The article by Feikema and colleagues1
in this issue of THE JOURNAL suggests that extraimmunization of children occurs
considerably more often than previously appreciated. Using data from the National
Immunization Survey, Feikema et al examined the immunization histories of
more than 22,000 children aged between 19 and 35 months. The National Immunization
Survey used 2 steps to collect information: in the first, parents with eligible
children were identified, and in the second, the child's immunization records
were obtained from their health care provider. The proportion of children
who received extra immunization doses ranged, by individual vaccine, from
2.5% for measles-containing vaccine to more than 14% for poliovirus vaccine.
Taken together, up to 21% of all children were reported to have received at
least 1 extra immunization before their third birthday. In the multivariate
analysis of risk factors for extraimmunization, Feikema and colleagues found
that children with more than 1 health care provider were almost 3 times more
likely to be extraimmunized compared with children with a single provider.
Extraimmunization not only wastes vaccine, money, and labor, but unnecessary
doses add to a child's stress and discomfort, increase the risk for adverse
events following vaccination, and may lead to confusion among parents and
health care providers about what vaccines have, and have not, actually been
administered. The authors conclude that more attention needs to be focused
on the problem of duplicate immunization.
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