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APHA Scientific Session and Event Listing

Quimby E. McCaskill, MD, MPH¹, David L. Wood, MD, MPH¹, Paula M. Crawford, BS², Alison M. Dekle, BA², and Tao Hou, MPH². (1) Department of Pediatrics, University of Florida/Jacksonville & Duval County Health Department, 515 W. 6th Street, Jacksonville, FL 32206, 904-665-2724, quimby.mccaskill@jax.ufl.edu, (2) Duval County Health Department, 515 W. 6th Street, Jacksonville, FL 32206

Background: While recent advances in immunization coverage have led to a significant decrease in the incidence of vaccine-preventable illnesses, many areas in the United States continue to report immunization rates well below the goals set for preschool age children. Given the Healthy People 2010 objective “to maintain > 95% vaccination coverage among children attending licensed child care centers and kindergarten through post-secondary school”, researchers have begun examining those key factors which lead to a high risk for underimmunization- poverty, urban setting and minority status. This study looks at the vaccination rates of poor, inner-city children attending subsidized daycare and offers insight as to how overall immunization rates may be improved through better education and policy change related to Hepatitis B vaccination.

Setting: Subsidized day care centers located in Jacksonville, Florida.

Population: Children, ages 19-35 months, and their families living below 150% of the poverty line who participate in the subsidized day care program.

Project Description: Immunization records were collected from a sample of children attending subsidized daycare and linked with demographic data already obtained from these families as part of the Healthy School Readiness Project (HSRP). Univariate, bivariate and logistic regression analyses were performed to evaluate immunization rates at 3 months and 12 months of age. Demographic information from these families was also compared with census data from 2000 to compare this group of children to similar low-income, inner-city children living in Jacksonville

Results/Lessons Learned: Results showed that individual antigen rates for Hepatitis B were substantially lower at 12 months of age than for other antigens (e.g., DTaP, IPV, and HiB). These differences were also seen at 3 months of age, despite the American Academy of Pediatrics recommendation that children receive Hepatitis B vaccination during the initial hospital stay following birth. No significant differences were found between those children who were up-to-date (UTD) at 12 months compared with those not UTD except for those receiving Hepatitis B vaccine at birth. Logistic regression analysis supported the notion that inconsistent immunization practices related to Hepatitis B are largely responsible for the lower UTD rates reported in this population. Given these findings, more effort should be made towards better educating families and clinicians about the importance of Hepatitis B immunization for all children prior to initial discharge from the hospital. Additionally, new policies need to be developed that mandate all hospitals routinely immunize children against Hepatitis B immunizations regardless of maternal risk status.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Identify differences seen in individual antigen rates for inner city, poor children.
• Develop strategies to improve Hepatitis B vaccination through education and public policy.
• Describe potential ways to utilize subsidized day care settings to better measure inner-city immunization rates.

Presenting author's disclosure statement:

Not Answered