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Gains persist in vaccination coverage of Alaska Natives, American Indians
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Recent gains in immunizations among Alaska Native and American Indian populations have not slowed, according to data published recently by the CDC.
CDC researchers reported information from National Immunization Surveys that included data from 2006 to 2010. The data indicated that although disparities exist between white and American Indian/Alaska Native (AI/AN) populations in 2001 to 2004, the findings from the latest surveys show the discrepancies are disappearing.
Amy V. Groom, MPH, of the Immunization Services Division, National Center for Immunization and Respiratory Diseases at CDC, and researchers said overall vaccination coverage was similar between the two groups in most years, with slightly lower coverage rates with four or more doses of pneumococcal conjugate vaccine among AI/AN children in 2008 and 2009 and 2006 and 2009. However, when stratified by geographic regions, “AI/AN children had coverage that was similar to or higher than that of white children for most vaccines in most years studied.”
Vaccination coverage assessed in this study included four or more doses of diphtheria and tetanus toxoids and pertussis vaccine, or diphtheria and tetanus toxoids, or diphtheria and tetanus toxoids and any acellular pertussis vaccine (4+DTaP); three or more doses of poliovirus vaccine (3+polio); one or more doses of measles, mumps, and rubella (1+MMR) vaccine; three or more doses of Haemophilus influenzae type b (3+Hib) vaccine; three or more doses of hepatitis B (3+HepB) vaccine; one or more doses of varicella (1+Var) vaccine; and four or more doses of pneumococcal conjugate (4+PCV) vaccine.
The researchers also examined coverage with the combined 4+DTaP; 3+polio; 1+MMR; 3+Hib; 3+HepB; and 1+Var vaccine series, referred to as the 4:3:1:3:3:1 series and coverage with this series plus 4+PCV, referred to as the 4:3:1:3:3:1:4 series.
In addition, they also analyzed coverage for these two series without Hib vaccine (4:3:1:x:3:1, 4:3:1:x:3:1:4) because of the Hib vaccine shortage from 2007 to 2009.
Disclosure: Groom reports no relevant financial disclosures.
Perspective
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Molly Howell, MPH
The North Dakota Immunization Information System (NDIIS) is one of eight CDC Immunization Information System (IIS) sentinel sites. Sentinel sites receive additional grant funds to achieve higher standards of data quality in their IIS and routinely analyze data for programmatic decision-making.
In 2011, North Dakota Department of Health staff compared NDIIS vaccination rates of American Indian and white children in North Dakota who were aged 19 to 35 months as of Dec. 31, 2010, in an effort to determine whether or not disparities in immunization coverage exist. According to the NDIIS, American Indian children in North Dakota were less likely to be up-to-date, compared with white children, for all vaccines except hepatitis B and Haemophilus influenzae type b.
For the last quarter of 2010, the immunization-rate disparity between American Indian children and white children averaged 11.4% for all vaccine series. American Indian children were also more likely than white children to be delayed at routine immunization milestones. By the 3-month milestone, 77% of American Indian children had received a dose of diphtheria-tetanus-acellular pertussis vaccine compared with 91.5% of white children. Because of these delays, fewer American Indian children are up-to-date by 19 to 35 months. Due to the small sample size of the National Immunization Survey, it is unable to be used to evaluate immunization rates for American Indians in North Dakota; therefore, the NDIIS is a useful tool for doing so.
Using the NDIIS data, we were able to not only identify an important disparity in immunization coverage, but also to drill down and look at the timeliness of vaccination to see how this impacts up-to-date coverage rates at 19 to 35 months. I agree with the statement in this article that IISs have the potential to provide more complete data regarding American Indian immunization rates. IISs provide a timely method of assessing immunization rates and identifying disparities rapidly and also provide immunization data to assess the impact of interventions.
If states are able to overcome challenges related to timeliness and completeness of reporting immunization data to the IIS and data quality issues, then others states should attempt to assess immunization rates by race and ethnicity using their IIS, when possible.
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