Rapid Vaccination of Hard-To-Reach Populations

This study follows a quasi-experimental design involving a multilevel community
participatory intervention that is designed to rapidly immunize hard-to-reach (HTR)
populations in disadvantaged minority communities. Low vaccination coverage among minorities
and persons living in and near poverty is a persistent problem that is particularly acute
among HTR populations (e.g. injection drug users, elderly shut-ins). Immunization rates are
affected by multiple factors including demographics, attitudes about vaccination, health
norms, barriers to access, and immunization delivery methods. Efforts to successfully
vaccinate HTR populations must address these factors. A community-based program with rapid
vaccination can serve as an initial model for emergency preparedness vaccination plans and
for future efforts to widely introduce HIV vaccination in disadvantaged urban communities.
This project will be conducted by a community-public health partnership in eight
disadvantaged neighborhoods within Harlem and the South Bronx in three phases. In Phase 1 we
will implement a brief survey assessment of residents in designated neighborhoods to
identify current key barriers to immunization faced by the target HTR populations in these
neighborhoods. Also, using several estimation methods, we will determine the size of the
target populations in the study neighborhoods to establish vaccine needed and to estimate
denominators for vaccination rates. In Phase 2, we will implement two waves of a multilevel
community intervention trial (developed with input from the survey and community partners).
In the first wave, four randomly selected neighborhoods will receive the intervention (i.e.,
community education, community-organization engagement, and door-to-door influenza
vaccination program for eligible groups etc). In the four control communities, target
populations will be invited to come for vaccination at specified locations as part of usual
public health efforts. In the second vaccination wave, using a crossover design, after
updating and revising the approach based on experience from Wave 1, we will implement the
intervention in the four control communities; this vaccination wave will be conducted over
one week to test the feasibility of rapid vaccination of these populations. Phase 3 of this
project will identify the promising elements of the program and develop materials to allow
generalizability to other urban areas and to other vaccines (e.g., HIV, HBV, etc).

Inclusion Criteria:

The possible participant pool for this project is the adult population (over the age of
18) of 8 circumscribed neighborhoods in East Harlem and South Bronx in NYC. These
neighborhoods have a total population of approximately 24,000 people (based on the 2000 US
Census) and we anticipate that up to 4,000 may be among the eligible hard-to-reach
populations that are the target of this proposal. We will identify eligible populations
through a brief survey instrument. During the intervention phase of this study, persons
who are eligible to receive influenza vaccination will be offered influenza vaccination.
Eligibility criteria for influenza vaccination are the eligibility criteria established by
the Advisory Committee on Immunization Practices guidelines. These will be determined as
part of the standard data collection instrument. Eligible persons include persons over the
age of 65 and persons concurrent comorbidity including immunosuppression (HIV or active
injection drug use), chronic pulmonary or cardiovascular disorder (including asthma), or
chronic metabolic diseases (including diabetes mellitus, renal or hepatic dysfunction).

Exclusion Criteria:

Exclusion criteria include an allergy to vaccines, an allergy to eggs, inability to
provide consent, currently under care of a physician and a plan to receive influenza
vaccine in the near-future, or having already received the influenza vaccine during this
year (CDC 1999).