1632. Different Healthcare Utilization Pattern in Vaccine Hesitant Children

BACKGROUND: National Immunization Program (NIP) in Korea provides 17 types of mandatory vaccines for all children free of charge. However, vaccine-hesitant group refusing the NIP are being a major threat to public health. We analyzed the healthcare utilization pattern observed in NIP eligible children and sought to identify those who remain unvaccinated using national population data. METHODS: History of receiving protein conjugate pneumococcal vaccine (PCV) was reviewed to determine the vaccination status of children born between 2013 and 2015. Children who had 3-doses or more out of 3 + 1 schedule were defined vaccinated, while those with no record of vaccination were defined unvaccinated. Their healthcare utilization records, including a number of visits, total duration, type of institution (hospitals, complementary and alternative medicine [CAM]), and purpose of visits (outpatient care, hospitalization), were retrieved from the National Health Insurance (NHI) Review and Assessment Service. Annual healthcare utilization rate and incidence of pneumococcal infections were estimated with Poisson regression and compared between study arm. The proportion of CAM out of total healthcare utilization was also compared. RESULTS: Among 1,272,685 children, 51% were boys and median age was 29.4-months. Two-percent of the cohort remained unvaccinated until study end. Annual hospital visiting rates were 26.9 times (95% confidence interval [CI] 26.9–27.0) for vaccinated and 3.4 (95% CI 3.4–3.5) for unvaccinated. Average NHI benefit period per year was 28.8 days (95% CI 28.8–29.0) for vaccinated and 3.9 (95% CI 3.8–3.9) for unvaccinated. The discrepancy resulted in under-detection of pneumococcal incidence in unvaccinated with 10.1 cases (95% CI 9.9–10.4) per 1,000 child-months whereas that of vaccinated was 42.5 (95% CI 42.4–42.6). Vaccine hesitant children preferred CAM at least 3-times more than vaccinated children (CAM proportion 3.5% in hesitant group vs. 1.07% in vaccinated group, P < 0.001). CONCLUSION: Vaccine hesitant group not only refuses vaccination but also tends to opt-out from the entire medical attention and prefer CAM. Active detection considering this different pattern should be implemented in order to ensure the public benefits from the vaccination program. DISCLOSURES: All authors: No reported disclosures.