Introduction
The Advisory Committee on Immunization Practices recommends administering the first
dose of hepatitis B vaccine at birth, making it the first vaccine that many children
receive. However, few studies examine whether children who miss the birth dose are
at increased risk of vaccination delay. This study investigates birth dose as a determinant
of up-to-date immunization status at age 18 months, considering 7 core childhood vaccine
series: diphtheria, tetanus, and acellular pertussis; polio; measles, mumps, and rubella;
Haemophilus influenzae type B; varicella; hepatitis B; and pneumococcal conjugate vaccine.
Methods
Cross-sectional data were collected in 2017 by National Immunization Survey-Child,
a nationally representative survey of children aged 19–35 months living in the U.S.,
and were analyzed in 2019. The primary outcome was combined 7-vaccine series (4:3:1:3:3:1:4)
up-to-date status at 18 months. Doubly robust estimates of association were calculated
using survey logistic regression and propensity scores estimated with boosted classification
and regression trees.
Results
Children who received the birth dose had 2.01 (95% CI=1.74, 2.33) times the odds of
being up-to-date on the combined 7-vaccine series as children who did not. ORs for
all the 7 individual vaccine series were positive, ranging from 1.59 (95% CI=1.28,
1.97) for measles, mumps, and rubella to 4.97 (95% CI=3.97, 6.24) for hepatitis B.
Conclusions
Receiving the birth dose is positively associated with up-to-date status later in
childhood, highlighting the importance of starting vaccination early. The association
is insensitive to confounding by factors observed in National Immunization Survey-Child,
but investigation of unobserved factors such as vaccine hesitancy could provide critical
information to guide intervention strategy.
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© 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
