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BACKGROUND: The Philadelphia Department of Public Health brings immunization-delayed children up-to-date (UTD) using a Community Based Outreach (CBO) strategy. Each year outreach aims to bring approximately 8,000 10- and 20-month olds from specific Philadelphia ZIP codes UTD on their age appropriate vaccinations. Outreach workers investigate immunization status, educate families on the importance of timely immunizations, and share resources for securing healthcare services.
METHODS: Analysis was conducted on children selected for outreach from January 2008-December 2011 and the remainder of the age cohort who was not outreached. Outreached children were compared with non-outreached children on UTD status for a standard set of vaccinations due by 18 months (4 DTAP: 3 IPV: 1 MMR: 3 HBV: 3 HIB: 1 VAR). UTD rates at 22, 32, 48 and 60 months were compared (when applicable). Age at which UTD status was achieved was also calculated.
RESULTS: Annually ~1,600 10-month olds and 750 20-month olds receive vaccinations through outreach; whereas, ~30,000 children in each of these birth cohorts are not outreached. Regardless of outreach, UTD rates increased as the children aged. Outreached children had higher UTD rates for all age groups and years, most of which were significantly higher. The most dramatic differences were seen for children selected for outreach at 20-months of age. At 32 months old, UTD rates increased from 11% higher for outreached children in 2008 to 91% in 2011. This gap did narrow to 33-39% by 60 months. The differences for 10-month olds were smaller with outreached children having 14-21% higher UTD rates at 32 months, but they seem to be sustained at 48 months (20-22% higher). From 2008 to 2011, median UTD age decreased 4 months for 10- and 20-month old outreached children but remained stable for non-outreached children.
CONCLUSIONS: Outreach is a useful tool for improving childhood immunization rates in urban settings. Since outreached 20-month olds fared better overtime, 10-month old children could be actively followed longer to ensure they get UTD. Follow-up of all groups will continue as the children age so that more robust comparisons can be made over time.