December 1999
CHICAGO - A recent study of Chicago's largest public housing facility revealed that hepatitis B virus immunization (HepB) rates are lower than the national average and not improving despite efforts aimed at this high-risk population.
The Pediatric Immunization Program (PIP) began in 1993 and was designed to monitor childhood immunization rates in one of the nation's largest public housing facilities, Chicago's Robert Taylor Housing Development. In 1998, the Chicago Public Housing Authority estimated that nearly 11,000 people lived in the housing facility, 70% of the residents were younger than 21 years of age and almost all of the residents were African Americans living below the poverty level. Community-based PIP outreach workers provide in-person evaluation of children's immunization status and return to the development at regular intervals to remind caregivers when immunizations are due.
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Despite dealing with a highly mobile population and the need to continually recanvas the facility to identify eligible children, PIP workers have enrolled nearly 75% of eligible children. A new study, recently published in the Journal of the American Medical Association,evaluated PIP data of 1,143 children born in 1991 through 1997 and enrolled in the program between 1993 and mid 1998. The mean age of children enrolled in the program was 26 months.
The researchers found that on-time HepB immunization rates increased dramatically following the issuance of new immunization guidelines in 1991, which recommended the first HepB dose be given at birth, but plateaued at about 50% coverage after four years. Coverage rates for HepB were also lower than the 1997 National Immunization Survey (NIS) report of 82% coverage with all three HepB doses among non-Hispanic black children age 19 through 35 months living below the poverty level.
The authors believe that one of the reasons for the low rate of HepB coverage compared to the NIS report may be that approximately 60% of residents in the housing facility do not have working telephones, which excluded them from NIS sampling. Among this population, the initial dose of HBV vaccine was the most likely of all recommended childhood vaccines to be received on time. The study authors were surprised to find that children who received the first HepB dose on time were more likely to receive the first dose of diphtheria-tetanus-pertussis (DTP) vaccine on time. Of infants who received HepB vaccination at month 0, a total of 60.1% (196/326) received the first DTP vaccine dose according to the immunization guidelines. In addition, initial HepB immunization at month 0 in this population was associated with completion of the HepB immunization series and 4:3:1 series completion (four DTP, three poliomyelitis vaccine doses and one measles-containing vaccine) by 19 months.
Previous studies have shown that on-time initiation of the DTP vaccination series is a significant indicator of up-to-date immunization status by 2 years of age. This data indicated that on-time initiation of HepB immunization may be the first step toward successful completion of the recommended childhood immunization schedule in this population.
For more information:
- Lauderdale DS, Oram RJ, Goldstein KP, et al. Hepatitis B vaccination among children in inner-city public housing, 1991-1997. JAMA.1999;282:1725-30.
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