Identifying Missed Opportunities for Routine Vaccination among People Who Use Drugs

Abstract

In the US, adult immunization coverage remains low, especially among vulnerable populations, as recent hepatitis A outbreaks have demonstrated. We studied the vaccination history variation among the US adults who use drugs by implementing a community-engaged research survey to identify reported immunization coverage, missed opportunities (MO), and places where immunizations might be delivered. Our analysis of a sample of 1127 participants recruited at community syringe exchanges in three cities identified higher overall vaccination receipt in Los Angeles compared to Atlanta or Las Vegas (e.g., HAV receipt 52.2% LA, 42.1% LV, 41.4% Atlanta). Overall, fewer participants reported having received HAV (45.9%), HBV (47.5%), or influenza (47.6%) vaccines than MMR (57.1%) or Td/Tdap (61.1%). Across sites, HAV receipt was higher for participants incarcerated ≥5 years (54.2% vs. 43.6% for those incarcerated <5 years, 49.4% no incarceration history, p = 0.02). HBV receipt was higher among participants who were not intravenous drug users (56.1% vs. 46.0%, p = 0.03). Additionally, income >$20k predicted higher rates of MMR receipt (67.0% vs. 56.5%, p = 0.009), as did stable housing (62.8% vs. 54.3%, p = 0.01). To address the need to expand vaccine coverage among vulnerable adults, delivering vaccine at sites where persons who use drugs access services, or in correctional facilities, may be warranted.

Vaccine confidence among people who use drugs: A cross-sectional survey

“… 66 For PWUD without insurance, this higher VC may suggest a pathway to improved vaccination rates, as we previously found that PWUD without insurance had lower rates of vaccine coverage than those with public or private insurance. 46 Further research is needed to determine the factors which influence higher VC among PWUD with different insurance coverage and to determine how community care organizations can leverage this confidence into vaccination opportunities.…”

“…Vaccine confidence among PWUD was surveyed as part of a larger cross-sectional study of health behaviors of PWUD in the United States. 46 , 64 Atlanta, Georgia, Los Angeles, California, and Las Vegas, Nevada were chosen as project locations based on characteristics of the populations of PWUD living in those cities, including vulnerability to HIV, viral hepatitis, and other vaccine-preventable diseases. Project protocols were approved by the University of Nevada Las Vegas Institutional Review Board (IRB), as well as independent determinations for secondary analyses by the IRBs of Emory University, the University of Nevada Las Vegas (#1428464-5), and the University of California Los Angeles (#19-001173).…”

COVID‐19 vaccination coverage and vaccine hesitancy among people with opioid use disorder in Barcelona, Spain

“…Finally, vaccination complacency was the other main reason for not being vaccinated in this study, which is a common barrier cited in studies of influenza vaccine hesitancy in people with OUD [14–17]. In the case of COVID‐19 vaccines, this finding may be a result of increased public health focus on vaccinating the elderly and populations with underlying chronic conditions [33] and the lack of outreach on COVID‐19 vaccination using social media platforms targeting younger populations [10, 34].…”

“…People with substance use disorders (SUD) are considered a priority group for SARS‐CoV‐2 vaccination as they are at an elevated risk of COVID‐19 and its severe complications, especially those with a recent diagnosis of SUD and opioid use disorder (OUD) [ 11 , 12 , 13 ]. However, they are a population characterised by low‐estimated vaccination coverage for other recommended vaccines, including pneumococcal, diphteria, tetanus and pertussis vaccine, hepatitis A, hepatitis B and influenza [ 14 , 15 , 16 ]. In the case of the COVID‐19 vaccine, previous studies regarding the vaccine roll‐out in developed countries have shown a high prevalence of hesitancy among people with SUD [ 17 , 18 , 19 ].…”

Opiate maintenance patients’ attitudes and self-reported adherence to protective measures against SARS-CoV-2 infections

“…Compared with the general population vaccination rates of illicit opiate drug users or people who inject drugs (PWID) are higher for hepatitis A virus and hepatitis B virus ( 6 , 7 ), with hepatitis B vaccination programs having shown to be useful in increasing vaccination levels ( 8 ), reaching completion rates of up to 70–80% ( 9–12 ). Nevertheless, high proportions from these target groups have still not been vaccinated against HBV ( 6 , 7 , 13 , 14 ). Influenza vaccination rates of PWID may be lower ( 5 , 15 ) or similar ( 7 ) to those observed in the general population ( 5 ).…”