A PROGRAM TO IMMUNIZE HOSPITALIZED PRESCHOOL-AGED CHILDREN - EVALUATION AND IMPACT

Objective. The Standards for Pediatric Immunization Practices suggest that hospitalization be viewed as an opportunity to vaccinate children . The purpose of the present study is 1) to determine the immunization status of an urban population of hospitalized preschool-aged children , 2) to study the impact of an immunization program designed to vaccin ate hospitalized 0 to 2-year-old children who are underimmunized at ad mission, and 3) to make immunization a routine part of care for the ho spitalized child. Methods. Prospective evaluation of the immunization status of hospitalized 0 to 2-year-old residents of Philadelphia admit ted to an urban children's hospital was performed. With verification o f the child's immunization record through the primary care provider (P CP), needed immunizations were given and records were forwarded to not ify the PCP. Educational information was provided to families and heal th care providers. Main Outcome Measure. The percentage of children fu lly immunized on admission compared with the percentage at the time of discharge. Results. Two thousand three hundred twenty-nine children f rom 0 to 2 years of age were hospitalized during the 22-month study pe riod. Immunization records were verified in 86% (2006), requiring an a verage of 1.5 phone calls to the PCP. The mean patient age was 10 mont hs. Average hospital length of stay was 4 days. On admission, 49% (980 ) of the 2006 study patients were fully immunized. The remaining 51% ( 1026) were eligible for vaccination. Immunizations were delayed greate r than or equal to 2 months in 18% (355) of the children. Neither type of health care insurance nor site of primary care affected the immuni zation status of those evaluated at the time of admission. Sixty-six p ercent (N = 674) of eligible patients received at least one vaccinatio n before hospital discharge. Medical contraindications accounted for o nly 4% of the reasons eligible patients were not immunized. Of the 200 6 children evaluated, the percentage of those fully vaccinated for age increased significantly from 44% on admission to 70% on discharge. Co nclusion. As a result of this program, there was a significant improve ment in vaccination percentage at the time of hospital discharge in th is group of urban preschool-aged children. The development of an immun ization program to vaccinate hospitalized preschool children is an opp ortunity to immunize in the urban setting where there is a high preval ence of underimmunization. In addition, it provides an opening for edu cational programs for families, nurses, and housestaff and linkage to the community PCPs.