504 - Disparities on vaccination rates in American Indian children in Great Plains region

Poster Number: 504
Publication Number: 504.325

Riley T. Paulsen, University of South Dakota - - Vermillion, SD, Vermillion, SD, United States; Claire Porter, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, United States; Santiago Lopez, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, United States

Background: American Indian (AI) children experience a greater infectious disease burden than non-AI children. Correspondingly, AI children are less likely to be fully immunized compared to non-AI children. In our published study evaluating outcomes of AI children during lower respiratory tract infection (LRTI), AI children under 2 years old had significantly higher morbidity compared with non-AI children during LRTI. In addition, AI children had lower vaccination rates compared with non-AI children. This study aims to evaluate which vaccines were delayed during hospitalization. Moreover, we evaluated vaccination rates until 6 years of age and time to catch up for delayed immunizations

Objective: Evaluate immunization rates in AI children compared with non-AI children at hospitalization and longitudinally until 6 years of age in the Great Plains region

Design/Methods: Retrospective chart review study evaluating vaccination rates of children admitted with LRTI and subsequent follow up on vaccination rates. Vaccination records were obtained from a multistate integrated data base (SD, ND, MN, IA, NE). Up to date immunization status was determined by the Advisory Committee on Immunization Practices recommendation. For the analysis, we excluded routine vaccines given after 6 years of age

Results: A total of 644 subject were included in the study, 114 AI and 529 non-AI. At the time of hospitalization, AI children had a significantly lower rates of vaccination compared to  non-AI children [(n= 48 (42%) of AI vs. n=372 (70%) non-AI, p < 0.0001, Fischer’s exact test]). The greatest disparities in vaccine coverage were seen in rotavirus, the first 3 doses of DTaP, the first 3 doses of Hib, the first 2 doses of Hepatitis B, the first 3 doses of conjugated pneumococcal vaccine (PCV13), and the first 2 doses of IPV. At present day, AI children continued to be underimmunized when compared with non-AI children. We observed significant delays for immunization in AI children compared with non-AI children (p < 0.0001, Fischer’s exact test) for Hepatitis B and A virus, DTaP, Hib, PCV13, and IPV series. The majority of AI children residing in a zip code federally recognized as a Native American reservation were underimmunized (n=43, 77%).Conclusion(s): Health disparities in the AI population continue to be a public health problem. Our study highlights significantly lower vaccination rates in AI children during early childhood. Increasing vaccination rates and access to vaccines in AI children should be a public health priority in our rural Great Plains region