Rapid vaccine distribution in non-traditional settings in New York City

Low vaccination coverage among minorities and persons living in and near poverty is a persistent problem. With growing fear of a worldwide influenza pandemic, effective programs that can rapidly vaccinate “hard-to-reach” populations (substance users, homeless, homebound elderly) in underserved communities are needed and community nurses may play a key role in this effort. Project VIVA (Venue-Intensive Vaccination for Adults), a community-based intervention staffed by community nurses and outreach workers, aimed to deliver vaccines rapidly within the East Harlem and South Bronx neighborhoods of New York City (NYC). The project was also designed to test the feasibility of a rapid distribution protocol that could be utilized in the event of an emergency. Eight nurses and sixteen outreach workers offered free influenza vaccinations door-to-door and on street corners in four low-income communities over ten days in October, 2005. A baseline survey was conducted in September and October of 2005 to document characteristics of persons that were the target of the intervention. Of 1,668 participants screened, 99% (1,648) received vaccine. Reactions to the project were positive in the local communities and participants formed long lines to receive the vaccine. Among those vaccinated, the mean age was 46; 52% were female, 76% Hispanic/Latino and 77% reported income of less than $9,600/yr. Almost half (47%) were members of a hard-to-reach population, and 38% were medically-indicated to receive influenza vaccine. 58% of the vaccine was distributed on street corners. Compared to those surveyed during the baseline assessment, those vaccinated were more likely to be: undocumented immigrants (p<0.0001), homebound elderly (p<0.0001) or uninsured (p<0.0001). They were less likely to be: Black (p<0.0001), homeless (p=0.03), or current substance users (p<0.0001). Factors key to project success were: selection of nurses and outreach staff with complementary research skills and firsthand knowledge of the communities, community involvement in project development and implementation, ongoing community outreach, and prioritizing street-based distribution. To prepare urban communities for a possible influenza pandemic, instituting annual mass vaccination efforts in non-traditional settings is recommended. These results demonstrate that vaccination can feasibly be delivered by public health nurses to members of hard-to-reach populations through a community-based approach.