More than a third of infants who were taken to the doctor for an acute ear infection, and who were also due for a scheduled immunization, were not immunized during their sick visit and didn’t go back to the doctor for a subsequent well visit, according to a new study published Monday in the journal Pediatrics.
That put the infants significantly behind in their vaccines, compared to other infants who were immunized while sick.
“I think a lot of providers are thinking, ‘We can put this off and they’ll come back,’” says the study’s author, Steve G. Robison, an epidemiologist with the Oregon Health Authority.
“But if you don’t use this chance to give an immunization, over a third of (those patients) you’re not going to see again.”
For new parents, the findings mean two things: Children with acute ear infections can be immunized during a sick visit if they’re due for a vaccine. And regardless of whether an infant is immunized while sick, it’s important parents keep the child’s subsequent well-visit appointment. Pediatricians use that time to cover issues like sleeping, nutrition and developmental milestones – topics there often isn’t time to address during a sick visit.
Robison gathered data on 1,060 infants who went to the doctor with cases of an acute ear infection at 2, 4 and 6 months. At the time of the sick visit, all the infants were due for a scheduled immunization but had not received it yet.
“The contraindication for getting a vaccine is for moderate or severe illness,” explains Dr. Lisa Thebner, a pediatrician in New York City who is not affiliated with the study.
“For a mild or minor illness (like an acute ear infection), there is no contraindication to get the vaccine and you want to take advantage of that.”
Robison and Thebner agree that physicians should base their decision on whether to vaccinate during a sick visit, or wait until a subsequent well visit, on how confident they are that the parents and infant will return for their scheduled follow-up. If the health care provider doesn’t know the family well, or is not confident they’ll make a later visit due to child care or work concerns, they say the practitioner should take advantage of having the child in the office but strongly encourage the family to show up for a later well visit.
“The ideal is to vaccinate during a sick visit unless there is a proven track record of coming for every well visit, then perhaps it can be deferred,” says Thebner.
“But otherwise it seems reasonable to take advantage of having the child in the office and then encourage the family to come back for a well visit to over all the other points covered during one of those visits.”
If practitioners aren’t comfortable immunizing a child during a sick visit, he advises doctors to make sure families have their appointments scheduled before leaving the building.
“When you don’t know the patients well, if the parents are going to leave the visit without getting a shot for their child, it would at least be nice to know they have an appointment to come back,” he says.