Abstract
Background: The number of homeless families has increased considerably since the 1990s in France. We aimed to estimate the homeless children vaccination coverage (VC) for diphtheria, tetanus, polio, measles–mumps–rubella and hepatitis B and identify factors associated with insufficient VC according to birthplace. Methods: A cross-sectional survey was conducted among homeless shelter families in the greater Paris area. A nurse conducted face-to-face interviews and collected vaccination records. We analyzed factors associated with insufficient VC, stratified by birthplace and vaccine, using robust Poisson regression. Results: The study included 214 children born in France and 236 born outside France. VC in French-born homeless children was high (>90% at 24 months for most vaccinations) and similar to levels observed in the general population, whereas VC in those born outside France was low (<50% at 24 months for all vaccines). Factors significantly associated with insufficient VC among children born outside France were age, parents with French-language difficulties, and changing residence at least twice in the previous year. Children in contact with the healthcare system at least once in the previous year had significantly higher VC, irrespective of vaccine and birthplace. Conclusion: Special attention should be paid to homeless children born outside France, with recent European and French recommendations confirming the need for catch-up vaccination in children with undocumented VC.
Highlights
In Europe—and France is no exception—families represent the fastest growing segment of the homeless population, in urban areas [1]
We focused our analyses on DT-IPV, MMR and hepatitis B (HepB), all monitored by Santé publique France (French public health agency), as we aimed to compare them to data produced by the national French vaccination program
Our study showed that for homeless children born in France, vaccination coverage (VC) levels at 24 months of age were higher for HepB and quite comparable for DT-IPV and MMR compared to those found in the general population
Summary
In Europe—and France is no exception—families represent the fastest growing segment of the homeless population, in urban areas [1]. In 2010, the homeless emergency services in Paris sheltered more families than single people: more than 11,000 parents and children were accommodated, corresponding to a 300% increase over the previous 10 years [3]. Unstable housing prospects may complicate a successful vaccination program for homeless children [11] These results contrast with some studies in the US, which point to low levels of vaccination coverage (VC) in homeless children and the general population (with a few age-related differences). Factors significantly associated with insufficient VC among children born outside France were age, parents with French-language difficulties, and changing residence at least twice in the previous year. Conclusion: Special attention should be paid to homeless children born outside France, with recent European and French recommendations confirming the need for catch-up vaccination in children with undocumented VC
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