title: Immunization programs in non-traditional settings.
abstract: BACKGROUND
  The Downtown Eastside (DTES) of Vancouver is an inner-city neighbourhood of 10 square blocks where poverty, crowded housing, homelessness, poor nutrition and hygiene, chronic illness, and substance abuse put residents at risk for communicable diseases. The objective of the program was to minimize the burden of illness from vaccine-preventable diseases in this vulnerable population. This article describes the process and lessons learned to enable others to implement similar programs.
  
  
  METHODS
  Influenza and pneumococcal vaccinations were offered in community settings to all persons living in, working in, or visiting the DTES by teams of public health nurses and volunteers in the fall of 1999. Hepatitis A and B vaccinations were offered in January/February 2000. All 4 vaccines were offered in Fall 2000, influenza vaccine alone was offered in Fall 2001 and 2002; and pneumococcal, hepatitis A and B vaccines were offered in June 2002.
  
  
  RESULTS
  During the initial 5-week influenza/pneumococcal immunization blitz, 8,723 persons were immunized; 79% received both vaccines. There was a reduction in visits for pneumonia to local emergency departments in the 3 months following this blitz. During the 5-week 2000 hepatitis A and B vaccination blitz, 3,542 persons were immunized; 58% received both vaccines. A reduction in reported cases of hepatitis A followed. Uptake of influenza vaccine was considerably reduced when offered in combination with 3 other vaccines. To maximize uptake, influenza vaccine was offered alone in subsequent years.
  
  
  CONCLUSIONS
  Immunizations can be successfully delivered to high-risk inner-city populations in non-traditional settings, using public health nursing outreach in a blitz format.
authors.affiliation: Vancouver Coastal Health, Vancouver, BC. shelagh_weatherill@vrhb.bc.ca
authors.forename: Shelagh A
authors.initials: SA
authors.lastname: Weatherill
authors.forename: Jane A
authors.initials: JA
authors.lastname: Buxton
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Daly
mesh_terms: D001955:British Columbia; D006506:Hepatitis A / Q000517:prevention & control; D022362:Hepatitis A Vaccines; D006509:Hepatitis B / Q000517:prevention & control; D017325:Hepatitis B Vaccines; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007252:Influenza Vaccines; D007251:Influenza, Human / Q000517:prevention & control; D011008:Pneumococcal Infections / Q000517:prevention & control; D022242:Pneumococcal Vaccines; D011637:Public Health Nursing; D014504:Urban Health
chemical_list: D022362:Hepatitis A Vaccines; D017325:Hepatitis B Vaccines; D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines