Community-Centered Education Improves Vaccination Rates in Children From Low-Income Households

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Obstacles to vaccine delivery, including poverty, reduced access to medical care, and incomplete understanding of vaccine safety and importance, result in suboptimal coverage rates in some populations, allowing for disease outbreaks. Multicomponent interventions are successful in increasing immunization coverage rates. WHAT THIS STUDY ADDS:We show that collaboration with local resources, including the county health department and a large community-based organization, effectively increases immunization coverage rates in low-income, resource-poor children.abstract OBJECTIVE: We partnered with the Salvation Army to educate resourcepoor families regarding childhood immunizations in an effort to improve vaccine coverage rates. METHODS:Eligibility for enrollment included children of families presenting at registration for our Salvation Army holiday gift program, available to families with an annual income ,150% of federal poverty guidelines. Parents completed a questionnaire, were provided each child' s vaccination status as documented in the New York State Immunization Information System, and interacted with the study team to address immunization-related concerns. Missed vaccines were identified and parents were directed to their child' s medical home for necessary immunizations. Vaccine coverage was ascertained via the New York State Immunization Information System every 6 to 8 weeks with telephone follow-up for children who remained delayed. The McNemar test and standard 2-proportion comparison were used to determine confidence intervals when analyzing matched or independent data, respectively. RESULTS:A total of 1531 children were enrolled; 416 (28%) of the 1477 children with accurate immunization records were vaccine complete. When we excluded influenza vaccine, 1034 (70%) of children had received all other recommended vaccines. Nine months later, vaccine completion rates increased from 28% to 45%, largely because of improvements in influenza vaccination rates, which increased by 17% (confidence interval [CI] 15.5-19.5), a significant improvement over county (8%, 95% CI 7.4-8.1) and statewide (5%, 95% CI 4.7-4.8) rates during the same period. CONCLUSIONS:Immunization rates in poor children are suboptimal. Partnering with community-based organizations to address parental concerns, provide education, and perform follow-up was effective in improving immunization rates, particularly for influenza vaccine. Pediatrics 2013;132:319-325

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