Abstract
In the US, adult immunization coverage remains low, especially among vulnerable populations, as recent hepatitis A outbreaks have demonstrated. We studied the vaccination history variation among the US adults who use drugs by implementing a community-engaged research survey to identify reported immunization coverage, missed opportunities (MO), and places where immunizations might be delivered. Our analysis of a sample of 1127 participants recruited at community syringe exchanges in three cities identified higher overall vaccination receipt in Los Angeles compared to Atlanta or Las Vegas (e.g., HAV receipt 52.2% LA, 42.1% LV, 41.4% Atlanta). Overall, fewer participants reported having received HAV (45.9%), HBV (47.5%), or influenza (47.6%) vaccines than MMR (57.1%) or Td/Tdap (61.1%). Across sites, HAV receipt was higher for participants incarcerated ≥ 5 years (54.2% vs. 43.6% for those incarcerated < 5 years, 49.4% no incarceration history, p = 0.02). HBV receipt was higher among participants who were not intravenous drug users (56.1% vs. 46.0%, p = 0.03). Additionally, income >$20k predicted higher rates of MMR receipt (67.0% vs. 56.5%, p = 0.009), as did stable housing (62.8% vs. 54.3%, p = 0.01). To address the need to expand vaccine coverage among vulnerable adults, delivering vaccine at sites where persons who use drugs access services, or in correctional facilities, may be warranted.
Highlights
Released CDC surveillance has identified an ongoing problem among the US adults—the persistence of suboptimal vaccination despite public health efforts to achieveHealthy People 2020 immunization goals established to increase immunization rates and reduce preventable infectious diseases [1,2,3,4,5,6,7]
We did observe that Hepatitis A virus (HAV) and Hepatitis B virus (HBV) vaccination levels reported by the participants are higher than those for the general U.S population (i.e., HBV: 25.8% for >3 doses and HAV: 10.9%) and similar to those for influenza [11]
We found that HAV/HBV, influenza, and MMR/Tdap vaccination was associated with characteristics signifying its perceived acceptability [41]
Summary
Released CDC surveillance has identified an ongoing problem among the US adults—the persistence of suboptimal vaccination despite public health efforts to achieveHealthy People 2020 immunization goals established to increase immunization rates and reduce preventable infectious diseases [1,2,3,4,5,6,7]. Seasonal influenza vaccination remains very low at 45.3% coverage among adults aged 18 years and older during the 2018–2019 influenza season, well below the Healthy People 2020 goal of 70% for non-institutionalized adults [1,8,9,10]. Influenza vaccine coverage has decreased in recent years among whites and has declined overall among adults ≥ 65 years [4]. Other recommended vaccines for those over age 18 years including pneumococcal, Tdap, hepatitis A, and hepatitis B fall below Healthy People goals [5]. In 2017, hepatitis A vaccination coverage was reported at 10.9% for adults over the age of 19 [11]. Hepatitis B coverage had a higher vaccination coverage among adults over 19 years of age reported at 25.8% [11]
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