Immunization outreach in an inner-city housing development: reminder-recall on foot.

OBJECTIVE: To determine rates of immunization coverage among children 3 to 72 months of age in a large public housing development, to develop a community-based outreach program to increase coverage, and to evaluate the effect of the program. DESIGN: A door-to-door canvass of the development by specially trained emergency medical technicians to enroll families, to determine immunization status from written records, and to follow-up to encourage immunizations and well-child care. The program was evaluated, comparing rates of immunization by age with an expectation based on the immunization histories before enrollment. SETTING: A Chicago public housing development, October 1993 through December 1996. OUTCOME VARIABLES: Antigen-specific and series-specific coverage based on written records. RESULTS: Of the caregivers, 92% were able to identify a primary care provider. At the time of enrollment, 37% of 1075 children were up-to-date, but that proportion varied by age with 27% of children 19 to 35 months of age being up-to-date. The program increased rates of immunization compared with the expectation from the preenrollment rates. At their final assessment, 50% of the children were up-to-date. For individual vaccines, there was a positive program effect. For example, before enrollment, 22% of children 15 months of age had received measles, mumps, and rubella vaccine. However, 39% of children who were enrolled in the program before they were 12 months of age had received their first immunizations by 15 months of age. CONCLUSIONS: Children in the housing development had very low rates of immunization before enrollment. An in-person intervention was effective in reaching families and determining immunization status. In the 3-year enrollment and observation period, rates of immunization increased.

Hepatitis B vaccination among children in inner-city public housing, 1991-1997.

CONTEXT: In 1991, the Advisory Committee on Immunization Practices recommended universal vaccination of infants against hepatitis B virus (HBV), with series initiation within days of birth. OBJECTIVE: To determine HBV vaccine coverage in a low-income urban population and to examine whether HBV immunization within the first month of life affects subsequent vaccine receipt. DESIGN: Cohort study based on immunization records collected in the Pediatric Immunization Program. Setting Large public housing development in Chicago, Ill. PARTICIPANTS: All 1143 children who were born between 1991 and 1997 and enrolled between 1993 and mid-1998, with follow-up to age 35 months. MAIN OUTCOME MEASURES: On-time vaccine receipt of HBV vaccine doses, diphtheria-tetanus-pertussis vaccine (DTP) dose 1, and the 4:3:1 series (4 doses of DTP vaccine, 3 doses of poliomyelitis vaccine, and 1 dose of measles-containing vaccine), analyzed by year. RESULTS: On-time HBV vaccination increased quickly following new guidelines and reached a plateau of about 50% coverage for those born in or after 1995. Since 1994, more children (64%) received the first HBV vaccine dose on time than any other vaccine. Children who received a dose of HBV vaccine during their first month of life were more likely to receive the first DTP vaccine dose on time (60.1%) than those who did not get an HBV vaccine dose during the first month (36.4%; chi2 = 53.7; P<.001). Children who received the first HBV vaccine dose during their first month were more likely than those receiving it at age 1 to 2 months to complete 3 HBV doses by 19 months (70.6% vs 51.1%; chi2 = 11.6; P = .001) and to complete the 4:3:1 series by age 19 months (49.8% vs 37.9%; chi2 = 4.0; P = .05). CONCLUSIONS: In this inner-city population, HBV vaccine has been received at rates similar to those of other vaccines within 3 years of issuance of new recommendations. Of note, immunization with HBV vaccine at birth was associated with timely receipt of other vaccines and, therefore, may have the potential to increase vaccination among groups less likely to be up-to-date on early childhood vaccines.

The effect of epidemic measles on immunization rates.

OBJECTIVE: To evaluate whether immunization against a vaccine-preventable disease is sought to avoid the naturally occurring disease itself, we hypothesized that the rate of "on-time" measles immunization would increase during an epidemic of that disease. If such an effect occurred, we wondered whether it would have an impact on on-time administration of other recommended immunizations. DESIGN: Retrospective evaluation of immunization rates of children at their second birthday with the use of computerized health records of children entering kindergarten in an 8-year interval spanning the onset of epidemic measles in Chicago, Ill, in 1989 and 1990. SETTING: Children entering Chicago public schools. MAIN OUTCOME MEASURES: Rates of receipt of measles-containing vaccine (MCV), 1 to 4 doses of a diptheria toxoid-tetanus toxoid-pertussis (DTP) or diphtheria toxoid-tetanus toxoid (DT) vaccine, 1 to 3 doses of oral or inactivated polio vaccine (OPV/IPV), and the full series of these vaccines (4:3:1) that are required to be "up-to-date" by the second birthday. RESULTS: The rate of on-time MCV receipt increased from 56% to 58% in the years prior to 70% during the epidemic (1989 and 1990). A similar increase did not occur to DTP/DT 4 or OPV/IPV 3. Moreover, among older children delayed in MCV receipt, evidence of catch-up immunization also occurred during the epidemic years; similar catch-up for delayed DTP/DT 4 or OPV/IPV 3 immunization did not occur. CONCLUSIONS: Dramatic increases in one-time and catch-up MCV receipt occurred during the Chicago measles epidemic of 1989 and 1990. The lack of similar increases in DTP/DT 4 and OPV/IPV 3 suggests MCV receipt was not associated with receipt of other recommended immunizations during that time.

Accuracy of immunization histories provided by adults accompanying preschool children to a pediatric emergency department.

OBJECTIVE: Because some have advocated the use of emergency departments to administer delayed childhood immunizations, we evaluated the accuracy of immunization histories obtained in this setting by comparison with medical records of inner-city health care facilities. DESIGN: Questionnaires were orally administered to adults accompanying children to the emergency department. Individual medical records were reviewed. SETTING: Pediatric emergency department at Wyler Children's Hospital, University of Chicago and 68 inner-city primary care clinics. PATIENTS: Children aged 3 to 65 months registering for medical care. Of the sample, 98% were African American; 75% were Medicaid recipients. MAIN OUTCOME MEASURES: Adults' knowledge of immunization histories, immunization cards, and medical records compared with American Academy of Pediatrics/Immunization Practices Advisory Committee recommendations. RESULTS: Of the accompanying adults, 64% stated that their child's general immunization status was "up-to-date"; 65% of these had clinic records confirming that status. Only 8% of specific regimens stated by these adults accurately matched those found in clinic records. Moreover, 45% of adults accompanying children at least 16 months and older provided inaccurate information regarding previous receipt of measles immunization. CONCLUSION: Information provided by accompanying adults (from recall or from immunization cards) is inadequate to determine accurately which preschoolers in the pediatric emergency department are delayed in immunizations.