DTaP combination vaccine use and adherence: A retrospective cohort study

• Published in: Vaccine Vol. 39; no. 7; pp. 1064 - 1071
• Main Authors: Loiacono, Matthew M., Pool, Vitali, van Aalst, Robertus
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 12.02.2021; Elsevier Limited
• Subjects: Adherence; Age; Allergy and Immunology; Birth; Children; Cohort analysis; cohort studies; Combination vaccines; Diphtheria; DTaP vaccine; gender; Immunization; Minority & ethnic groups; Pediatrics; Pertussis; Poliomyelitis; Schedules; socioeconomic status; Socioeconomics; Tetanus; Timeliness; Vaccine coverage; Vaccines; Whooping cough; United States > US; Hib; SES; Pediatrics; OR; Timeliness; DTaP vaccine; IPV; Combination vaccines; Adherence; Vaccine coverage; ACIP; NIS; DTaP; inactivated polio virus vaccine; odds ratio; the National Immunization Survey; the Advisory Committee on Immunization Practices; diphtheria, tetanus, acellular pertussis vaccine; Haemophilus influenzae type b; socioeconomic status
• ISSN: 0264-410X; 1873-2518; 1873-2518
• DOI: 10.1016/j.vaccine.2021.01.009

•DTaP combination vaccine receipt was associated with significantly greater adherence.•Adherence to the 4-dose DTaP series was significantly lower among minority children.•Children of lower socioeconomic status were less likely to be vaccinated on time. Despite universal recommendation of the 4-dose diphtheria, tetanus, and pertussis (DTaP) vaccine series, coverage and timeliness in the US remain suboptimal. DTaP-containing combination vaccines (i.e. quadrivalent and pentavalent) are presumed to improve vaccine coverage rates and timeliness, but research supporting this claim is limited. We sought to investigate the associations between DTaP-containing vaccine use and adherence to the recommended DTaP immunization schedule among children in the US. Using a large claims database, we identified privately insured children born between 2009 and 2016 that received ≥1 DTaP-containing vaccine and had ≥24 months of enrollment from birth, excluding those with DTaP vaccinations not aligned with approved dose indications. Children were classified by DTaP-containing vaccine receipt: combination vaccines only, stand-alone vaccines only, or a mixture of both. Outcome measures included: 1) completion of the 4-dose series and 2) timely receipt of doses. Outcomes were adjusted for gender, birth year, race, and socioeconomic status. The study cohort contained 412,441 children. Of these, 40.5% (167,084) received combination vaccines only, 14.9% (61,342) received stand-alone vaccines only, and 44.6% (184,015) received a mixture of both. Combination vaccine recipients were nearly 3 times as likely to complete the 4-dose series (OR 2.93 (95% CI: 2.88, 2.99)) and for all doses received, more than 4 times as likely to receive doses on time (OR 4.12 (4.04, 4.21), relative to stand-alone vaccine recipients. Significance disparities in adherence were also observed, where minorities were up to 30% less likely (OR 0.70 (0.68, 0.71)) to complete the 4-dose series and up to 27% less likely (OR 0.73 (0.72, 0.75)) to receive doses on time, relative to white children. Our findings demonstrated that adherence to the recommended DTaP immunization schedule was significantly greater among combination vaccine recipients, relative to stand-alone recipients. Further research is needed to investigate underlying causes of disparities in adherence.