Childhood Immunization Disparities

There are large disparities in immunization rates in the City of Milwaukee across racial/ethnic groups as well as geographic location (urban vs. suburban).   Among city residents, African American immunization rates (36%) are much lower than rates for Whites and Hispanics (52% and 57%, respectively), and a much larger disparity is found comparing city rates (41%) vs. suburban rates (82%). 

Missed opportunities (MOs) are a major factor contributing to under-immunization and delay in age-appropriate immunization in children, leaving these children – and their household and community contacts – vulnerable to a variety of serious, preventable communicable diseases. Research has shown that up to 60% of the time spent overdue for some immunizations during the first two years of life is due to missed opportunities, especially for children living in poverty. Thus, MOs contribute not only to poor health outcomes but also to health disparities along socioeconomic and racial-cultural lines.  Studies in four inner city clinics showed that 69 to 82% of children seen had at least one MO for vaccination.

The purpose of this project is to implement provider education and process refinement interventions with immunization providers to decrease missed opportunities and improve immunization completion rates.  This demonstration project aims to evaluate the effectiveness of these interventions, and is expected to result in sustainable and transferable interventions for reducing racial, ethnic, and socioeconomic disparities in immunization completion rates.

Each enrolled clinic will undergo a full AFIX process, which will be tailored to the needs of the clinic.  AFIX (Assessment, Feedback, Incentive, and Exchange) is a formalized process created by the National Immunization Program (NIP) of the Centers for Disease Control and Prevention (CDC) to raise immunization levels and improve standards of practices at the provider level.  Through the yearly assessment portion of the AFIX process, the strengths and weaknesses of each clinic will be assessed and interventions will be customized and prioritized, and may include education, technical assistance, or administrative assistance, such as assistance with reminder notices to parents when children are due for immunizations, or recall notices for children who are overdue for vaccines, plus case management (telephone calls and home visits) for those not responding to a recall notice.