Steve G. Robison

Dr Jhaveri expresses a concern that our findings are not consistent with national trends, supporting this by noting that our reported Oregon child immunization rates are below the CDC’s National Immunization Survey (NIS) rates as reflected in the FluVaxView report. Differences between our data and the CDC’s NIS likely reflect methodological differences between our study and how FluVaxView coverage estimates are generated. FluVaxView child rates are based on parent self-reporting, which for older children and teenagers likely have substantial upward biases. Our data, from Oregon’s ALERT Immunization Information System, are based on provider … E-mail: steve.g.robison{at}state.or.us

BACKGROUND: A substantial body of work has related survey-based parental vaccine hesitancy to noncompliant childhood immunization. However little attention has been paid to the connection between parents’ own immunization behavior and the immunizations their children receive. METHODS: Using the Oregon ALERT Immunization Information System, we identified adult caregiver–child pairs for children between 9 months and 17 years of age. The likelihood of adult–child concordance of influenza immunization per influenza season from 2010–2011 through 2014–2015 was assessed. The utility of adult immunization as a predictor was also assessed for other, noninfluenza recommended immunizations for children and adolescents. RESULTS: A total of 450 687 matched adult caregiver–child pairs were included in the study. The children of immunizing adults were 2.77 times more likely to also be immunized for seasonal influenza across all seasons (95% confidence interval, 2.74–2.79), with similar results applying within each season. Adult immunization status was also significantly associated with the likelihood of children and adolescents getting other noninfluenza immunizations, such as the human papillomavirus vaccine (HPV). When adults improved their own behavior from nonimmunizing to immunizing across influenza seasons, their children if not immunized in the previous season were 5.44 times (95% confidence interval, 5.35–5.53) more likely to become immunized for influenza. CONCLUSIONS: Children’s likelihood of following immunization recommendations is associated with the immunization behavior of their parents. Encouraging parental immunization is a potential tool for increasing children’s immunization rates.

We calculated the effectiveness of pertussis vaccine in preventing parapertussis among Oregon children 2 months to 10 years of age using 2 methods. During 2011–2016, the 2 VE methods found 66% (95% CI, 59–75%) and 82% (95% CI, 69–90%) effectiveness against parapertussis. Pertussis vaccine may induce cross-immunity.

That disease and poverty are connected is a cornerstone of public health thought. In the case of pertussis, however, it is possible that the expected relationship to poverty is reversed. Grounds exist for considering that increases in income are associated with increases in pertussis rates, both in terms of real risk through social and network features and through the possibility of greater likelihood of care seeking and detection based on income. Using reported adolescent pertussis cases from a 2012 outbreak in Oregon, pertussis incidence rates were determined for areas grouped by zip code into higher, middle, and lower median household income. Adolescents of ages 13–16 years in higher income areas were 2.6 times (95% CI 1.8–3.8) more likely as all others to have reported pertussis during the 2012 outbreak and 3.1 (95% CI 1.4–6.5) times as likely as those in lower income areas. The higher pertussis rates associated with higher income areas were observed regardless of Tdap rate differences. These results suggest that income may be associated with disease risk, likelihood of diagnosis and reporting, or both. Further evaluation of this finding is warranted.