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Highlights in Minority Health
August, 2004
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AUGUST IS NATIONAL IMMUNIZATION AWARENESS MONTH |
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Each year, National Immunization Awareness Month (NIAM) increases
awareness about immunization across the lifespan as parents and
children prepare for the return to school, and the medical community
begins preparations for the upcoming flu season.
Immunization has been cited as one of the top ten public
health achievements of the 20th century.
Yet the burden of vaccine-preventable diseases in adults in the U.S.
is staggering – approximately 46,000 to 48,000 adults die each year
from vaccine-preventable diseases. |
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Each year approximately 114,000 people in the United States are
hospitalized because of influenza; an average of 36,000 people die
annually due to influenza and its complications– most are people 65
years of age and over. Annually there are approximately 60,000 cases
of invasive pneumococcal disease in the United States and one-third
(20,000) of these cases occur in people 65 and older.
Influenza vaccine coverage rates were up from 33 percent in
1989 to 64 percent in 1998, and pneumococcal vaccine coverage rates
were up from 15 percent to 46 percent. Despite these increases,
adult vaccination
coverage rates for certain racial and ethnic groups remain
substantially below the general population. On
the national level, vaccination coverage among U.S. preschool
children is at or near record high levels. This successful
achievement of the past decade has largely reduced the marked racial
and ethnic disparities in vaccination coverage rates among children
that existed during the late 1980s and early 1990s. While
disparities have been greatly reduced for the individual vaccines
received by children, there is an indication that racial and ethnic
disparities in series complete childhood vaccination coverage have
been increasing in the last few years. |
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| EXAMPLES
OF IMPORTANT DISPARITIES |
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Blacks or African Americans |
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In 2003, non-Hispanic black persons were 21% less likely than
non-Hispanic white persons to have received a flu shot during the
past 12 months and 23% less likely to have ever received a
pneumococcal vaccination. For adults aged 65 years and over, the
percent of persons receiving a flu shot during the past 12 months
was 68.6% for non-Hispanic white persons and 47.7% for non-Hispanic
black persons. The percent of adults aged 65 years and over who had
ever received a pneumococcal vaccination was 59.6% for non-Hispanic
white persons, and 36.9% for non-Hispanic black persons. |
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In 2001, 85% of African American children ages 19-35 months had
received hepatitis B vaccine, compared with 89% of the
total population. In that same year, 4.33 per 100,000 African
Americans were reported with acute hepatitis B
virus, compared with 1.31 per
100,000 white non-Hispanic Americans. |
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Although disparities in childhood immunization coverage have been
greatly reduced for most vaccines that children routinely
receive, disparities in the full immunization series (4:3:1:3:3
completion)* have not been eliminated. From 1996-2001, the
immunization coverage gap between non-Hispanic white children and
non-Hispanic black children widened by an average of 1.1% (+_0.7%;
p=0.01) each year. The growing disparity is due to failure of
series completion rates among non-Hispanic blacks to increase
substantially during the period 1996 to 2002 (66.8% to 67.7%), while
series completion rates among non-Hispanic whites increased (68.9%
to 77.7%) during this same period. |
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Hispanics or Latinos |
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In 2003, Hispanic/Latino persons were less likely than non-Hispanic
white persons to have received a flu shot during the past 12 months
or to have ever received a pneumococcal vaccination. For adults
aged 65 years and over, the percent of persons receiving a flu shot
during the past 12 months was 45.4% for Hispanic/Latino persons and
68.6% for non-Hispanic white persons. The percent of adults aged 65
years and over who had ever received a pneumococcal vaccination was
31.0% for Hispanic/Latino persons and 59.6% for non-Hispanic white
persons. |
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In 2001, 90% of Hispanic/Latino children ages 19-35 months had
received hepatitis B vaccine, compared with 89% of the total population.
In that same year, 1.84 per 100,000 Hispanic/Latinos were reported
with acute hepatitis B virus, compared with 1.31 per 100,000 white non-Hispanic
Americans. From 1996-2001, for the full
vaccination series the immunization coverage gap between
non-Hispanic white children and Hispanic/Latino children widened by
an average 0.5% (+_1.0%; p=0.14). For Hispanic/Latino children, as
for African American children, disparities have been closed or
greatly reduced for most vaccines. |
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Asian Americans or Pacific Islanders |
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Immunization with hepatitis B vaccine is the most effective means of
preventing hepatitis B virus infection and its consequences. However, while the
rate of acute Hepatitis B (HBV) among AAPIs has been decreasing, the
reported rate in 2001 was more than twice as high among AAPIs (2.95
per 100,000 population) as among white Americans (1.31 per 100,000
population). In 2001, 90% of AAPI children ages 19-35 months had
received hepatitis B vaccine, compared with 89% of the total population. |
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American Indians or Alaska Natives |
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Viral hepatitis has historically been common in AI/AN communities.
However, the number of viral hepatitis infections in these
communities has been reduced. In 2001, 86% of AI/AN children ages
19-35 months had received the hepatitis B vaccine, compared with 89% of the
total population. In that same year, 1.86 per 100,000 AI/AN were
reported with acute HBV, compared with 1.31 per 100,000 white
non-Hispanic Americans. |
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In FY 2002, 82,231 AI/ANs 65 years and older were eligible for
influenza and pneumococcal vaccination. Of those,
25,700 or 31 % received an influenza vaccination and 13,866, or 17%
received a pneumoccocal vaccination in Indian Health Service (IHS)
healthcare facilities. This compares to 63.1%
of Americans overall who received an influenza vaccination in 2001,
and 54% of all Americans who had ever received a pneumoccocal
vaccination in 2001. |
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EVIDENCE BASED STRATEGIES |
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Studies have consistently shown that
focusing efforts to improve coverage on health care providers, as
well as health care systems, is the most effective means of raising
vaccine coverage in adults. For example, all health care providers
should assess routinely the vaccination status of their patients.
Likewise, health plans should develop mechanisms for assessing the
vaccination status of their participants. Also, nursing home
facilities and hospitals should ensure that policies exist to
promote vaccination. |
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Efforts need to be intensified,
particularly to increase vaccination coverage for children living in
poverty. Substantial numbers of undervaccinated children remain in
some areas, particularly the large urban areas with traditionally
underserved populations, creating great concern because of the
potential for outbreaks of disease. Reasons for racial disparities
in coverage rates for
the full vaccination series among pre-school aged children are
incompletely understood. Further studies are
planned to develop an understanding of the underlying causes of
these disparities so that effective strategies to reduce the
disparities can be developed. |
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A comprehensive strategy to prevent hepatitis B
virus infection, acute hepatitis B,
and the sequelae of hepatitis B virus infection in the United States must
eliminate transmission that occurs during infancy and childhood, as
well as during adolescence and adulthood. A comprehensive prevention
strategy includes a) prenatal testing of pregnant women for HBsAg to
identify newborns who require immunoprophylaxis for the prevention
of perinatal infection and to identify household contacts who should
be vaccinated, b) routine vaccination of children born to HBsAg-negative
mothers, c) vaccination of certain adolescents, and d) vaccination
of adults at high risk of infection. Integrating hepatitis B
vaccine into childhood vaccination schedules in populations with
high rates of childhood infection (e.g., Alaskan Natives and Pacific
Islanders) has been shown to interrupt hepaitis B
virus transmission. |
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FEDERAL PROGRAMS THAT ADDRESS RACIAL/ETHNIC
DISPARITIES IN IMMUNIZATION |
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CDC’s National Immunization Program (NIP) strives to prevent disease,
disability, and death in children and adults through vaccination.
NIP is committed to promoting immunization at every stage of life,
providing leadership on vaccines and immunization, strengthening and
communicating immunization science, establishing partnerships and
fostering collaboration, providing immunization education and
information, and improving health in the United States and globally.
NIP supports the following programs: |
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Racial and Ethnic Adult Disparities Immunization Initiative (READII) |
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The Department of Health and Human Services (HHS) has made the
elimination of racial and ethnic disparities in influenza and
pneumococcal vaccination coverage for people 65 years of age and
older a priority. To address these disparities and to assist in
reaching the 2010 national health goal of 90% influenza and
pneumococcal vaccination rates among persons 65 and over, HHS,
in collaboration with the Centers for Disease Control and
Prevention (CDC) and other federal partners, launched the Racial
and Ethnic Adult Disparities Immunization Initiative (READII) in
July 2002. READII is a two-year
demonstration project being conducted in five sites (Chicago,
IL;
Rochester, NY;
San Antonio, TX;
Milwaukee, WI; and 19 counties in the
Mississippi Delta region) to improve influenza and
pneumococcal vaccination rates for African-Americans and
Hispanics 65 years of age and older. CDC is implementing the
READII project with the support of the Centers for Medicare &
Medicaid Services, the Health Resources and Services
Administration, the Administration on Aging, the Agency for
Healthcare Research and Quality, and other federal agencies. |
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Vaccines for Children (VFC) |
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Since 1994, the Vaccines for Children (VFC) program has allowed
eligible children to receive vaccinations as part of routine care,
supporting the reintegration of vaccination and primary care.
Based on the total doses of routinely recommended pediatric
vaccines distributed in the U.S., the VFC program served about
41% of the childhood population in 2002. The VFC program
provides publicly purchased vaccines for use by all
participating providers. These vaccines are given to eligible
children without cost to the provider or the parent. The VFC
program provides immunizations for children who are uninsured,
Medicaid recipients, Native Americans, or Alaska Natives at
their doctors' offices. VFC also provides immunizations for
children whose insurance does not cover immunizations at
participating federally qualified health centers (FQHCs) and
rural health clinics (RHCs). The program has contributed to
high immunization rates and reduced delays in immunizations and,
subsequently, the risk of serious illness or death from
vaccine-preventable diseases. |
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National Minority Organization Immunization Programs |
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This project seeks to strengthen the cultural competence of the
health care system to better serve Asian Americans in the area
of immunizations and to provide support to community-based
organizations through subcontracts. The program has four
objectives: provide immunization information on the web, provide
training for health care professionals, translate immunization
information into at least five Asian languages, and conduct
education projects to raise immunization awareness. |
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Vacunas para la familia |
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This project seeks to increase immunization rates by providing
support to large Hispanic communities. Hispanic communities are
targeted in six cities with high Hispanic populations: New York
City, Los Angeles, Miami, San Antonio, Phoenix and Oklahoma
City. The program has four objectives: disseminate
linguistically appropriate and culturally sensitive materials,
post current health information on the National Alliance for
Hispanic Health web site, participate in local and national
immunization coalitions, and provide health care providers with
cultural sensitivity training. |
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Indian Health Service (IHS) |
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IHS clinics are encouraged to provide influenza vaccine to
adults 55 years of age and pneumococcal vaccine to adults 65
years of age during clinic visits and during mass immunization
clinics. Educating patients is a part of the strategy to ensure
influenza vaccine is provided. The proposed FY 2004 IHS budget
will support the capacity for sites to continue existing
strategies and maintain current immunization coverage levels in
the face of population growth. |
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