Influenza vaccination among U.S. pediatric patients receiving care from federally funded health centers

Diné teachings and public health students informing peers and relatives about vaccine education: Providing Diné (Navajo)-centered COVID-19 education materials using student health messengers

Introduction/background

On 9 April 2021, the Centers for Disease Control and Prevention (CDC) reported that only 19. 9% of United States (US) adults were fully vaccinated against COVID-19. In that same week, the Navajo Nation (NN) reported that 37.4% of residents were fully vaccinated, making the NN a leader in the uptake of COVID-19 vaccines. Despite high vaccination rates, vaccine hesitancy exists within the NN. The Diné (Navajo) Teachings and Public Health Students Informing Peers and Relatives about Vaccine Education (RAVE) intervention was designed to utilize trusted health messengers as an effective means to address adults' vaccine concerns and hesitancy.

Methods

The research team used COVID-19 vaccine materials developed in a previous collaboration with non-Navajo tribal communities and publicly available materials. Diné Traditional Knowledge Holders (TKHs) were interviewed to develop and incorporate Diné-specific information on individual and collective health behaviors into the RAVE materials. These drafted health education materials were presented to NN community health representatives (CHRs) and Diné public health students using a consensus panel approach. NN residents who participated in the intervention completed a 16-element retrospective pretest.

Results

The adaptation and tailoring process of materials yielded 4 health education materials. The students recruited 46 adults for health education sessions. These participants then completed the retrospective pretest. Changes in the 16 elements were in the desired direction, although only six were significant: four related to attitudes and two concerned with vaccination intention. Participants were more likely to consider vaccination and to try to get vaccinated after the education session.

Discussion

Trusted messengers and culturally centered materials have been identified as effective means of health behavior education with Native American audiences. RAVE applied these intervention elements by (1) training Diné College public health students to leverage their cultural knowledge and social relationships (cultural and social capital) to recruit vaccine-hesitant adults and provide education; (2) building on previous understanding of Native American communities' vaccine concerns; and (3) integrating Diné perspectives on individual and collective health into the adaptation of materials designed for general audiences; this knowledge was gained from interviews with TKHs.

Pediatric influenza vaccination rates lower than previous estimates in the United States

BACKGROUND

Annually, pediatric influenza vaccination coverage estimates are ascertained from health surveys, such as the National Immunization Survey (NIS-Flu). From 2010 to 2017, vaccination coverage among children ranged from 51 to 59 %. Recognizing the limitations of national health survey data, we sought to describe temporal trends in pediatric influenza vaccination coverage, and demographic differences among a commercially insured large national cohort from 07/01/2010 to 06/30/2017.

METHODS

Influenza vaccination coverage was assessed among children (<18 years) with continuous enrollment in the de-identified Optum Clinformatics® Data Mart database, and from NIS-Flu. Time trends in vaccination coverage were assessed using Joinpoint regression, overall and stratified by age group, sex, and geographic region.

RESULTS

The average annual pediatric influenza vaccination coverage was 33.4 % in our study population versus 56.5 % reported from NIS-Flu during the same period (p-value < 0.0001). Vaccination coverage was highest in children 6 months-4-years old at 52.6 % (versus 68.8 % NIS-Flu, p-value < 0.0001), and lowest in the 13-17-year-old age group at 20.1 % (versus 42.8 % NIS-Flu, p-value < 0.0001). Vaccination coverage over time remained stable in our study population (average annual percent change 1.8 %, 95 % confidence interval [CI] -2.3 % to 6.0 %) versus significantly increasing by 2.8 % in NIS-Flu (95 % CI 0.3 % to 5.3 %).

CONCLUSIONS

Vaccination coverage in our commercially insured pediatric population was 51.4% lower than estimates from NIS-Flu during the same period, suggesting the need for more accurate vaccination coverage surveillance, which will also be critical in future COVID-19 vaccination efforts. Effective interventions are needed to increase pediatric influenza vaccination rates to the Healthy People 2020 target of 70%.

Barriers to and facilitators of early childhood immunization in rural areas of the United States: a systematic review of the literature

•

Early childhood vaccination coverage is low in rural areas of the United States.

•

Reminder-recall & positive family-provider relationships facilitate vaccine uptake.

•

Parental hesitancy is a barrier to early childhood vaccination in the rural U.S.

•

Vaccine referrals & distance to providers are also rural-specific barriers.

•

To increase vaccine coverage, interventions across rural populations are needed.

Early childhood vaccination rates are lower in rural areas of the U.S. compared with suburban and urban areas. Our aim was to identify barriers to and facilitators of early childhood immunization in rural U.S. communities. We completed a systematic review of original research conducted in the U.S. between January 1, 2000-July 25, 2021. We searched PubMed, Cumulative Index for Nursing and Allied Health Literature, and Web of Science. We included studies that examined barriers to and facilitators of routine immunizations in children <36 months old in rural areas. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we reported studies’ methodologies and targeted populations, definitions of rurality, and common themes across studies that reflected barriers to or facilitators of vaccination. Ultimately, 17 papers met inclusion criteria for review. The majority of studies (10/17) were conducted within one U.S. state, and the same number (10/17) were conducted prior to 2005. Facilitators of vaccine uptake in rural communities identified across studies included reminder/recall systems and parents’ relationships with providers. Parental hesitancy, negative clinic experiences, referrals outside of primary care settings, and distance to providers were identified as barriers to vaccination in rural settings. This review revealed a limited scope of evidence on barriers to and facilitators of early childhood immunization in rural communities. More investigations of the causes of low vaccine coverage and the effectiveness of interventions for increasing vaccine uptake are urgently needed in rural pediatric populations to address persistent rural–urban immunization disparities.