Wednesday, May 12, 2004 - 11:45 AM
5109

Offering Free Vaccination Eliminates Disparities in Adult Immunization, But Low Cost Vaccination Does Not

Daniel B. Fishbein1, William B. Cassidy2, Dale Bell Marioneaux2, Mark L. Messonnier3, Glenn N. Jones2, Monica Pradhan2, and Sarah D'Autremont4. (1) ISD-HSREB, CDC - NIP, 1600 Clifton Road, NE, MS E-52, Atlanta, GA, USA, (2) Department of Medicine/Earl K. Long Medical Center, Louisiana State University Health Sciences Center, 5825 Airline Highway, Baton Rouge, LA, USA, (3) National Immunization Program, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS E-52, Atlanta, GA, USA, (4) Baton Rouge General Medical Center - Mid City, 3600 Florida Boulevard, Baton Rouge, LA


BACKGROUND:
Lower immunization coverage among the poor has been recognized for years. Although many co-factors have been identified, practical interventions have not. We determined the extent to which vaccination in an urban emergency department could overcome lower coverage among the poor.

OBJECTIVE:
Determine the extent to which assessment and vaccination in an urban emergency department (ED) can increase coverage.

METHOD:
In December 2003 and January 2004, college students assessed influenza, pneumococcal (PPV) and hepatitis B (HBV) vaccination status of all persons 18 years of age and older upon admission to the emergency department. Adults <65 who were neither critically ill or nor mentally impaired were further assessed to determine which vaccines were indicated and then randomized to be offered indicated vaccines at no charge ($0 group), $5 ($5 group), or $10 ($10 group) per vaccination.

RESULT:
The median monthly household income of the first 208 patients was $1000-1999; 59 (28%) had no insurance and 48 (24%) had only Medicaid. Of 109 (54%) meeting ACIP criteria for annual influenza vaccination, 25 (24%) were up-to-date (UTD). Absolute coverage increased 47% in the $0 group, 31% in the $5 group, and 18% in the $10 group. Of 48 (24%) meeting ACIP criteria for PPV, only 11 (22%) reported having received PPV. Coverage increased by 46% in the $0 group, 20% in the $5 group and 5% in the $10 group. Of 48 (24%) meeting ACIP criteria for HBV, 18 (38%) reported received 3 doses of HBV. HBV was administered to 50% of those offered vaccine at no charge, 18% in the $5 group, and 24% in the $10 group. Influenza and PPV acceptance was related only to amount charged (P=0.06 for influenza and P=0.04 for PPV) and unrelated to age, gender, race, insurance, or income. HBV acceptance was unrelated to any factors including cost.

CONCLUSION:
Offering vaccine at no cost increased coverage, but even a modest charge markedly decreased vaccine acceptance in this setting. Acceptance of vaccination was unrelated to previously described demographic factors.

LEARNING OBJECTIVES:
List one factor that does and two factors that do not influence acceptance of vaccination in an inner city emergency department.

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