Journal of Urban Health

, Volume 84, Issue 4, pp 615–631 | Cite as

Strategies for Improving Influenza Immunization Rates among Hard-to-Reach Populations

  • David Vlahov
  • Micaela H. Coady
  • Danielle C. Ompad
  • Sandro Galea
Article
First Online:

Abstract

Whereas considerable attention has been devoted to achieving high levels of influenza immunization, the importance of this issue is magnified by concern over pandemic influenza. Most recommendations for vaccine administration address high risk groups such as the elderly and those with chronic diseases, but coverage for hard-to-reach (HTR) populations has had less attention. HTR populations include minorities but also include other primarily urban groups such as undocumented immigrants, substance users, the homeless, and homebound elderly. Obstacles to the provision of immunization to HTR populations are present at the patient, provider, and structural levels. Strategies at the individual level for increasing immunization coverage include community-based educational campaigns to improve attitudes and increase motivation for receiving vaccine; at the provider level, education of providers to encourage immunizations, improving patient–provider interactions, broadening the provider base to include additional nurses and pharmacists, and adoption of standing orders for immunization administration; and at the structural level, promoting wider availability of and access to vaccine. The planning process for an influenza pandemic should include community engagement and extension of strategies beyond traditional providers to involve community-based organizations addressing HTR populations.

Keywords

Immunization Influenza Vaccination High-risk populations  Hard-to-reach populations Pandemic 
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Notes

Acknowledgments

The authors’ contributions are as follows: David Vlahov conceived the project and led with the writing of the manuscript, Micaela H. Coady was the project director for the review and contributed to the writing, and Danielle C. Ompad and Sandro Galea contributed to the writing of the manuscript. We are grateful to Jeremiah A. Barondess, MD for reviewing this manuscript.

Researchers at the Center for Urban Epidemiologic Studies at The New York Academy of Medicine hosted a day-long meeting on optimizing strategies to vaccinate HTR populations in September 2006. Meeting participants made presentations and participated in discussion, but the sole responsibility for the content of this manuscript is that of the authors and does not represent the view of individual participants nor the official position of any of the institutions represented at the meeting. Participants were (in alphabetical order): Deborah Alfano (Merck); Nancy M. Bennett, MD, MS (University of Rochester Medical Center); Gus Birkhead, MD, MPH (New York State Department of Health); Elizabeth Blowers-Nyman (Merck); Nicholas Daniels, MD, MPH (University of California San Francisco); Kristine Gebbie, DrPH, RN (Columbia University); Bruce Gellin, MD, MPH (Health and Human Services); John Grabenstein, RPh, PhD (Merck); Neal Halsey, MD (Johns Hopkins); Patrick Kelley, MD, DrPH (Institute of Medicine); Sarah Landry, MA (GlaxoSmithKline); Arnold Monto, MD (University of Michigan); Stephanie G. Phillips, PhD (Project House); Anne Schuchat, MD (Centers for Disease Control and Prevention); Shelagh Weatherill, BScN, MA (Vancouver Coastal Health); Isaac Weisfuse, MD, MPH (New York City Department of Health and Mental Hygiene); Richard K. Zimmerman, MD, MPH (University of Pittsburgh), and Jane R. Zucker, MD, MSc (New York City Department of Health and Mental Hygiene).

This meeting was convened as part of Project VIVA (Venue-Intensive Vaccines for Adults), a multilevel community participatory intervention developed by members of the Harlem Community and Academic Partnership (HCAP) and the Center for Urban Epidemiologic Studies (CUES). The VIVA Intervention Working Group members are: Ann Boyer (Mt. Sinai Medical Center, Women’s Information Network and Birdsong); Robert Brackbill (New York City Department of Health and Mental Hygiene); Brian Brown (Harm Reduction Educators); Jose Caraballo (Palladia, Inc.); Micaela Coady (CUES); Sandro Galea (CUES); Katherine Glidden (CUES); Karyn London (Mt. Sinai Medical Center); Gail Love (Women’s Information Network); Pat Monahan (East Harlem Community Health Committee, Inc. and Little Sisters of the Assumption Family Health Services); Danielle Ompad (CUES); Erica Phillips (Weill Cornell Medical College, New York Presbyterian Hospital); Sarah Sisco (CUES); Sharon Stancliff (Harm Reduction Coalition); David Vlahov (CUES), and Linda Weiss (Office of Special Populations at the New York Academy of Medicine). This work was supported by a grant from the National Institute on Drug Abuse (DA017004) and the Merck Foundation.

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Copyright information

© The New York Academy of Medicine 2007

Authors and Affiliations

  • David Vlahov
    • 1
  • Micaela H. Coady
    • 1
  • Danielle C. Ompad
    • 1
  • Sandro Galea
    • 1
    • 2
  1. 1.Center for Urban Epidemiologic StudiesNew York Academy of MedicineNew YorkUSA
  2. 2. Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborUSA

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