Persistent Low Immunization Coverage Among Inner-city Preschool Children Despite Access to Free Vaccine

Thomas A. Kenyon · Michael A. Matuck · George Stroh

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Vaccine Coverage and Hesitancy Child and Adolescent Health Immune responses and vaccinations

Abstract

OBJECTIVE: To compare vaccination coverage among children 19 to 35 months of age from public housing developments where a free vaccine outreach program was in place with children residing elsewhere in the city. DESIGN: A household survey using a multistage cluster sampling method to compare community areas which accounted for 80% of measles cases during 1989 (high-risk stratum), areas which accounted for the remaining 20% of cases (low-risk stratum), and public housing developments (public housing stratum) having free, on-site vaccination services. SETTING: Inner-city Chicago households, April to May 1994. OUTCOME VARIABLES: Antigen-specific and series-specific coverage based on written records. RESULTS: Based on evaluation of 1244 children, citywide coverage for four doses of diphtheria-tetanus-pertussis vaccine, three doses of polio vaccine, and one dose of measles-containing vaccine (4:3:1) was 47% [95% confidence interval (CI), 40% to 55%]. Coverage was significantly lower among children residing in public housing (23%; 95% CI, 18% to 28%) compared with those residing in high-risk strata (45%; 95% CI, 38% to 52%) and low-risk strata (51%; 95% CI, 43% to 60%). Compared with white children (53%), coverage for the 4:3:1 series was lower among African-American children in public housing (29%) or outside public housing (36%). Moreover, 11% (95% CI, 8% to 14%) of children residing in public housing had never received any immunizations. CONCLUSIONS: African-American children throughout Chicago, particularly in public housing, remain at increased risk for vaccine-preventable diseases and should be targeted further for vaccination services. Vaccination coverage remains low several years after a major outbreak of measles and implementation of a free vaccine outreach program. Cluster surveys may be useful for monitoring vaccination coverage in high-risk urban settings.

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References

1991The Measles Epidemic 1995Factors Related to Immunization Status Among Inner-City Latino and African-American Preschoolers 1994Low vaccination levels of US preschool and school-age children. Retrospective assessments of vaccination coverage, 1991-1992 1995Interaction of Socioeconomic Status and Provider Practices as Predictors of Immunization Coverage in Virginia Children 1992Causes of Low Preschool Immunization Coverage in the United States

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