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Successes and failures in vaccine delivery: evaluation of the immunization delivery system in Puerto Rico
J S Gindler1, F T Cutts, M E Barnett-Antinori
1Division of Immunization, National Center for Prevention Services, Centers for Disease Control, Atlanta, GA 30333.
Insights
Low immunization coverage in Puerto Rico is due to significant deficiencies in vaccine delivery. Missed opportunities and barriers to services delay essential childhood immunizations, impacting public health.
Area of Science:
- Public Health
- Pediatrics
- Immunization Practices
Background:
- Childhood immunization is critical for preventing infectious diseases.
- Low vaccine coverage rates in public clinics pose a significant public health concern.
- Understanding barriers to immunization delivery is essential for improving public health outcomes.
Purpose of the Study:
- To evaluate immunization delivery processes in public clinics in Puerto Rico.
- To identify the primary reasons for low immunization coverage among preschool-aged children.
- To assess missed immunization opportunities and their contributing factors.
Main Methods:
- Cross-sectional study in 25 randomly selected public clinics in Puerto Rico.
- Assessed vaccination status and missed opportunities in 273 children (2-59 months).
- Conducted interviews with parents and healthcare providers; surveyed two neighborhoods.
Main Results:
- Only 55% of children with vaccination cards were up-to-date post-visit; 45% were not.
- 69% of eligible children missed at least one vaccine during the visit.
- Missed opportunities stemmed from vaccine unavailability, service integration issues, provider misconceptions, and lack of simultaneous administration.
Conclusions:
- Deficiencies in immunization delivery significantly delay vaccinations and reduce overall coverage.
- Barriers to services, information gaps, and provider-related issues contribute to suboptimal immunization rates.
- Improving immunization delivery systems is crucial for enhancing childhood vaccination coverage in Puerto Rico.
Abstract:
The objective of this study was to evaluate immunization delivery and determine reasons for low coverage among preschool-age public clinic attendees in Puerto Rico. In 25 randomly selected clinics, coverage and missed immunization opportunities were assessed in 273 children aged 2 to 59 months, exist interviews were conducted with parents, and providers were interviewed. Two neighborhoods close to the clinics were surveyed to determine parental knowledge about immunizations, and the vaccination status of children in these neighborhoods was assessed. Two hundred seventy-three clinic attendees were interviewed. Among 229 (84%) with vaccination cards, only 126 (55%) had received all indicated vaccines by completion of the clinic visit. Forty-five percent of children with cards in the household survey were not up-to-date. Of 171 (75%) clinic attendees eligible for vaccination at the visit, 118 (69%) missed one or more immunizations at the visit. In addition, half of all children had previously missed one or more immunizations when they had received another vaccine. Missed opportunities occurred because of nonavailability of vaccines, lack of integration of services, provider misconceptions about contraindications, and failure to administer vaccines simultaneously. Other problems included barriers to immunization services and lack of information and education activities. It is concluded that deficiencies in immunization delivery substantially delay immunization and reduce coverage.