SAN DIEGO — A door-to-door survey found higher immunization rates among African American toddlers in Los Angeles than expected and revealed ways to improve vaccination rates further, Alvin Nelson El Amin, M.D., said at the annual meeting of the National Medical Association.
Physicians might consider implementing a reminder/recall system or participating in a computerized immunization registry with a reminder/recall feature, said Dr. El Amin of the Los Angeles County Department of Health Services.
“Parents and guardians for the most part relied on their child's health care provider to inform them of when the child's next immunization was due,” he said.
The main reason for missing vaccination appointments was a lack of transportation. “Consider collaborative arrangements with nonprofit community agencies that provide bus tokens or taxi vouchers in order to address the transportation problem,” Dr. El Amin said.
Investigators used cluster survey methodology to identify five contiguous zip codes with a high percentage of African American residents. Then they randomly selected 50 clusters of blocks with at least 20 toddlers according to U.S. Census data, and interviewed the parents or guardians of 10 children from each cluster. They reviewed the child's immunization card during the interview or obtained permission to contact the child's health care provider for immunization information.
Of a total of 500 children aged 24-47 months, 74% had received the 4:3:1 series of vaccinations (four DTP shots, three polio shots, and one MMR shot), compared with 55% of 144 African American children and 71% of 2,475 children overall in the 2003 California Kindergarten Retrospective Survey (KRS). The KRS assessed 5-year-olds to retrospectively determine toddler vaccination rates and may not reflect current immunization levels, he said.
Vaccination rates were below the Healthy People 2010 goal of 90% coverage for all universally recommended vaccinations among children aged 19-35 months. Coverage rates for series of immunizations in the current study also lagged rates reported for all Los Angeles children of comparable ages reported in the 2002 National Immunization Survey (NIS). The sample of African American children in the NIS was too small to estimate coverage rates for that population.
In the NIS, 79% of children had received the 4:3:1 series of vaccinations. In the current survey, coverage rates for some individual vaccinations were comparable to those seen for all Los Angeles children in the NIS, Dr. El Amin noted.
Survey results suggest that health care providers should pay particular attention to increasing the rates of three vaccinations in this population: Haemophilus influenzae type b, hepatitis B, and pneumococcal conjugate vaccines.
The current study showed that health care providers were the main source of information on vaccinations, influencing 82% of parents and guardians. Most parents and guardians had positive attitudes toward immunizations.
Overall, 97% said that they felt respected by the physician or clinic providing the vaccinations, and 97% said that they trusted the physician or clinic.
A large majority of parents and guardians (88%) said that they scheduled appointments for immunizations, and 74% of these kept the appointments. Only 47% of those who missed an appointment, however, received a reminder from the health care provider to reschedule the visit.
The survey results were limited by the fact that the data came only from parents and guardians who were available and willing to be interviewed, which may be a population with more positive attitudes toward immunizations, Dr. El Amin explained.