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Impact of vaccine delays at the 2, 4, 6 and 12 month visits on incomplete vaccination status by 24 months of age in Quebec, Canada

  • Nicole Boulianne1,
  • Denis Talbot2,3,
  • Manale Ouakki1,
  • Maryse Guayone,four,5,
  • Monique Landryvi,
  • Chantal Sauvageau1,2,3 &
  • Gaston De Serres1,two,3

BMC Public Health book 18, Commodity number:1364 (2018) Cite this article

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Abstract

Background

Timeliness in the administration of recommended vaccines is often evaluated using vaccine delays and provides more information regarding the susceptibility of children to vaccine-preventable diseases compared with vaccine coverage at a given age. The importance of on-time administration of vaccines scheduled at the first visit is well documented, simply data are scarce about the impact of vaccine delays at other visits on vaccination status by 24 months of age. Using vaccine delays for the starting time three doses of DTaP-containing vaccines and for the get-go dose of measles-containing vaccines as markers of timeliness at the ii, iv, 6 and 12 month visits, we estimated the proportion of incomplete vaccination status by 24 months of historic period attributable to a vaccine delay at each of these visits.

Methods

We used the data from vi cross-sectional coverage surveys conducted in the Province of Quebec from 2006 to 2016 which included 7183 children randomly selected from the universal wellness insurance database. A vaccine dose was considered delayed if received xxx days or more than subsequently the recommended age. The touch of new vaccine delays at each visit on incomplete vaccination status past 24 months of age was estimated with the owing risk in the population.

Results

The proportion of children with vaccine delay was 5.4% at 2 months, xiii.iii% at 4 months, 23.one% at 6 months and 23.vi% at 12 months. Overall, 72.5% of all two-yr-old children with an incomplete status past 24 months were attributable with a vaccine delay, of which xvi.1% were attributable with a start vaccine filibuster at 2 months, 10.vi% at iv months, 14.0% at 6 months and 31.8% at 12 months.

Conclusions

While nifty emphasis has been put on vaccine delays at the first vaccination visit, the prevalence of vaccine delays was greater with later visits and virtually children with an incomplete vaccination status by 24 months had a vaccine filibuster occurring during these later visits. Interventions to better timeliness should address vaccine delays at each visit and non only focus on the beginning visit.

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Background

Vaccine coverage is a common indicator used for the evaluation and monitoring of vaccination programs. Information technology evaluates the proportion of individuals who accept received all the recommended vaccines, regardless of the timeliness [1]. Timely vaccination is increasingly used to monitor vaccination programs. Past assessing the interval between the recommended age and the age at which a dose was administered, this indicator provides a amend approximate of the catamenia during which children are protected [two,iii,4]. Timely vaccination is often evaluated using vaccine delays for which several definitions exist. The definition most normally used is a filibuster of 30 days or more later on the recommended age for each dose [iii,4,five,6,seven,8,nine,10]. A vaccine delay for a dose may affect on-time assistants of subsequent doses and increment the child'due south adventure of disease targeted by the vaccine [11, 12].

In Quebec (Canada), vaccines recommended to children are gratuitous of charge and are mostly administered by public wellness clinics. In 2005, a survey conducted by the Quebec Ministry of Wellness reported that vaccine delays to the childhood schedule were occurring in public health clinics of several regions of the province. These delays were attributed to a variety of factors including the introduction of new vaccine programs in the early 2000'due south [13, 14], missed opportunities due to providers reluctance to administer several injections at the same visit and barriers like difficulty to become a vaccination appointment. In response, monitoring of vaccine delays has been introduced in 2006 in public wellness clinics for the 2-month and the 12-calendar month visits. To improve the 2-month visit timeliness, appointment periods with priority given to outset visits were added and activities such every bit reminders and recalls were implemented. For children with vaccine delays, an accelerated vaccination schedule can be applied using the minimum intervals between the vaccine doses instead of the intervals recommended for routine vaccination.

Since 2006, vaccine coverage surveys accept been conducted every 2 years in children aged 1 and ii years. The 2006 survey found that only 17% of 24-month old children had received all recommended vaccine doses with no delays. This survey as well every bit other studies had shown that vaccine delays of xxx days or more for vaccines scheduled at the first visit at 2 months of age were associated with vaccine delays at subsequently visits or with an incomplete vaccination status by 24 months of age [9, fifteen,16,17,18]. However at that place are scarce information regarding the frequency of vaccine delays at other visits and their bear upon on vaccine coverage by 24 months of historic period. Using Quebec vaccine coverage surveys from 2006 to 2016, nosotros estimated the proportion of children with vaccine delays at 2, 4, six and 12 months and the proportion of incomplete vaccination status by 24 months of age attributable to a vaccine delay at each of these visits. To identify more vulnerable populations, factors associated with vaccine delays at each vaccination visit from 2 to 12 months were assessed.

Methods

Written report population and survey design

The present study is based on the data from half dozen cantankerous-sectional surveys conducted in Quebec in 2006, 2008, 2010, 2012, 2014 and 2016 [15, 19,20,21,22,23]. With the authorization of the Quebec Access to Information Commission, children in these studies were randomly selected from the Quebec Universal Health Insurance database which includes all children from the province. Each survey included a "1-year accomplice" and a "2-year accomplice" with children anile 15 to 17 months and 24 to 26 months respectively at the time of the survey. With surveys conducted every other yr and cohorts defined by year of birth (e.g. in the survey conducted at the showtime of 2006, the two-year accomplice included children born in 2003 and those in the 1-year cohort were born in 2004), the six surveys assessed the immunization information in 12 different nascence cohorts (built-in between 2003 and 2014). The surveys invited approximately 1000 children in each cohort (only 600 for 2006), a number deemed sufficient to obtain a precision of ±3% in the vaccine coverage for each survey assuming a response rate of about 60% [24]. Were excluded children living in the two northern regions of the province.

Questionnaires were sent by mail service and were filled out by parents or legal guardians. A postal reminder was sent to non-respondents 2 weeks and 4 weeks afterwards. In the absence of response, parents were called directly 2 weeks after the terminal postal reminder and those with unknown telephone number or not reached by telephone received another questionnaire by mail. Respondents were invited to transcribe on the questionnaire the data available in their child's vaccination booklet (i.e. vaccine names, appointment of vaccination and vaccine providers). The questionnaire too collected data on the characteristics of the child, the mother and the parents. For children without vaccination booklets and those with data incomplete or inconsistent with the provincial vaccine schedule, vaccine providers were contacted to collect/validate the information. Only written information on doses from parents or vaccine providers were accepted. Each survey was approved by the Ethic Board Commission of the CHU de Quebec-Université Laval Hospital and written consent was obtained from all the participants.

Vaccination schedule

Since 2004, many new vaccines had been introduced in the Quebec's vaccination schedule (Table 1).The pneumococcal conjugate vaccine (PCV) was introduced in December 2004 with 3 doses scheduled at 2, 4 and 12 months. A unmarried dose of monovalent varicella vaccine at 12 months of age was introduced in 2006 and replaced in 2008 by the combined measles, mumps, rubella and varicella vaccine (MMRV). Since November 2011, children are receiving ii doses of rotavirus vaccine at 2 and four months of age. Finally, in June 2013, hepatitis B vaccine programme was launched and the combined vaccine against diphtheria, acellular pertussis, tetanus, polio, Haemophilus influenzae type b and Hepatitis B (DTaP-IPV-Hib-HB) replaced the pentavalent vaccine DTaP-IPV-Hib in the schedule at 2, 4 and 18 months of historic period.

Table 1 The Quebec vaccine schedule earlier 24 months of historic period and definition of vaccine delays used in the analysis

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Outcomes

Birth and vaccination dates were used to compute age at vaccination in days. A dose was administered on-time if received within 30 days of the recommended historic period and was considered delayed after this flow (Tabular array 1). Vaccine delays were assessed for each of the first three doses of the DTaP-containing vaccine (DTaP) recommended at ii, 4 and 6 months of age and for the commencement dose of the measles-containing vaccine (Measles) recommended at 12 months. As virtually recommended vaccines are administered at the same visit, these vaccines have been used as markers of all vaccines administered at each visit. A vaccine delay at i dose is frequently followed by a vaccine delay at the following dose(s). A new vaccine filibuster was divers equally a delay occurring among children whose previous dose(south) were on-fourth dimension (due east.g. Filibuster at 4 months amid children with no delay at 2 months).

Given the changes in the Quebec vaccination schedule over the report menstruum, the vaccination status was defined for antigens common to all surveys (DTaP-IPV-Hib, Men C-C and measles-mumps-rubella). A complete vaccination status past 24 months of age was divers as having received four doses of DTaP-IPV-Hib, 1 dose of Men-C-C vaccine and 2 doses of MMR vaccine earlier two years of age. Otherwise, the vaccination status was incomplete.

Statistical assay

All analyses were performed with Statistical Analysis Organisation (SAS Constitute Inc. Conduct, NC, version ix.4). Proportions were compared using Chi-square test or Chi-square test for trend when appropriate. Missed opportunities at 2 and 12-calendar month visits occurred when a vaccine-eligible child did not receive all recommended vaccines at the same vaccination engagement [25]. Other independent variables included information regarding the child, the family unit and the vaccine provider. The data on vaccine provider at the 2 month visit were used for the analysis of vaccine delays at 2, 4 and 6 months and the data on vaccine provider for all vaccination visits from two to 12 months were used for the analysis of vaccine delays at 12 months.

As vaccine delays occurred before fifteen months of historic period, the analyses on factors associated with new vaccine delays included all participants to maximize the statistical power. In contrast, equally children in the "i-year cohort" had not still reached two years of age, the impact of new vaccine delays at 2, 4, 6 or 12 months on vaccination status by 24 months of age was estimated merely with children in the "two-year cohort".

The impact of new vaccine delays at 2, 4, half-dozen and 12 calendar month on vaccination status by 24 months of age was estimated with a robust Poisson multivariable regression. This alternative to logistic regression for binary outcomes directly estimates relative risk without risking convergence issues associated with log-binomial regressions [26,27,28]. The SAS GENMOD procedure was used with a log link and a robust estimator of the standard errors. All potential factors associated to incomplete vaccine coverage and to vaccine delay were included in the model without any pick process [29]. Take chances-ratio modification by the survey twelvemonth was assessed with an interaction term between vaccine delay and survey year in the model. A model based standardization approach was used to gauge adjusted adventure divergence (RD) in incomplete vaccination condition by 24 months of age between children with and without vaccine delays [30]. Briefly, using predicted probabilities of the model, the standardized run a risk of effect considering all children exposed (with vaccine delays) was estimated. The standardized take chances considering all children unexposed (without vaccine delays) was also estimated similarly. The standardized RD was obtained as the difference between these two quantities. Adjusted attributable risks in the population (ARp) were estimated for delays at each dose also using a model based standardization approach. That is, ARp were estimated as one minus the ratio of the predicted risk of outcome considering all children unexposed over the observed risk of upshot [31]. Confidence intervals for RD and ARp were obtained through the percentile method by performing non-parametric bootstrap with grand samples [32, 33].

Factors associated with new vaccine delays were assessed for each dose with the same SAS procedure used to estimate the effect of vaccine delays on vaccination status by 24 months of historic period. A backward procedure with a p value < 0.05 was used for the pick criteria. The year of survey was kept in multivariable models to ensure face validity.

Results

Characteristics of participants, vaccine delays and vaccine coverage

Of the xi,200 children invited to participate since 2006, the participation rate was lxx% (844/1200) in 2006, 64% (1282/2000) in 2008, 62% (1233/2000) in 2010, 73% (1459/2000) in 2012, 69% (1384/2000) in 2014 and 65% (1295/2000) in 2016. Children born outside Quebec were excluded from the analysis because they were exposed to a different vaccine schedule (north = 140 for the 1-year cohorts and due north = 174 for the 2-year cohorts). This left a total of 3675 children in the 1-year cohorts and 3508 children in the 2-year cohorts (95% of participants for both cohorts) for the analysis.

Twoscore-4 percentage of participant children were the commencement kid in the family, 76.9% attention daycare and the majority were vaccinated in public health clinics (66.seven%). Almost parents lived with a partner (91.ix%) and most mothers have completed a higher or university degree (70.5%). Missed opportunities occurred in three.1% of children at the 2-month visit for which two injections were to be administered and in fourteen.8% at the 12-month visit where three injections were recommended (from 31.one% in 2006 to 7.0% in 2016). All characteristics of children participants are presented in Additional file 1.

The proportion of children vaccinated by age in days for each dose is presented in Fig. 1. At 2 months, a greater proportion of children received their DTaP1 close to the recommended historic period compared to subsequent visits. At 6 months, 14.1% of children received DTaP3 afterward 227 days. The proportion of new vaccine delays increased from 5.4% at ii months to xiv.three% at 12 months (Fig. ii). Amid children who experienced vaccine delays at 2 months (due north = 386), 77.2% had vaccine delays at other visits (298/386) (Fig. iii) and 33.seven% had vaccine delays at each of the next three visits. At 4 months there were 2.4 times more vaccine delays (northward = 941) than at 2 months of which 66.6% (627) were new vaccine delays. Among these new vaccine delays, 84.one% experienced vaccine delays at subsequent visits (527/627). At 6 months, there were 4.2 times (1617) more vaccine delays than at the 2 month visit and 49.ix% (807) were new vaccine delays. At 12 months, the number of vaccine delays was similar to that at vi months (1624) and sixty.7% (986) were new vaccine delays (Fig. 2 and Table 2). In children with a vaccine delay for DTaP doses, instead of using the minimum interval recommended for accelerated schedule to prevent additional vaccine delays, the majority received their next dose with 2-month intervals equally recommended for routine schedule (meet Additional file 2).

Fig. 1
figure 1

Proportion of children vaccinated according to age in days at ii–4-half-dozen and 12 months, 2006–2016*. *Both cohorts included. The vertical reference lines indicate recommended age at vaccination for each visit and dotted lines indicate historic period when a dose becomes delayed

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Fig. 2
figure 2

Proportion of children with and without vaccine delays at ii–4-6 and 12 month visits, 2006–2016*. *Both cohorts included. DTaP1 is recommended at 2 months, DTaP2 at 4 months, DTaP3 at 6 months and the first measles-containing vaccine at 12 months

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Fig. 3
figure 3

Distribution of total vaccine delays by visit with showtime (new) vaccine delay, 2006–2016*. *Both cohorts included. DTaP1 was recommended at 2 months, DTaP2 at iv months, DTaP3 at 6 months and the first measles-containing vaccine at 12 months. Categories of vaccine delays were mutually exclusive. The maximum number of delayed doses was iv for a first (new) filibuster at two months, three at iv months, 2 at vi months and 1 at 12 months

Total size paradigm

The characteristics of participants co-ordinate to vaccine delays at 2, four, half dozen and 12 months of historic period are presented in Tabular array 2. The proportion of children with a vaccine delay increased with age, from 5.iv% at the 2-month visit to 23.1% at the half dozen-month visit and 23.vi% at the 12-calendar month visit. Among children with a vaccine delay, the interval betwixt 30 days after the recommended historic period and the time they received their dose was a median of 17 days for DTaP1 at 2 months, 10 days for DTaP2 at 4 months, xiii days for DTaP3 at vi months and 21 days for measles at 12 months. Overall, 39% of children experienced at least one vaccine delay at one of the iv visits, decreasing from l% in 2006 to xxx% in 2016. In univariate assay, all characteristics except the sex were associated with new vaccine delays for at least one of the visits (Tabular array two). Between 2006 and 2016, for children immunized in public wellness clinics, the proportion with new vaccine delays decreased from nine.1 to 3.vi% at the starting time visit, from xiii.7 to half-dozen.five% at the 4 month visit, from 20.3 to 11.0% at the six month visit and from 31.0 to xi.2% at the 12 month visit. In contrast, no significant differences were observed for children vaccinated in medical clinic/infirmary for the 4 and 6 month visits (see Boosted file three).

Table 2 Characteristics of the participants according to new vaccine delays (2–4-six and 12 months), 2006–2016 (Due north = 7183)a

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Impact of new vaccine delays on vaccination status by 24 months of age

Among children with and without a vaccine delay for the DTaP1 at 2 months, 46.4 and xi.1% respectively had an incomplete vaccination status by 24 months for an unadjusted risk divergence of 35.three% and a 27.7% adapted risk difference (RD) (Table 3). The adjusted run a risk difference for incomplete vaccination status by 24 months was 13.8, x.five and 8.8% for new vaccine delays at 4, 6 and 12 months respectively. The relative hazard of incomplete vaccination status by 24 months of age betwixt children with and without a vaccine filibuster varied betwixt ii.three and 3.six with overlapping conviction intervals. As computed with predicted probabilities from the multivariable models, 72.5% of 2-year children with an incomplete status past 24 months were attributable to a vaccine delay: 16.ane% were attributable to a vaccine delay that first occurred at two months, 10.vi% at 4 months, 14.0% at 6 months and 31.eight% at 12 months. There was no risk-ratio heterogeneity for the survey year.

Table 3 Proportion of incomplete vaccination status by 24 months of historic period attributable to new vaccine delays, 2006–2016 (Due north = 3508)a

Full size tabular array

Factors associated with new vaccine delays

Compared to the firstborn, other children were more than likely to take a new vaccine delay at ii, 4, 6 and 12 months (Table 4). Missed opportunity at the ii-month visit was the most important factor associated with vaccine delays for DTaP1 (RR 4.28 (IC 3.18; 5.77)). At 2 months, children who were not attending daycare (versus attending daycare) and children whose parent who completed the survey was living without a partner (versus with a partner) were more likely to feel delays. Vaccination in medical clinic/hospital (versus in public health clinics) at the 2-calendar month visit was associated with lower take a chance of vaccine delay for DTaP2 and DTaP3. The risk of vaccine delays for DTaP1 and DTaP2 decreased with higher maternal education. Missed opportunity at the 12-month visit was the most important cistron associated with vaccine delays for measles at 12 months. Gestational age at nascency lower than 37 weeks (vs ≥ 37 weeks) was also associated with vaccine delays at 12 months. Finally, in contrast to results observed for DTaP2 and DTaP3, children vaccinated in medical dispensary/hospital or in both settings for the 12-month visit were more likely to feel measles vaccine delays at 12 months compared with children vaccinated in public health clinics.

Table 4 Factors significantly associated with new vaccine delays at ii–4-6 and 12 months of historic period, 2006–2016 (North = 7183)a

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Give-and-take

While the literature on vaccine coverage put an emphasis on vaccine delays at 2 months, this study shows that the proportion of vaccine delays was greater at later on visits increasing from 5.iv% at 2 months, to 13.3% at 4 months, to 23.1% at vi months and to 23.half-dozen% at 12 months. Vaccine delay at one visit had an impact on the timing and assistants of subsequent doses equally most children with vaccine delay for a DTaP dose received their subsequent dose with a 2-month interval rather than the shortened interval recommended in the accelerated schedule. A vaccine delay decreased the probability of having received all recommended vaccines by 24 months of age and 72.v% of incomplete status by 24 months of age were attributed to a new vaccine delay at two, four, 6 or 12 months (16.1% at two months, 10.6% at four months, xiv.0% at half-dozen months and 31.eight% at 12 months).

This written report found that delays at the starting time visit did contribute to incomplete vaccination condition by 24 months of age and that more than 75% of children with a vaccine delay at 2-months also had vaccine delays at later visits including a third with vaccine delays at all next three visits. Clan betwixt vaccine delays at the first vaccination visit and after vaccine delays or incomplete vaccination condition past 24 months of age has been widely reported [9, xvi,17,18]. While other studies also identified that vaccine delays increased at subsequent vaccine visits [9, 11, 34, 35], they did not appraise their touch on on incomplete vaccination status by 24 months, the additional step this study provides.

The interventions deployed in public health clinics in Quebec since 2006 to improve timeliness at the two and 12 calendar month visits seem to have successfully reduced vaccine delays at all visits. While but 17% of 2-year-old children had received all recommended doses with no filibuster in 2006, this proportion had increased to 50% in 2016 [xv, 23]. In a accomplice of 361,901 children born from 2004 through 2012 in United states, 55% of children had been fully vaccinated with no delay past 24 months of age [36]. Reminders or recollect interventions sent by vaccine providers are effective to increase the likelihood of being vaccinated and to reduce the number of underimmunized days [37, 38]. In the current written report, for children vaccinated in public health clinics, the proportion with new vaccine delays decreased from 2006 to 2016 for each vaccination visits: a decrease of 5.5% at 2 months, vii.ii% at 4 months, 9.three% at six months and 19.8% at 12 months. The risk of vaccine delays for the 12 calendar month visit was 1.22 times higher for children vaccinated in medical clinic/hospital versus those vaccinated in public health clinics. In contrast, in medical clinic/hospital where no intervention was done, no major changes take been observed in the proportion of new vaccine delays from 2006 to 2016. In public wellness clinics, efforts to reduced vaccine delays were more than important for the 2 and 12 month visits and the proportions of children with vaccine delays at 4 and six months remained higher in this setting compared with medical clinic/hospital for each survey year except in 2016, resulting in a higher take a chance of vaccine delays.

In the present study, children who are not the firstborn and those with missed opportunities at the two-month and the 12-calendar month visits were more likely to had vaccine delays. These two factors take been often associated with vaccine delays in other like studies [6, x, 34, 39]. A high number of children in the household may impact the accessibility to healthcare settings, including vaccination services. In improver, children with older siblings are possibly more exposed to modest disease, resulting in missed opportunities and vaccine delays [40,41,42]. We observed that children of single parent (versus living with a partner) had a greater run a risk for vaccine delays at 2-months and these results might be associated with constraints to access vaccination services [half dozen, 34]. In the current study, the take chances of vaccine delays for DTaP1 and DTaP2 decreases with college maternal education. The literature is inconsistent on this issue; some authors institute an association similar to ours while others observed a higher risk of delays with an increasing educational activity level [6, x]. A literature review found that higher maternal level of pedagogy was associated with vaccine hesitancy which is itself associated with vaccine delays [43]. This subject may crave future studies.

This study has some limitations. The response rate to vaccine coverage surveys varied from 61 to 73% depending upon the year and cohort. Participants may accept had more positive behaviours regarding vaccination than non-participants, resulting in less vaccine delays and higher vaccine coverage. Validation of the information on immunization from questionnaires was restricted to children whose information was not consistent with the provincial vaccine schedule. We cannot rule out that this practice has led to an overestimation of vaccine coverage, simply the impact on our results might be minimal as vaccination bill of fare compared to medical chart usually has a proficient positive predictive value [44, 45]. As simply written data were accustomed in this study, underestimation of vaccine coverage cannot exist ruled out but is unlikely every bit many sources were consulted to obtain vaccine information. As markers of timeliness, vaccine delays were estimated only for DTaP and measles containing vaccines despite other vaccines being administered at 2, four, vi and 12 months. While near recommended vaccines are administered at the same visit, the burden associated with vaccine delays presented in this analysis has probably been underestimated.

The current written report estimated the run a risk of incomplete vaccination condition by 24 months attributable to vaccine delays at dissimilar ages an information that tin be useful to determine or prioritize public wellness interventions. However, the interpretation of ARp every bit the fraction of the outcome that could be eliminated if exposure could be totally removed from the population is valid only under sure atmospheric condition [46]. Outset, exposure has to be causal rather than merely associated with the disease. Past estimating counterfactual gamble with model-based standardization, we attempted to judge the average causal effect of new vaccine delays at 2, iv, 6 or 12 months on vaccination status by 24 months. However, root causes of vaccine delays remained unknown and the elimination of vaccine delays may not result in an improvement of complete vaccination status by 24 months every bit big every bit estimated past ARp. Second, estimation of ARp has to be unbiased. While multivariable models included almost of the determinants identified in the literature, as for whatever observational study, residual misreckoning cannot be ruled out. Finally, the elimination of exposure has to be without whatsoever effect on distribution of other take chances factors. As other factors included in this analysis are mainly unmodifiable risk factors, it is unlikely that the elimination of vaccine delays has whatsoever outcome on their distribution. As the attributable adventure depends upon the prevalence of vaccine delays at diverse visits, which may vary between populations, this limits the generalizability of this result to other jurisdictions [46].

Decision

While great emphasis has been put on vaccine delays at the first vaccination visit, the prevalence of vaccine delays in this study was greater with subsequently visits and most of incomplete vaccination status by 24 months of age was associated with vaccine delays occurring afterwards the 2 month visit. Interventions to meliorate timeliness deployed in public wellness clinics in Quebec seem to have reduced vaccine delays at all visits from 2006 to 2016. These interventions should also focus on other vaccine visits which contributed to the burden associated with vaccine delays and on more than vulnerable groups identified in this study. Accelerated vaccination schedules recommended for children with vaccine delays may prevent further delays and reduce their impact.

Abbreviations

ARp:

Owing risk in the population

CI:

Confidence interval

DTaP:

Diphtheria, tetanus, acellular pertussis and polio containing vaccine

DTaP-IPV-Hib:

Diphtheria, tetanus, acellular pertussis, polio virus and Haemophilus Influenzae type b vaccine

DTaP-IPV-Hib-HB:

Diphtheria, tetanus, acellular pertussis, polio virus, Haemophilus Influenzae type b vaccine and Hepatitis B vaccine

Measles:

Measles-containing vaccine

Men-C-C:

Meningococcal C conjugate vaccine

MMR:

Measles, mumps and rubella vaccine

MMRV:

Measles, mumps, rubella and varicella vaccine

PCV:

Pneumococcal conjugate vaccine

Rota:

Rotavirus vaccine

RR:

Risk ratio

VPD:

Vaccine-preventable diseases

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Acknowledgements

Not applicable.

Funding

MK has received a scholarship from the Fonds de recherche du Quebec-Santé (FRQS).

DT is a FRQS inferior 1 Chercheur-Boursier.

Vaccine coverage surveys from 2006 were funded by the Ministère de la Santé et des Services sociaux du Québec. Funding sources had no involvement on the deport of this inquiry and on the redaction of this manuscript.

Availability of information and materials

The datasets used and analysed during this electric current study are available from the corresponding author on reasonable request.

Author information

Affiliations

  1. Institut national de santé publique du Quebec, 2400 d'Estimauville Artery, Quebec, G1E 7G9, Canada

    Marilou Kiely, Nicole Boulianne, Manale Ouakki, Maryse Guay, Chantal Sauvageau & Gaston De Serres

  2. Department of Social and Preventive Medicine, Laval University, Quebec, Canada

    Marilou Kiely, Denis Talbot, Chantal Sauvageau & Gaston De Serres

  3. CHU de Québec-Université Laval, Quebec, Canada

    Denis Talbot, Chantal Sauvageau & Gaston De Serres

  4. Department of Community Health Sciences, Sherbrooke University, Quebec, Canada

    Maryse Guay

  5. Centre intégré de Santé et Services Sociaux de la Montérégie-Centre, Quebec, Canada

    Maryse Guay

  6. Ministère de la Santé et des Services Sociaux, Quebec, Canada

    Monique Landry

Contributions

NB, GDS and MK (since 2016) conceptualized the research and collected the information. MK performed analyses, interpreted the results and prepared the initial draft of the manuscript. GDS, DT and NB were supervisors of MK's PhD campaigning and assisted in performing analyses and provided overall guidance to MK. MK, NB, GDS, MO, MG, ML and CS participated in the study design and methodology. All authors contributed significantly to towards drafting and editing the manuscript. All authors have read and canonical the final version of the manuscript.

Corresponding author

Correspondence to Marilou Kiely.

Ideals declarations

Ideals approval and consent to participate

Each survey from 2006 to 2016 was approved by the Ethic Board Committee of the CHU de Quebec-University Laval Hospital and written consent was obtained from all the participants.

Consent for publication

Not applicable.

Competing interests

Gaston De Serres received research 1000 for investigator-initiated studies from Pfizer and GlaxoSmithKline (GSK) and was reimbursed expenses to travel to an ad hoc advisory lath meeting by GSK just received no honoraria. He has as provided paid skilful testimony in a grievance against a vaccine-or-mask healthcare worker flu vaccination policy for the Ontario Nurse Clan. Other authors take no conflicts of involvement to declare.

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Additional files

Additional file 1:

Characteristics of children participants, 1-twelvemonth and two-year cohorts, 2006–2016 (n = 7183). (DOCX 20 kb)

Additional file ii:

Intervals following the next vaccine dose for children with new vaccine delays at the DTaP1 and DTaP2. (DOCX 26 kb)

Additional file 3:

New vaccine delays at 2, 4, 6 and 12 months past vaccine provider and survey year, 1-year and two-year cohorts, 2006–2016. (DOCX 17 kb)

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Kiely, M., Boulianne, N., Talbot, D. et al. Touch of vaccine delays at the 2, 4, 6 and 12 month visits on incomplete vaccination condition by 24 months of historic period in Quebec, Canada. BMC Public Health eighteen, 1364 (2018). https://doi.org/x.1186/s12889-018-6235-half-dozen

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  • DOI : https://doi.org/ten.1186/s12889-018-6235-6

Keywords

  • Filibuster
  • Timeliness
  • Vaccine coverage
  • Vaccination
  • Infant

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