June 26, 2024

In The News: Childhood Vaccine Uptake Differs Among Immigrant Communities

Healio reports on a study examining vaccine coverage among immigrant communities in Washington state. Structural inequities in these communities, including language barriers, promote poor health outcomes and run the risk of vaccine-preventable disease outbreaks due to low and declining coverage. The study evaluated differences in coverage by parental birth country. One in four children in the state have a parent born outside of the United States.

Researchers conducted a retrospective cohort study evaluating childhood vaccine coverage using data from the state’s immunization information system and birth certificate records. The parental country of birth field is self-reported. It was used by researchers as a proxy for country of origin among migrant communities. The research used two U.S.-born parents as a control and at least one parent born outside the U.S. as the focus using birth records of 902,909 eligible children – 24% had at least one non-U.S.-born parent – between January 2006 and November 2019.

Vaccines evaluated for the study focused primarily on MMR, but also DTaP and polio by 36 months. Controlling for socioeconomic status and health care utilization in their models, MMR receipt by this age ranged from 41% for children born to a parent from Ukraine to 93.2% for children born to a parent born in Mexico (two U.S. parent children compared at 85.6%). Similarly, poliovirus ranged between a low amongst Ukrainian-born parents (41%) and a high amongst Mexican-born parents (93.2%) with a control coverage of 85.5%. Four or more DTaP doses was fell between 32.6% of children born to a parent from Ukraine to 86.9% of children born to a parent from India, control for DTaP was 77.3%.

Researchers said the similar country-level coverage patterns suggest more general parental barriers, though there were outliers. Children born to Somali born parents, for example, had significantly lower MMR coverage, which researchers suggest may be due to MMR-specific parental vaccine concerns.

Such country level trends reflect community heterogeneity and ensuring vaccine equity necessitates collection and reporting of health outcomes reflective of those communities. The study researchers advocate for equitable vaccine coverage and argue their findings provide actionable information to support tailoring interventions to the specific community to improve vaccine coverage.

PIDS member Liset Olarte commented on the article, “The novel approach of using parental birth country as a proxy for first-generation migrant experiences to evaluate childhood vaccine coverage highlights the need to use public health data beyond race and ethnicity to more accurately assess health outcomes within diverse communities and understand their unique barriers to equitable care. As vaccine coverage was highly heterogeneous based on parental birth country, universal or standard interventions to improve the childhood vaccination coverage among immigrant communities will likely not contribute effectively to overcome the existing vaccine inequities. Thus, we need to foster and develop community-specific strategies to prevent outbreaks of vaccine-preventable disease within the communities with the lowest vaccine coverage. Similar approaches can be taken to address other inequities within our field.”

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