title: Persistent low immunization coverage among inner-city preschool children despite access to free vaccine.
abstract: OBJECTIVE
  To compare vaccination coverage among children 19 to 35 months of age from public housing developments where a free vaccine outreach program was in place with children residing elsewhere in the city.
  
  
  METHODS
  A household survey using a multistage cluster sampling method to compare community areas which accounted for 80% of measles cases during 1989 (high-risk stratum), areas which accounted for the remaining 20% of cases (low-risk stratum), and public housing developments (public housing stratum) having free, on-site vaccination services.
  
  
  METHODS
  Inner-city Chicago households, April to May 1994.
  
  
  METHODS
  Antigen-specific and series-specific coverage based on written records.
  
  
  RESULTS
  Based on evaluation of 1244 children, citywide coverage for four doses of diphtheria-tetanus-pertussis vaccine, three doses of polio vaccine, and one dose of measles-containing vaccine (4:3:1) was 47% [95% confidence interval (CI), 40% to 55%]. Coverage was significantly lower among children residing in public housing (23%; 95% CI, 18% to 28%) compared with those residing in high-risk strata (45%; 95% CI, 38% to 52%) and low-risk strata (51%; 95% CI, 43% to 60%). Compared with white children (53%), coverage for the 4:3:1 series was lower among African-American children in public housing (29%) or outside public housing (36%). Moreover, 11% (95% CI, 8% to 14%) of children residing in public housing had never received any immunizations.
  
  
  CONCLUSIONS
  African-American children throughout Chicago, particularly in public housing, remain at increased risk for vaccine-preventable diseases and should be targeted further for vaccination services. Vaccination coverage remains low several years after a major outbreak of measles and implementation of a free vaccine outreach program. Cluster surveys may be useful for monitoring vaccination coverage in high-risk urban settings.
authors.affiliation: Communicable Disease Division, Chicago Department of Health, Chicago, Illinois, USA.
authors.forename: T A
authors.initials: TA
authors.lastname: Kenyon
authors.forename: M A
authors.initials: MA
authors.lastname: Matuck
authors.forename: G
authors.initials: G
authors.lastname: Stroh
mesh_terms: D002641:Chicago; D002675:Child, Preschool; D016000:Cluster Analysis; D003625:Data Collection / Q000379:methods; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000706:statistics & numerical data*; D007223:Infant; D008297:Male; D008458:Measles Vaccine; D011055:Poliovirus Vaccine, Oral; D011204:Poverty Areas; D012306:Risk; D012494:Sampling Studies; D012959:Socioeconomic Factors; D014505:Urban Population
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D008458:Measles Vaccine; D011055:Poliovirus Vaccine, Oral