| Abstract | BACKGROUND: In 2003, a pentavalent vaccine (diphtheria, tetanus and acellular pertussis, injectable polio and hepatitis B) was introduced into the childhood vaccination schedule. A premarketing study showed a higher incidence of fever than with the vaccines administered separately. Because fevers in young infants prompt medical evaluations, this study examines the impact of this vaccine (DTaP-IPV-HB) on subsequent use of health services. METHODS: We compared use of health services among 6- to 10-week-old infants receiving DTaP-IPV-HB (n = 1776) with a historical control receiving the prior schedule (n = 2162) at an inner-city practice network. Data sources included a hospital immunization registry and medical records. Outcome measures were visits to the emergency department and ambulatory practices, fever, tests, antibiotics and hospitalizations. Outcomes were stratified by age (<8, 8-10 weeks) and days since vaccination (3, 7). RESULTS: Infants vaccinated with DTaP-IPV-HB were more likely to visit the ED (1.2% versus 0.6%, P = 0.03) and receive tests (47.6% versus 8.3%, P = 0.03) within 3 days of vaccination compared with the controls. Multivariate analysis showed infants vaccinated with DTaP-IPV-HB had a 7-fold increased risk of receiving a full sepsis workup and a 3-fold increased risk of receiving antibiotics within 7 days of vaccination. Medical evaluations decreased over time after implementation of the DTaP-IPV-HB vaccine. Concurrently, the rate of vaccination for infants <8 weeks markedly dropped. CONCLUSIONS: The DTaP-IPV-HB vaccine was associated with increased use of health services in the emergency department, but these associations lessened over time. These findings reveal a conflict between the obligation of timely and efficient vaccination with the medical management of febrile young infants. |
| Authors | Lindsay A Thompson, Matilde Irigoyen, L Adriana Matiz, Philip S LaRussa, Shaofu Chen, Frank Chimkin
(Affiliation: Division of General Pediatrics, University of Florida, Gainesville, FL 32608, USA. lathompson at peds.ufl.edu)
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| Journal | The Pediatric infectious disease journal
(Pediatr Infect Dis J)
Vol. 25
Issue 9
Pg. 826-31
(Sep 2006)
ISSN: 0891-3668 United States |
| PMID | 16940842
(Publication Type: Journal Article)
|
| Chemical References |
- Diphtheria-Tetanus-acellular Pertussis Vaccines
- Hepatitis B Vaccines
- Poliovirus Vaccine, Inactivated
- Vaccines, Combined
|
| Topics |
- Diphtheria-Tetanus-acellular Pertussis Vaccines
(administration & dosage, adverse effects)
- Female
- Fever
(etiology)
- Hepatitis B Vaccines
(administration & dosage, adverse effects)
- Humans
- Infant
- Male
- Poliovirus Vaccine, Inactivated
(administration & dosage, adverse effects)
- Vaccination
(adverse effects, methods)
- Vaccines, Combined
(administration & dosage, adverse effects)
|
