P2.138: Pediatric Vaccination Patterns: Outcomes from the HealthySteps Cohort in New Jersey

Background: In New Jersey, fewer than 70% of children receive the full series of recommended vaccinations by age two, with rates significantly lower in underserved and immigrant populations. This gap in preventive care places young children at increased risk for vaccine-preventable diseases and reflects broader disparities in access to pediatric services. HealthySteps (HS) is a national, integrated pediatric-behavioral health primary care program that supports early childhood development and positive parenting, especially for low-income, culturally diverse families. This project launched New Jersey’s first HS sites by integrating HS Specialists into three primary care practices to improve care coordination and outcomes. One aim of the project was to evaluate vaccine completion and timeliness across the HS cohort, comparing results across tiers, and statewide benchmarks.

Methods: Children aged 0–3 (n=3,367) who received care at HS-affiliated practices were included. Vaccine status was assessed for those ≥24 months (n=1,669), and on-time vaccination analysis focused on those who had WCVs within guideline-aligned timeframes (n=1,211 for 0-6 months and n=932 for 11-15 months). Complete vaccination was defined as receiving all doses of 7 CDC-recommended vaccines. On-time vaccination required administration within ±1 month of the recommended age. Analyses were stratified by tier (service intensity based on family needs). Data were collected via electronic medical records and standardized surveys.

Results: Complete vaccination rates were high: 91.7% of eligible children received the full vaccine series, significantly exceeding the 2020 NJ state average of 68.7%, p<.001 (Figure 1). Only 5.3% received selective vaccination and 3.0% were incomplete. Tier 1 children (low-risk families) had significantly lower completion rates than Tier 3 families deemed at highest-risk (p <.05), possibly due to fewer touchpoints with care teams.
On-time vaccination rates varied by vaccine: 83.2% received MMR and 82.3% received VZV within the recommended 12–15 months window. For vaccines administered in infancy, median ages aligned closely with CDC guidelines (e.g., DTAP doses at 2, 4, and 6 months). HIB’s third dose showed wider timing variation, suggesting potential delays in series completion for some families.

Conclusion: The HS model achieved a complete vaccination rate far exceeding the NJ average, highlighting its potential to address healthcare disparities in vulnerable populations. Differences in tier-based completion suggest enhanced outreach to Tier 1 families could further improve outcomes. The higher timeliness for vaccines with earlier schedules (e.g., Hep B, PCV) may reflect higher visit adherence during infancy. Targeted efforts to improve adherence to later infant vaccine schedules (e.g., HIB) may close remaining gaps. These findings underscore the effectiveness of integrated family-centered care models in promoting preventive health among at-risk children.

Funded by the Burke Foundation, the Turrell Fund, and Hackensack Meridian Health.