In an article and accompanying video abstract being early released this week in Pediatrics, Celeste Romano, MS, and colleagues from the Naval Health Research Center in San Diego, California, examined the vaccine completion rate and timeliness of vaccination by 24 months among children in the Military Health System (MHS) (10.1542/peds.2023-064965).
The study population was infants born 2010–2019 to military families who were enrolled in the military health insurance (TRICARE) by age 12 months, with continuing enrollment through 24 months and steady access to a Military Treatment Facility (MTF), and with at least one well care visit annually.
Per the recommendations of the Advisory Committee on Immunization Practices (ACIP), vaccine completion was measured using the 4:3:1:3:3:1:4 vaccine series; both completion and timeliness were assessed. The comparator was the HealthyPeople 2020 target for overall vaccine completion of 80%, with individual vaccine series targets of 90%. The authors combined administrative medical encounter data from the MHS Data Repository and identified immunizations using Current Procedural Terminology (CPT) and Vaccine Administered (CVX) codes.
A total of 275,967 children were included in the analysis.
The key findings included:
- Overall completion of the combined 7-vaccine series was 74.4%.
- Of those who completed the series, 36.2% had delays.
- DTaP, Hib, and PCV vaccine series were the leading contributors to noncompletion.
Although vaccine completion nearly achieved HealthyPeople 2020 goals for at least one year (2016–17), notable differences in risk for noncompletion and delay—and lower vaccination rates—were noted for those born to parents who were:
- Younger
- Identified as American Indian or Alaska Native
- Enlisted
- In the Coast Guard.
This leads us to the excellent and informative commentary by Drs. Courtney Judd and Meaghan S. Wido from the Uniformed Services University of the Health Sciences, who provide a lived experience context for the vaccine facts and figures (10.1542/peds.2024-067123).
Challenges that military families face with respect to adherence to well care schedules are several, but frequent relocations occurring at least every 2–3 years are likely the most important and disruptive. In the population studied by Romano et al., 65.4% relocated in the first 24 months. Families experience personal and social stress with relocation, must identify a new primary provider who either is a military provider or a civilian provider who accepts TRICARE, may be relocated to remote or international regions where this is even more challenging, and have long duty hours with little flexibility.
What can pediatric providers do? Drs. Judd and Wido ask us to develop a deep understanding of the challenges military families face, and to respect their extraordinary resiliency. We can act by accepting TRICARE in our practices, by informing ourselves about supportive resources, and by participating in research that addresses the needs of military families. The work by Romano and colleagues, and the commentary by Judd and Wido, open the door for pediatricians to support military families, whose service sustains the freedoms we all enjoy.
