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American Journal of Epidemiology Advance Access published online on January 18, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj074
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received March 8, 2005
Accepted November 16, 2005

ORIGINAL CONTRIBUTIONS

Assessment of Delay in Age-appropriate Vaccination Using Survival Analysis

Gustavo H. Dayan 1 *, Kate M. Shaw 2, Andrew L. Baughman 1, Liliana C. Orellana 3, Raúl Forlenza 4, Alejandro Ellis 4, Jorge Chaui 4, Silvia Kaplan 4, and Peter Strebel 5

1 Epidemiology and Surveillance Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA
2 Immunization Services Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA
3 School of Public Health, Harvard University, Boston, MA; School of Natural and Exact Sciences, Buenos Aires University, Buenos Aires, Argentina
4 Secretariat of Health, Buenos Aires, Argentina
5 Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA

* To whom correspondence should be addressed.
Gustavo H. Dayan, E-mail: gdayan{at}cdc.gov


  Abstract

Assessment of delay in age-appropriate vaccination provides more information about timeliness of vaccination than up-to-date vaccination coverage. The authors applied survival analysis methods to data from a vaccination coverage survey among children aged 13-59 months conducted in Argentina in 2002. By age 19 months, 43% of children (95% confidence interval (CI): 40, 46) were vaccinated with the fourth dose of diphtheria, tetanus, and pertussis (DTP4). By age 13 months, 55% of children (95% CI: 52, 57) were vaccinated with measles-containing vaccine. By age 7 months, 33% of children (95% CI: 27, 40) were vaccinated with the third dose of hepatitis B. Compared with firstborn children, third children were more likely to be delayed for DTP4 (relative risk (RR) = 1.41, 95% CI: 1.22, 1.62), measles-containing vaccine (RR = 1.54, 95% CI: 1.32, 1.78), and the third dose of hepatitis B (RR = 1.31, 95% CI: 1.03, 1.67). Children whose caregivers had completed secondary school were less likely to be delayed for DTP4 (RR = 0.68, 95% CI: 0.52, 0.90) compared with those whose caregivers had not completed primary school. Survival analysis methods were helpful in measuring vaccine uptake and should be considered in future surveys when assessing delay in age-appropriate vaccination.

Keywords: health surveys; immunization; preventive health services; survival analysis.
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