[Relationship between precariousness, social coverage, and vaccine coverage: survey among children consulting in pediatric emergency departments in France].
Poor children are more susceptible to infectious diseases. Routine medical follow-up is infrequent in these patients, sometimes resulting in immunization delays. The aim of this study was to correlate a number of socioeconomic factors related to poverty with vaccination coverage in children visiting a pediatric emergency ward.


METHODS
Previous routine vaccinations and various socioeconomic features were prospectively recorded for children aged 9 months to 7 years visiting two public pediatric emergency departments in Marseilles (southern France) from 2009 to 2010.


RESULTS
Three hundred and seventy-five children were included. Vaccination coverage was 87% for diphtheria, tetanus, poliomyelitis, Haemophilus influenzae type b infections and pertussis, 69% for tuberculosis (Bacillus Calmette-Guérin), 77% for measles, mumps and rubella, 74% for pneumococcal infections (conjugate vaccine), and 55% for hepatitis B. Socioeconomic factors related to poverty were significantly associated with delays in immunizations. Children not attending school (OR=2.5), having parents who were not fluent in French (OR=5.7), living in caravans or squatting (OR=11.5), or being recipients of the national medical assistance for foreigners (OR=12.8) had significant delays with diphtheria, tetanus, and poliomyelitis vaccines. The measles-mumps-rubella vaccine was also delayed in homeless children (OR=3.4). Children who were recipients of the national medical assistance for citizens were better vaccinated against tuberculosis and hepatitis B.


CONCLUSIONS
Poor children living in southern France had significant delays in their routine immunizations, resulting in gaps in their protection. Every medical visit, even those conducted in an emergency ward, should identify children with immunization delays and offer a catch-up schedule if necessary.
Service d'urgences des enfants, CHU Nord, AP-HM, chemin des Bourrely, 13915 Marseille cedex 20, France.
N
N
Bouhamam
R
R
Laporte
A
A
Boutin
M
M
Uters
V
V
Bremond
G
G
Noel
P
P
Rodier
P
P
Minodier
D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006306:Health Surveys; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D008297:Male; D008483:Medical Assistance; D011203:Poverty / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011632:Public Assistance / Q000706:statistics & numerical data*; D014611:Vaccination / Q000706:statistics & numerical data*