Vaccine Administration in Children’s Hospitals

OBJECTIVES: To examine inpatient vaccine delivery across a national sample of children’s hospitals.

METHODS: We conducted a retrospective cohort study examining vaccine administration at 49 children’s hospitals in the Pediatric Health Information System database.

Children <18 years old admitted between July 1, 2017, and June 30, 2019, and age eligible for vaccinations were included.

We determined the proportion of hospitalizations with ≥1 dose of any vaccine type administered overall and by hospital, the type of vaccines administered, and the demographic characteristics of children who received vaccines.

We calculated adjusted hospital-level rates for each vaccine type by hospital.

We used logistic and linear regression models to examine characteristics associated with vaccine administration.

RESULTS: There were 1 185 667 children and 1 536 340 hospitalizations included.

The mean age was 5.5 years; 18% were non-Hispanic Black, and 55% had public insurance.

There were ≥1 vaccine doses administered in 12.9% (95% confidence interval: 12.8–12.9) of hospitalizations, ranging from 1% to 45% across hospitals.

The most common vaccines administered were hepatitis B and influenza.

Vaccine doses other than the hepatitis B birth dose and influenza were administered in 1.9% of hospitalizations.

Children had higher odds of receiving a vaccine dose other than the hepatitis B birth dose or influenza if they were <2 months old, had public insurance, were non-Hispanic Black race, were medically complex, or had a length of stay ≥3 days.

CONCLUSIONS: In this national study, few hospitalizations involved vaccine administration with substantial variability across US children's hospitals.

Efforts to standardize inpatient vaccine administration may represent an opportunity to increase childhood vaccine coverage.