Military children experience unique barriers to timely vaccination
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Key takeaways:
- Overall, 74.4% of children had completed the combined seven-vaccine series.
- Being born outside the U.S. and changing well-child care locations increased the risk for noncompletion.
Vaccine coverage among military children is higher than the national average, but there are unique barriers that prevent military children from receiving their childhood vaccinations on time, according to findings published in Pediatrics.
As Healio previously reported, routine childhood immunizations prevented an estimated 1.1 million deaths over the last 30 years, but children who are uninsured or living below the poverty level were less likely to have completed their combined seven-vaccine series on time.
“Many structural barriers to immunization remain, including lack of access to affordable well-child care, inconvenient office times and difficulty tracking vaccine schedules,” Celeste J. Romano, MS, from the Deployment Health Research Department at the Naval Health Research Center in San Diego, and colleagues wrote. “Despite few financial barriers to care, military beneficiaries might have difficulty finding a provider that accepts TRICARE, the military health insurance plan, and experience frequent work-related moves and stringent workplace schedules that reduce opportunities for vaccination.”
Romano and colleagues tracked vaccination coverage for 275,967 children of military members who were born from 2010 to 2019, attended annual well-child visits at a military treatment facility and were continuously enrolled in TRICARE.
The researchers analyzed individual and combined coverage of vaccines for diphtheria, tetanus and pertussis; polio; measles, mumps and rubella; Haemophilus influenzae type b; hepatitis B; varicella and pneumonia by age 24 months. They also evaluated rotavirus vaccine coverage separately.
Overall, 74.4% of children in the study had completed the combined seven-vaccine series, 36.2% of whom experienced delays. Vaccine coverage was highest for polio (95%) and lowest for rotavirus (77.5%).
More children completed the combined seven-vaccine series by age 2 years over time, with the highest risk for noncompletion among children born from 2010 through 2011 (adjusted RR = 1.44; 95% CI, 1.41-1.47). The researchers noted that the COVID-19 pandemic disrupted routine vaccinations among children born from 2018 through 2019.
Other factors that increased the risk for noncompletion included being born outside the United States (aRR = 1.08; 95% CI, 1.06-1.11) and changing well-child care locations (aRR = 1.1; 95% CI, 1,09-1.12). Factors associated with noncompletion also increased the risk for delayed completion, the researchers wrote.
In a related commentary, Courtney A. Judd, MPH, MHPE, Col (Ret), USAF, LCDR, and Meaghan S. Wido, MD, MC, USN, from the department of pediatrics at Uniformed Services University of Health Sciences in Bethesda, Maryland, wrote that military children encounter unique barriers to timely vaccination. Those on TRICARE must find a new primary care manager after relocating, and nearly two-thirds of children in the study relocated before their second birthday, they wrote.
Children of active-duty military members may have to live with family or friends while their parents are deployed, which can also hinder continuity of care, Judd and Wido explained.
One variable that was not accounted for in this study was parental vaccine hesitancy, something Judd and Wido said could be another barrier to higher vaccine coverage.
“One especially unique facet of military life that ties directly to the current work of Romano [and colleagues] is that service members are subject to mandatory vaccination against commonly encountered infectious diseases,” they wrote. “Anecdotally, vaccine refusals and hesitancy are less common among military families than in the general population.”
Romano and colleagues recommended several solutions to improve timely vaccination of military children, including using shorter vaccine series, administering multiple vaccines at the same visit and establishing a Military Health System immunization registry that follows children to any health care setting.
References:
- Judd CA, et al. Pediatrics. 2024;doi:10.1542/peds.2024-067123.
- Romano CJ, et al. Pediatrics. 2024;doi:10.1542/peds.2023-064965.
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