title: Sick-visit immunizations and delayed well-baby visits.
abstract: OBJECTIVE
  Giving recommended immunizations during sick visits for minor and acute illness such as acute otitis media has long been an American Academy of Pediatrics/Advisory Committee on Immunization Practice recommendation. An addition to the American Academy of Pediatrics policy in 2010 advised considering whether giving immunizations at the sick visit would discourage making up missed well-baby visits. This study quantifies the potential tradeoff between sick-visit immunizations and well-baby visits.
  
  
  METHODS
  This study was a retrospective cohort analysis with a case-control component of sick visits for acute otitis media that supplanted normal well-baby visits at age 2, 4, or 6 months. Infants were stratified for sick-visit immunization, no sick-visit immunization but quick makeup well-baby visits, or no sick-visit immunizations or quick makeup visits. Immunization rates and well-baby visit rates were assessed through 24 months of age.
  
  
  RESULTS
  For 1060 study cases, no significant difference was detected in immunization rates or well-baby visits through 24 months of age between those with or without sick-visit immunizations. Thirty-nine percent of infants without a sick-visit shot failed to return for a quick makeup well-baby visit; this delayed group was significantly less likely to be up-to-date for immunizations (relative risk: 0.66) and had fewer well-baby visits (mean: 3.8) from 2 through 24 months of age compared with those with sick-visit shots (mean: 4.7).
  
  
  CONCLUSIONS
  The substantial risk that infants will not return for a timely makeup well-baby visit after a sick visit should be included in any consideration of whether to delay immunizations.
authors.affiliation: Immunization Program, Oregon Health Authority, Portland, OR, USA. steve.g.robison@state.or.us
authors.forename: Steve G
authors.initials: SG
authors.lastname: Robison
mesh_terms: D002662:Child Health Services / Q000706:statistics & numerical data*; D015331:Cohort Studies; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D008297:Male; D009922:Oregon; D010033:Otitis Media / Q000453:epidemiology* / Q000628:therapy*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010819:Physician's Role; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014600:Utilization Review / Q000706:statistics & numerical data
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines
keywords: early childhood immunizations; otitis media; sick-visit shots; well-baby visits