We read with great interest the Brief Report in the November 2022 issue of the MSMR about pediatric vaccination rates by Romano et al.¹ The immunization schedule recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention provides guidance on protecting infants and children from preventable infectious diseases, and well-established national metrics allow assessment of Military Health System performance.

While the authors make some comparisons to national vaccination data, CDC’s Healthy People 2020 goals also provide a benchmark to compare MHS vaccination rates. The Healthy People initiative is the federal government’s prevention agenda, developed and published by the CDC, for building a healthier nation that includes goals to attain longer lives free of preventable disease.² It is updated every 10 years.

For rotavirus vaccine, the Healthy People 2020 goal was 80% of children receiving two or more doses of vaccine by ages 19-35 months (can receive vaccine up to eight months of age). The data presented by Romano et al. not only show that completion of rotavirus vaccine series well exceeded this metric by 2016 (92.4%), but that compliance with the rotavirus vaccine series was also above 80%. In comparison, at the Healthy People 2020 final review, only 73.5% of children in the U.S. had completed two or more doses of rotavirus vaccine. The data presented by Romano et al. also demonstrate better vaccination rates for polio and DTaP compared to the Healthy People 2020 final review.³

This is an important perspective, as medical care for pediatric dependents of military service members involves extra variables that add complexity to vaccine series completion (e.g. frequent moves, parent deployments). Nevertheless, high vaccination rates for pediatric dependents of military service members occurred, with 82.5% of children receiving care in military clinics, despite 61.1% of children experiencing a change in well-child care location and 16.8% of mothers deploying within 24 months postpartum.¹

We concur with Romano et al. to suggest continued efforts for improving pediatric vaccination rates and the removal of barriers delaying vaccination within the MHS. We encourage the authors and other researchers to consider quantifying their data in relation to well-established national metrics to demonstrate MHS successes, as in this case, as well as identifying areas in need of improvement.

Author Affiliations

Air Force Medical Readiness Agency, Falls Church, VA (Lt. Col. Sayers); Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland (Lt. Col. Reynolds).

Disclaimer

The contents described in this publication are those of the authors and do not necessarily reflect official policy of the Department of the Air Force or Walter Reed National Military Medical Center.

References

1. Romano CJ, Bukowinski AT, Hall C, Burrell M, Gumbs GR, Conlin AVS, Ramchandar N. Brief report: pediatric vaccine completion and compliance among infants born to female active duty service members, 2006-2016. MSMR. 2022;29(11):18-22. 
2. Centers for Disease Control and Prevention. Healthy People 2020. Updated March 14, 2014. Accessed February 25, 2023. https://www.cdc.gov/dhdsp/hp2020.htm#:~:text=The%20over­arching%20goals%20of%20Healthy,good%20health%20for%20all%3B%20and
3. National Center for Health Statistics. Healthy People 2020 Final Review. Accessed March 9, 2023. https://dx.doi.org/10.15620/cdc:111173

In Reply

We thank Drs. Sayers and Reynolds for their interest in our brief report, "Pediatric Vaccine Completion and Compliance Among Infants Born to Female Active Duty Service Members, 2006-2016."

We agree with Drs. Sayers and Reynolds that the MHS performed well in relation to the U.S. population. We included comparisons to national estimates throughout the study period to facilitate this assessment, but elected not to include Healthy People 2020-realized estimates for comparative benchmarking because the study period did not fully correlate with the dates for this national framework. We agree, however, that there is added value in contextualizing our measures with Healthy People 2020 targets. Although MHS vaccination coverage did not achieve the Healthy People 90% target for diphtheria, tetanus, and acellular pertussis, MHS coverage surpassed the 90% and 80% targets for inactivated polio virus and rotavirus vaccines, respectively. In our ongoing work on pediatric immunizations, where we extend the study period to include the COVID-19 era and assess the complete pediatric immunization series, we will integrate discussion of Healthy People 2020 and 2030 targets.

Celeste J. Romano, M.S.; Anna T. Bukowinski, M.P.H; Clinton Hall, Ph.D.; Monica Burrell, M.P.H; Gia R. Gumbs, M.P.H; Ava Marie S. Conlin, D.O., M.P.H; Nanda Ramchandar, M.D., M.P.H