: Kleinman
authors.forename: K Arnold
authors.initials: KA
authors.lastname: Chan
authors.forename: Xian-Jie
authors.initials: XJ
authors.lastname: Yu
authors.forename: Eric K
authors.initials: EK
authors.lastname: France
authors.forename: Stanley
authors.initials: S
authors.lastname: Xu
authors.forename: Feifei
authors.initials: F
authors.lastname: Wei
authors.forename: John
authors.initials: J
authors.lastname: Mullooly
authors.forename: Jeanne
authors.initials: J
authors.lastname: Santoli
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
mesh_terms: D015331:Cohort Studies; D018073:Haemophilus Vaccines / Q000008:administration & dosage; D006279:Health Maintenance Organizations; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D016015:Logistic Models; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011008:Pneumococcal Infections / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D012189:Retrospective Studies; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D018073:Haemophilus Vaccines; D022242:Pneumococcal Vaccines