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Use of Combination Vaccines Is Associated With Improved Coverage Rates

Marshall, Gary S. MD*; Happe, Laura E. PharmD, MPH; Lunacsek, Orsolya E. PhD, MBA; Szymanski, Michael D. PhD; Woods, Charles R. MD, MPH*; Zahn, Matthew MD*; Russell, Argartha RN, MSA, CPH

The Pediatric Infectious Disease Journal: June 2007 - Volume 26 - Issue 6 - p 496-500
doi: 10.1097/INF.0b013e31805d7f17
Original Studies

Background: The number of shots represented by the routine childhood immunization schedule poses a logistical challenge for providers and a potential deterrent for parents. By reducing the number of injections, use of combination vaccines could lead to fewer deferred doses and improved coverage rates.

Objective: To determine the effect of combination vaccines on coverage rates.

Methods: This was a retrospective study of administrative claims data from the Georgia Department of Community Health Medicaid program conducted from January through September of 2003. Coverage rates were compared between children who received at least 1 dose of HepB/Hib (COMVAX) or DTaP/HepB/IPV (PEDIARIX) (the combination cohort) and children who received no doses of either combination (the reference cohort). Infants with fewer than 4 vaccination visits were excluded from the analysis. Multivariate logistic regression was performed on the whole study population to assess the effect of combination vaccines while controlling for potential confounders. Hepatitis B and pneumococcal conjugate vaccine coverage rates were not included as outcomes.

Results: The study population consisted of 18,821 infants, 16,007 in the combination cohort and 2814 in the reference cohort. Unadjusted coverage rates for DTaP, IPV and the 4 DTaP:3 IPV:1 MMR, 4 DTaP: 3 IPV: 1 MMR: 3 Hib: 1 varicella, and 3 DTaP:3 IPV: 3 Hib series were higher in the combination cohort. Receipt of at least 1 dose of a combination vaccine was independently associated with increased coverage for each of these vaccines and vaccine series when controlling for gender, birth quarter, race, rural versus urban residence and historical provider immunization quality.

Conclusions: Use of combination vaccines in this Medicaid population was associated with improved coverage rates. Additional studies are warranted, including those examining private sector populations and outcomes such as timeliness and cost.

From the *Division of Pediatric Infectious Diseases, University of Louisville School of Medicine, Louisville, KY; †Xcenda, Palm Harbor, FL; and ‡Georgia Department of Community Health Medicaid Program, Atlanta, GA.

Accepted for publication March 16, 2007.

Address for correspondence: Gary S. Marshall, MD, Division of Pediatric Infectious Diseases, University of Louisville School of Medicine, 571 S. Floyd St., Suite 321, Louisville, KY 40202. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.