Childhood vaccine uptake differs among immigrant communities
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Key takeaways:
- One in four children in the state of Washington have a parent who was born outside the U.S.
- Children of Filipino-, Indian-, and Mexican-born parents were more likely to be up to date on vaccines.
Many immigrant communities are at risk for outbreaks of vaccine-preventable diseases because of low and declining vaccination coverage, according to findings published in Pediatrics.
According to one of the study’s authors, immigrant communities may experience structural inequities and barriers to health care — including unmet language needs and systemic discrimination — that can lead to poor health outcomes, including undervaccination and increased risks for vaccine-preventable diseases.
“In Washington, one in four children have a parent born outside the United States,” Azadeh Tasslimi, MPH, an epidemiologist in the Washington State Department of Health’s Refugee and Immigrant Health Program, said in a video abstract published with the study. “Ensuring equitable vaccine access is critical to redress health disparities. However, disaggregated data on childhood vaccine coverage beyond broad race and ethnicity groupings are limited.”
Tasslimi and colleagues conducted a retrospective cohort study to evaluate differences in childhood vaccine coverage by parental birth country using data from the state’s immunization information system and birth certificate records, on which “parent’s birth country” is a self-reported field and can serve as a proxy for national origin among first-generation migrants and their children, Tasslimi said.
Their study included children born in Washington from Jan. 1, 2006, to Nov. 12, 2019, who had at least one parent born outside the U.S., with children born to two U.S.-born parents serving as the reference or control group.
“Our primary outcome of interest was MMR receipt by 36 months, and we also assessed DTaP and poliovirus [vaccines],” Tasslimi said. “Poisson regression was used to quantify the relationship between parental birth country and vaccine receipt. We controlled for markers of socioeconomic status and health care utilization in multivariable models.”
In all, the researchers identified 902,909 eligible children, of whom 24% had at least one non-U.S.-born parent.
Vaccine coverage at 36 months with one or more MMR doses ranged from 41% among children born to a parent from Ukraine to 93.2% for children born to a parent from Mexico, compared with 85.6% among children with two U.S.-born parents.
Coverage with three or more poliovirus doses ranged from 41% to 93.2% — with the high and low coverage rates also being from Ukraine and Mexico — compared with 85.5% among children in the control group. Coverage with four or more DTaP doses was between 32.6% for children with a parent from Ukraine to 86.9% for children with a parent from India compared with 77.3% for controls.
Compared with children of U.S.-born parents, the proportion of children up to date for all three vaccines was 3% to 16% higher among children of Filipino-, Indian-, and Mexican-born parents.
“In general, these country-level patterns were similar for poliovirus and DTaP, suggesting more general parental barriers and facilitators to vaccination,” Tasslimi said. “However, while children of Somali born parents experienced significantly lower MMR coverage, coverage was higher and nearly comparable for poliovirus and DTaP, suggesting MMR-specific parental vaccine concerns.”
(The study dates encompassed a measles outbreak in Minnesota that mostly occurred among unvaccinated children of Somali descent and was attributed to Somalis being targeted by anti-vaccine activists.)
According to Tasslimi, in certain communities, disparities and coverage have widened over time, with rates for MMR, DTaP and poliovirus vaccines being 33% to 56% lower among children of Moldovan-, Russian-, and Ukrainian-born parents. Within parental birth countries, coverage patterns were similar for all vaccines, with some exceptions. Similar parental birth country-level differences were observed at 7 years of age.
“These country level trends reflect heterogeneity and underlying community-level vaccination determinants and underscore the need for collection and reporting of health outcomes by factors which reflect lived experiences of communities,” Tasslimi said. “The findings provide actionable information to support clinician approaches and tailored interventions to enhance vaccine coverage.”
In an accompanying editorial, Elizabeth Dawson-Hahn, MD, MPH, assistant professor of pediatrics at the University of Washington, and Andrea E. Green, MDCM, associate professor of pediatrics in the Larner College of Medicine at the University of Vermont, said that to understand the differences in vaccine coverage, providers must consider cultural safety, “a concept that recognizes the social, historical, political, and economic circumstances that create power differences and inequities in health.”
“Parental country of birth highlights differences in vaccination rates for children in immigrant families and provides opportunities to examine factors that influence vaccine access and confidence,” Dawson-Hahn and Green wrote. “A family-centered cultural safety framework is a responsive approach for multisector systems to understand childhood vaccine rates, as they partner with, learn from, and are led by community members who have experienced migration.”
References:
Dawson-Hahn E, et al. Pediatrics. 2024;doi:10.1542/peds.2023-065190.
Tasslimi A, et al. Pediatrics. 2024;doi:10.1542/peds.2023-064626.
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