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1. Undervaccination is an increasing trend among US children, with alternative vaccination schedules becoming more popular.

2. Compared to age-appropriately vaccinated children, undervaccinated children access outpatient care less but inpatient care more.

This study reveals that undervaccination is a growing trend among children in the US. This may partially due to the increasing popularity of alternative regimens which delay scheduled vaccinations. The public health implications of these alternative regimens remain unclear, but the results of this large observational study suggest that children who are undervaccinated have different patterns of health care utilization than children who received age-appropriate vaccines. Due to the observational nature of the study, it is not possible to conclude that undervaccination causes the higher inpatient admission rates or lower outpatient utilization rates demonstrated in undervaccinated children. The diversity of children who are undervaccinated (ranging from those who experienced barriers to access care to those whose parents opted for an alternative vaccination regimen) also limits the conclusions that may be drawn from the study. However, the lower rates of outpatient visits among undervaccinated children does highlight an important barrier to studying the safety of alternative vaccination schedules.

Click to read the study in JAMA Pediatrics

This [retrospective matched cohort] study identified children born between 2004 and 2008 who were undervaccinated at eight managed care organizations, and created two matched cohorts: one with children undervaccinated for any reason and one with children undervaccinated because of parental choice. The health care utilization rates of these cohorts were compared to age-matched controls who were age-appropriately vaccinated. The study found that 48% of children born in the study period were undervaccinated, and 13% of these cases were due to parental choice. Overall, undervaccinated children access inpatient care at significantly higher rates and outpatient care at lower rates; though, among the subset of children who are undervaccinated due to parental choice, inpatient admission rates were not appreciably different from children who were age-appropriately vaccinated.

Further reading:

1. CDC: Immunization Schedules

2. Underimmunization Among Children: Effects of Vaccine Safety Concerns on Immunization Status

By [EK] and [MS]

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