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Frequency and Cost of Vaccinations Administered Outside Recommended Ages — 2014; Six Immunization Information System Sentinel Sites
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  • Alternative Title:
    J Pediatr
  • Description:

    To quantify vaccinations outside recommended ages by analyzing immunization information system (IIS) records.

    Study Design:

    We analyzed de-identified records of doses administered during 2014 to persons age ≤17 years within six IIS Sentinel Sites (10% of US population). We quantified doses administered outside of recommended ages according to the Advisory Committee on Immunization Practices childhood immunization schedule and prescribing information in package inserts, and calculated revaccination costs. To minimize misreporting bias, we analyzed publically funded doses where reported lot numbers and vaccine types were consistent.


    Among 3,394,047 doses with maximum age recommendations, 9,755 (0.3%) were given after the maximum age. One maximum age violation required revaccination: 1,344 (0.7%) of 194,934 doses of the 0.25 mL prefilled syringe formulation of quadrivalent inactivated influenza vaccine (Fluzone) administered after age 2 years (revaccination cost: $111,964). We identified 7,529,165 childhood, adolescent and lifespan doses with minimum age recommendations, among which 9,542 (0.1%) were administered before the minimum age. The most common among these were quadrivalent injectable influenza vaccines (3,835, or 0.7% of 526,110 doses administered before age 3 years) and Kinrix (DTaP-IPV) (2,509, or 1.2% of 208,218 doses administered before age 4 years). Revaccination cost for minimum age violations (where recommended) was $179,179.


    Administration of vaccines outside recommended ages was rare, reflecting general adherence with recommendations. Error rates were higher among several vaccines, some requiring revaccination. Vaccine schedule complexity and confusion among similar products might contribute to errors. Minimization of errors reduces wastage, excess cost, and inconvenience for parents and patients.

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