Are they protected? Immunization status of children at Kindergarten entry in Alberta

  • Author / Creator
    Dhungana, Manisha
  • Introduction: Immunization coverage for most childhood vaccines is measured and reported at 2 years and at 7 years of age in Alberta. There is currently a gap in knowledge regarding immunization coverage for children entering kindergarten (typically at age 5 years), as well as on factors associated with the incomplete immunization status of children at kindergarten entry in Alberta.
    Objective: Objective #1 was to examine the immunization coverage of a cohort of Alberta children at the start of kindergarten, as compared to the end of grade 1, when immunization status as per the Alberta routine childhood immunization schedule is normally assessed.
    Objective #2 was to determine the risk factors for incomplete immunization status at the start of kindergarten.
    Framework: This study was guided by the World Health Organization model of vaccine uptake/hesitancy.
    Methods: This retrospective cohort study used administrative health services data held by the Alberta Ministry of Health. Immunization coverage was assessed at September 1, 2013, when the 2008 birth cohort of children were entering kindergarten, and again at June 30, 2015, when children were at the end of grade one. Maternal age, marital status, number of children in family, household moves, location of the birth, attendant at the birth, sex of the child, gestational age, income, and household moves were our exposure variables. Outcome variables were: immunization status for each individual vaccine and for all vaccines in the schedule combined. Immunization status of children for all vaccines was categorized as: complete at kindergarten entry; incomplete at kindergarten entry, but complete at the end of grade 1; and still incomplete at the end of grade 1. Descriptive statistics and a multinomial logistic regression model were used to determine the coverage rate and to assess the association between exposure variables and immunization status respectively.
    Results: The final cohort included 41,515 children. We found higher immunization coverage at the end of grade 1 than at kindergarten entry for the vaccines that have doses scheduled for 4-6 years of age, i.e. diphtheria-tetanus-pertussis (DTaP)-containing vaccines and measles-mumps-rubella-varicella (MMRV) vaccine. For instance, 81.7% (95% CI 81.4-82.1) of the children were completely immunized at the end of Grade 1, whereas 47.5% (95% CI 47.0-48.0) were completely immunized at the start of kindergarten for DTaP-containing vaccines. For all vaccines combined, children at the end of grade 1 had higher immunization coverage than children entering kindergarten, i.e., 72.4%, 95% CI 72.0-72.8 versus 41.7%, 95% CI 41.2-42.2. The factors that were associated with incomplete immunization status at kindergarten entry were: single maternal marital status, large number of children in a household, young maternal age, and multiple household moves. Midwife delivery at hospital and home was strongly associated with still incomplete immunization status at the end of grade 1, i.e. OR 3.58 (95% CI 2.77-4.62) and 11.52 (95% CI 7.91-16.80) respectively.
    Conclusion and Relevance: Immunization coverage of children at the start of kindergarten was lower than children at the end of grade 1. This identified gap in immunization coverage supports the need for policy review and shift of a school based catch-up immunization program from grade 1 to a kindergarten entry immunization program.
    Implications & Recommendation: Public Health Nurses can play a significant role in increasing the immunization rate of children at kindergarten entry. Advocating for policy change, educating on immunization, and sending reminders to the caregiver are some of the strategies for increasing the immunization rates.

  • Subjects / Keywords
  • Graduation date
    Spring 2021
  • Type of Item
  • Degree
    Master of Nursing
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.