{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T20:47:58Z","timestamp":1740170878527,"version":"3.37.3"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"9-10","license":[{"start":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T00:00:00Z","timestamp":1719446400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,30]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>During the coronavirus disease of 2019 (COVID-19) pandemic, routine childhood immunization rates dropped dramatically across the world, and the Military Health System (MHS) was no exception. In the MHS, which is a large, universally covered, low-to-no-cost health system, the immunization rates with the measles, mumps, and rubella (MMR) vaccine remain below the rate necessary to prevent community transmission of measles. We aimed to improve childhood immunization rates in the MHS with an expansive quality improvement project.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Measles, mumps, and rubella immunization rates served as proxy outcome measures for routine immunization rates tracked by the Center for Disease Control multi-immunization combination measures. The tracked measure was the percentage of 16- to 18-month olds and 6-year olds who had received MMR #1 and MMR #2, respectively. Various countermeasures were implemented throughout the study period, and standard quality improvement analyses informed the effect of countermeasures.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>By January 2023, the percentage of 16- to 18-month olds and 6-year olds who had received MMR #1 and MMR #2 was 85% and 91%, respectively, with no positive shift in immunization rates despite various countermeasures introduced during the study period. For reference, the MMR immunization rates of commercial health maintenance organization and commercial preferred provider organization for 24-month-old populations were 92% and 90.3%, respectively. On chart review, the most common cause for under-immunization (55%) was vaccine abandonment. MMR #1 rates rose to 92% in 24-month olds.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Measles, mumps, and rubella immunization rates within the MHS remained below commercial health system rates and below public health standards required for herd immunity despite various countermeasures throughout the COVID-19 pandemic. Immunization rates increased with age, suggesting that children within the MHS eventually catch up despite potential barriers.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usae323","type":"journal-article","created":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T18:13:06Z","timestamp":1719511986000},"page":"e2284-e2289","source":"Crossref","is-referenced-by-count":0,"title":["Worth a Shot: Experience and Lessons From an Unsuccessful Pediatric Immunization Quality Improvement Effort in a Large Health System During the COVID-19 Pandemic"],"prefix":"10.1093","volume":"189","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0088-6193","authenticated-orcid":false,"given":"Bailey","family":"Howard","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Walter Reed National Military Medical Center , Bethesda, MD 20814, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"Gorman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Walter Reed National Military Medical Center , Bethesda, MD 20814, USA"},{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,6,27]]},"reference":[{"issue":"4","key":"2024083012554674200_R1","doi-asserted-by":"publisher","first-page":"E513","DOI":"10.15167\/2421-4248\/jpmh2022.63.4.2587","article-title":"Childhood immunization coverage during the COVID-19 pandemic in the province of Siracusa, Italy","volume":"63","author":"Contarino","year":"2022","journal-title":"PubMed"},{"issue":"8","key":"2024083012554674200_R2","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1136\/archdischild-2021-323630","article-title":"National rates and disparities in childhood vaccination and vaccine-preventable disease during the COVID-19 pandemic: English sentinel network retrospective database study","volume":"107","author":"Hoang","year":"2022","journal-title":"Arch Dis Child"},{"issue":"15","key":"2024083012554674200_R3","doi-asserted-by":"publisher","first-page":"2292","DOI":"10.1016\/j.vaccine.2022.02.076","article-title":"The impact of COVID-19 on routine pediatric vaccination delivery in Brazil","volume":"40","author":"Moura","year":"2022","journal-title":"Vaccine"},{"issue":"5","key":"2024083012554674200_R4","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1016\/j.vaccine.2020.12.054","article-title":"Childhood vaccinations: hidden impact of COVID-19 on children in Singapore","volume":"39","author":"Zhong","year":"2021","journal-title":"Vaccine"},{"author":"National Committee for Quality Assurance","key":"2024083012554674200_R5","article-title":"Childhood immunization status"},{"issue":"4","key":"2024083012554674200_R6","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1542\/peds.2004-0440","article-title":"Measles vaccines and the potential for worldwide eradication of measles","volume":"114","author":"Meissner","year":"2004","journal-title":"Pediatrics"},{"article-title":"More than 140,000 die from measles as cases surge worldwide","volume-title":"World Health Organization","author":"World Health Organization: WHO","key":"2024083012554674200_R7"},{"author":"Center for Disease Control","key":"2024083012554674200_R8","article-title":"Measles cases and outbreaks. 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