Vaccination coverage among young homeless children compared to US national immunization survey data

Linda Y Fu; Rachel Torres; Susan Caleb; Yao I Cheng; Erica Gennaro; Elizabeth Thoburn; John McLaughlin; Ronika Alexander-Parrish; Jichuan Wang

doi:10.1016/j.vaccine.2021.09.073

Vaccination coverage among young homeless children compared to US national immunization survey data

Vaccine. 2021 Oct 29;39(45):6637-6643. doi: 10.1016/j.vaccine.2021.09.073. Epub 2021 Oct 8.

Authors

Linda Y Fu¹, Rachel Torres², Susan Caleb², Yao I Cheng², Erica Gennaro³, Elizabeth Thoburn⁴, John McLaughlin⁴, Ronika Alexander-Parrish⁴, Jichuan Wang²

Affiliations

¹ Goldberg Center for Community Pediatric Health, Children's National Hospital, 111 Michigan Ave., NW, Washington, DC 20010, USA; Center for Translational Science, Children's National Hospital, 111 Michigan Ave., NW, Washington, DC 20010, USA. Electronic address: linda.fu@nih.gov.
² Center for Translational Science, Children's National Hospital, 111 Michigan Ave., NW, Washington, DC 20010, USA.
³ Goldberg Center for Community Pediatric Health, Children's National Hospital, 111 Michigan Ave., NW, Washington, DC 20010, USA.
⁴ Pfizer, Inc., 500 Arcola Rd, Collegeville, PA 19426, USA.

PMID: 34629209
DOI: 10.1016/j.vaccine.2021.09.073

Abstract

Introduction: Comprehensive vaccination coverage among homeless children in the United States (US) is largely unknown although a few studies suggest low coverage with single vaccinations. This study compared vaccination coverage with a combined 7-vaccines series among homeless children in the District of Columbia (DC) to coverage among other US children.

Materials and methods: A cross-sectional survey of homeless children in DC was conducted from 2018 to 2019. Recruitment occurred at housing shelters, social services centers, and a diaper dispensary, and through limited chain referral. English-speaking parents of a child aged 19 to 35 months who spent the majority of the last 30 nights homeless were recruited. Participants consented for their child's healthcare providers to submit vaccination records. The vaccination coverage estimate of this sample was compared with estimates of three populations in the 2018 National Immunization Survey (NIS): children in DC (NIS DC), children in the US (NIS US), and children in the US below the federal poverty level (NIS poor).

Results: Most of the 135 children had experienced at least two lifetime episodes (63.7%) and 12 months (57%) of homelessness. The estimated percent up to date was 52.6% (95% CI: 43.8%, 61.3%). This estimate was 20.4 (95% CI: 11.9, 28.8, p < .0001), 20 (95% CI: 11.5, 28.4, p < .0001), and 11.5 (95% CI: 3.1, 20, p < .01) percentage points lower than estimates for the NIS DC, NIS US and NIS poor populations, respectively. After adjusting for child's age and race/ethnicity, vaccination coverage of the NIS DC sample was below that of NIS US (p < .01) and NIS poor samples (p < .05).

Conclusion: Children experiencing homelessness may be at risk of under-vaccination, even when compared to a general population of children in poverty. Awareness of this heightened risk may allow for more precise targeting of vaccination delivery support specifically to children experiencing homelessness.

Keywords: Child health; Homeless children; Immunization; Poverty; Public assistance; Social welfare.

MeSH terms

Child
Cross-Sectional Studies
Homeless Youth*
Humans
Immunization
Infant
United States
Vaccination
Vaccination Coverage*