Interventions to “boost” implementation of vaccine recommendations

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It is remarkable that in resource-rich countries such as the United States and Europe, failure still exists to accomplish immunizations that are basic to protecting children’s health. In the current issue of The Journal, Muehleisin et al report a study of “reminder” interventions on the rate of catch-up immunization in underimmunized hospitalized infants, children and adolescents in Basel, Switzerland. Using a prospective intervention-control study design, parents (and patients when appropriate) were informed of lagging vaccinations during hospitalization and encouraged to receive catch-up doses soon after discharge. Additionally, within one week of discharge, primary providers were informed and encouraged similarly to administer needed vaccines.

A remarkable 49% of hospitalized children were underimmunized. One month following discharge, 27% in the intervention group versus 7% in the control group had received at least one catch-up immunization (P < 0.001). Regrettably, 8 months later, only 40% had received at least one catch-up immunization, with no significant difference between the intervention and control groups.

Although encouraging in one way (i.e., education and reminders for parents, patients and providers has impact), the study shows how woefully short of the goal we fall. The narrow age window of eligibility for the recently recommended rotavirus vaccine adds the need for real-time outreach to whomever it takes in whatever way it takes to fix this basic health care gap between what is good for children and what children get.