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Clinical Pediatrics
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Inadequate Immunizations

Identification Using Clinic Charts

Terri J. Hymel, M.D.

Center for Ambulatory Research and Education Department of Pediatrics University of Arkansas for Medical Sciences Arkansas Children's Hospital Little Rock, Arkansas

Joseph Sherman, M.D.

Children's National Medical Center The George Washington University Medical Center Washington, DC

Sandra K. Pope, M.P.H.

Center for Ambulatory Research and Education Department of Pediatrics University of Arkansas for Medical Sciences Arkansas Children's Hospital Little Rock, Arkansas

Kelly J. Kelleher, M.D., M.P.H.

Center for Ambulatory Research and Education Department of Pediatrics University of Arkansas for Medical Sciences Arkansas Children's Hospital Little Rock, Arkansas

Immunizations are cost-effective measures for assuring public health. However, recent outbreaks of measles, mumps, and pertussis underscore the inadequacy of current immunization programs. A model identifying those children who are likely to be inadequately immunized could focus the use of limited health funds. A retrospective examination of the medical charts of 101 children in a large inner-city clinic was undertaken to determine if specific factors were associated with inadequate immunization status. Fifty percent of the children were inadequately immunized by 18 months of age (no measles-mumps-rubella or fewer than three diphtheria-pertussis-tetanus vaccinations). Logistic regression analyses showed that older maternal age, no recurrent or chronic illnesses, and vaginal delivery were independently associated with inadequate immunization status. However, on many charts, information on maternal, social, and environmental variables was incomplete. The increasing use of structured medical charts will enhance data collection and the determination of an appropriate index. A prospective study of the variables identified, along with standardization of medical records and inclusion of social history data, is necessary to further investigate the utility of screening criteria for inadequate immunizations.

Clinical Pediatrics, Vol. 32, No. 3, 156-160 (1993)
DOI: 10.1177/000992289303200306
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