P0072 - Early Childhood Vaccination Delays in Children with Prenatal Exposure to Opioids and Tobacco

The opioid epidemic has disproportionately affected rural communities and has led to an increase in foster care placements due to parental substance use disorder. Both foster care placement and living in a rural area are known risk factors for immunization delays. Thus, we hypothesized that children with prenatal opioid exposure would be at risk for early childhood immunization delays. We identified a sample of 383 children born in West Virginia between January 1, 2016 and December 31, 2018 with prenatal opioid exposure based on the ICD10 code p04.14, and utilized the state’s mandatory immunization information registry to evaluate for current vaccine delays. Sixty-two additional children with isolated, prenatal tobacco exposure (p04.2) were included in the sample as a control group. Patients who died, moved out of state, or lacked any updated state immunization registry information were excluded from analysis (n=54). Demographics of each group appear in Table 1. Vaccine delays were common in both cases (77%) and controls (75%), but opioid-exposed children were more likely to be delayed on multiple vaccines. We found a significant difference (F=35.81 (402); p <.001) in the mean number of vaccine delays among opioid-exposed children (2.7 vaccine delays) and children in the control group (1.5 vaccine delays). Vaccine delays from most to least prevalent are listed in Table 2. Patients had more vaccine delays if they were lower gestational age at birth, lower birth weight, had a longer length of stay in the birth hospitalization, and were from a more rural area. There were no significant differences in the severity of vaccine delays between opioid-exposed children placed in foster care versus those discharged with the biologic parents. Given the ongoing opioid epidemic, the rise in vaccine-preventable diseases in the United States, and the importance of influenza vaccination as the COVID-19 pandemic evolves, it is of the utmost importance for pediatricians to be aware of the prevalence of vaccine delay prior to school entry in children prenatally exposed to opioids.