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Jennifer C. Nelson, PhD, Rachel C. L. Bittner, MS, Lora Bounds, BS, Shanshan Zhao, MS, James Baggs, PhD, James G. Donahue, DVM, PhD, MPH, Simon J. Hambidge, MD, PhD, Steven J. Jacobsen, MD, PhD, Nicola P. Klein, MD, PhD, Allison L. Naleway, PhD, Kenneth M. Zangwill, MD and Lisa A. Jackson, MD, MPH

Jennifer C. Nelson, Rachel C. L. Bittner, Lora Bounds, Shanshan Zhao, and Lisa A. Jackson are with the Group Health Research Institute, Seattle, WA. Jennifer C. Nelson, Rachel C. L. Bittner, and Shanshan Zhao are also with the Department of Biostatistics, University of Washington, Seattle. James Baggs is with the Centers for Disease Control and Prevention, Atlanta, GA. James G. Donahue is with the Epidemiology Research Center, Marshfield Clinic Research Foundation, Marshfield, WI. Simon J. Hambidge is with Kaiser Permanente Institute for Health Research, Denver Health Community Health Services, and University of Colorado, Denver, CO. Steven J. Jacobsen is with Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA. Nicola P. Klein is with the Vaccine Study Center and Division of Research, Northern California Kaiser Permanente, Oakland, CA. Allison L. Naleway is with Center for Health Research, Kaiser Permanente Northwest, Portland, OR. Kenneth M. Zangwill is with the Center for Vaccine Research at the University of California and the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles. Lisa A. Jackson is also with the Department of Epidemiology, University of Washington, Seattle.

Correspondence: Correspondence should be sent to Jennifer C. Nelson, PhD, 1730 Minor Ave, Suite 1600, Seattle, WA 98101 (e-mail: nelson.jl{at}ghc.org). Reprints can be ordered at http://www.ajph.org by clicking on the "Reprints/Eprints" link.

Objectives. We studied compliance with multiple-dose vaccine schedules, assessed factors associated with noncompliance, and examined timeliness of series completion among older children, adolescents, and adults.

Methods. We conducted a large, multisite, retrospective cohort study of older children, adolescents, and adults in the Vaccine Safety Datalink population from 1996 through 2004. We quantified the rates of completion of all required doses for varicella, hepatitis A, and hepatitis B vaccines according to their recommended schedules.

Results. Among those who received a first dose of varicella (n = 16 075), hepatitis A (n = 594 917), and hepatitis B (n = 590 445) vaccine, relatively few completed the series (55%–65% for hepatitis B vaccine and 40%–50% for hepatitis A and varicella vaccines in most age groups). Compliance was lowest among adolescents (35.9%) and Medicaid recipients (29.7%) who received varicella vaccine and among younger adult age groups who received hepatitis A vaccine (25%–35% across those age groups). Even among series completers, there was a relatively long interval of undervaccination between the first and last doses.

Conclusions. Compliance with multiple-dose vaccine series among older children, adolescents, and adults is suboptimal. Further evaluations of strategies to improve compliance in these populations are needed.