Addressing persistent pockets of need for childhood immunization: Use of an urban drop-in vaccination clinic by high-risk children

Background. National immunization rates continue to improve, but rates are lowest and risks of vaccine-preventable illness is highest in poor, minority, and immigrant children. It is unknown whether drop-in vaccination clinics might be used by these high-risk populations. Objective. To characterize the socio-demographics, vaccination rates, barriers to vaccination, and reasons for use among children visiting an urban drop-in vaccination clinic. Methods. Cross-sectional survey (50 questions), using bilingual personnel and interpreters, of parents of all children attending an urban drop-in vaccination clinic. Results. The median age of the 74 children was 8 years (range, 0.5-17 years); 94% were non-white. Most parents were born outside the USA (80%), were not US citizens (58%), were unemployed (65%), and were most comfortable speaking a language other than English (55%). Most of the children had no health insurance (74%), lived in extremely impoverished families (72% with annual combined family incomes < $10,000), were born outside the USA (65%), and were most comfortable speaking a language other than English (58%). Although 74% of parents believed that their child's vaccinations were up-to-date, only 18% of their children were actually so; the median number of vaccinations missed was four (range, 0-13). Only 22% of parents accurately predicted their child's immunizations in advance. Just 41% of children were up-to-date on their diphtheria-tetanus-pertussis vaccination, and 27% had never received any; 47% were up-to-date on the measles-mumps-rubella vaccination, and 49% had never received any; and 25% were up-to-date on the Haemophilus influenzae type B vaccination, and 68% had never received any. Only 18% of children were up-to-date on the age-appropriate complete series of vaccinations, 70% were missing more than one vaccination, and 27% had never received a single documented vaccination in their lifetime. The most common reasons that children were not brought in for vaccinations in the past included language problems (cited by 20% of parents), forgetting (14%), misplacing the vaccination booklet (10%), and child illness (10%). Conclusions. Most children brought to an urban drop-in vaccination clinic were severely delayed in their immunizations and at great risk for vaccine-preventable outbreaks. Drop-in clinics may be helpful in immunizing under-vaccinated children, particularly those living in hard-to-reach, vulnerable families.