Promoting Infant and Early Childhood Vaccines in a Refugee Population

Background: Refugee children and children of refugees are at risk for under-immunization. Reminder and recall is an intervention that has been shown to improve vaccination rates, but has not been studied in a refugee-specific population. This quality improvement project was conducted from September-November 2018 at an International Family Medicine Clinic (IFMC) at an academic medical center in Charlottesville, Virginia. The purpose was to pilot a reminder and recall intervention and identify risk factors for delayed immunization for refugee children. Methods: Charts were reviewed for 441 children under ten years old to identify factors associated with delayed immunization. The 120 children under four years old were screened for the reminder and recall intervention, as older children are prompted to get vaccines by school policies. Parents of children with missing vaccines were contacted with a reminder to make an appointment for vaccination. Results: Twenty-two children required reminder calls for missing vaccines. By the end of the study, 12 of 22 (54.5%) had appointments scheduled. Foreign-born status, maternal origin country, and number of children per household were among the factors associated with a decreased rate of vaccination on the recommended schedule. Factors associated with improved vaccination rates included use of Women, Infants, Children (a federal nutritional program for low-income families) services, older maternal age at birth, and increased maternal time since immigration. Conclusion: These results will allow IFMC providers to identify children who are at risk for delayed immunization and provide a basis for a sustainable intervention to improve vaccination rates.