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Emergency department vaccination of preschool-age children during a measles outbreak
T L Schlenker1, I Risk, H Harris
1Salt Lake City-County Health Department, UT, USA.
Insights
An emergency department (ED) vaccination program during a measles outbreak showed low effectiveness in vaccinating preschool-age children. Significant barriers, including parental refusal and lack of physician offer, limited vaccination uptake.
Area of Science:
- Pediatric Emergency Medicine
- Vaccinology
- Public Health
Background:
- Measles outbreaks necessitate rapid public health interventions.
- Emergency departments (EDs) serve a large pediatric population, presenting a potential venue for vaccination.
- Assessing the feasibility of ED-based vaccination programs is crucial for outbreak control.
Purpose of the Study:
- To evaluate the effectiveness of an emergency department vaccination program for preschool-age children during a measles outbreak.
- To identify barriers to vaccination within the ED setting.
Main Methods:
- A cross-sectional study was conducted in an urban pediatric ED.
- Eligible children (12-59 months) presenting during a one-month measles outbreak were offered measles-mumps-rubella (MMR) vaccine.
- Vaccination status and reasons for non-vaccination were recorded.
Main Results:
- Only 25% of vaccination-eligible children presenting to the ED received the MMR vaccine.
- In 50% of cases where eligible children were not vaccinated, parents declined.
- Physicians failed to offer vaccination in the other 50% of eligible, unvaccinated children.
- Children with physical injuries were more likely to be vaccinated, while those with upper respiratory infections were less likely.
Conclusions:
- The emergency department vaccination program demonstrated limited effectiveness during the measles outbreak.
- Significant logistical and practical barriers hinder successful ED-based vaccination.
- Targeted strategies are needed to overcome barriers and improve vaccination rates in pediatric EDs.
Study Objective:
To determine the effectiveness of an emergency department vaccination program for preschool-age children during a measles outbreak.
Design:
Cross-section study.
Setting:
Urban pediatric ED with an annual census of 24,000.
Participants:
Children, 12 to 59 months old, who presented to our ED between April 1 and April 30, 1994.
Intervention:
Staff trained in rationale for and protocol of ED vaccination offered measles-mumps-rubella (MMR) vaccine, free of charge, to all eligible children.
Results:
Of the 541 children seen, 7% lacked measles vaccination; MMR vaccination status could not be determined in 10%. From history it was determined that all the others had been vaccinated. Of the vaccination-eligible children, 25% were vaccinated in the ED. Of the eligible children who were not vaccinated, parents declined in half of the cases and physicians did not offer vaccination in the other half. Eligible children with physical injury were more likely to be vaccinated, and those with upper respiratory tract infections were less likely to be vaccinated than were eligible children with other diagnoses (P < .05).
Conclusion:
During a measles outbreak, few children receiving care at a busy pediatric ED were definitively identified as vaccination eligible. Only a few children identified as eligible for vaccination were vaccinated. Significant logistic barriers to effective ED vaccination exist.