Identifying Missed Opportunities for Routine Vaccination among People Who Use Drugs

• Published in: International journal of environmental research and public health Vol. 18; no. 4; p. 1447
• Main Authors: Frew, Paula M, Schamel, Jay T, Randall, Laura A, King, Adrian R, Holloway, Ian W, Burris, Katherine, Spaulding, Anne C, Hbou Project Team
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 04.02.2021; MDPI
• Subjects: Adult; Adults; African Americans; Age; Amphetamines; Cocaine; Consent; Drug abuse; Drugs; Health care; Hepatitis; Hepatitis A; Hepatitis B; Heroin; Humans; Immunization; Infectious diseases; Influenza; Influenza Vaccines; Intravenous administration; Los Angeles - epidemiology; Narcotics; Pharmaceutical Preparations; Population; Public health; Risk factors; Sociodemographics; Socioeconomic factors; Vaccination; Vaccination Coverage; Vaccines; Los Angeles; United States > US; social determinants; substance use; vaccine missed opportunities; adult vaccination; opioid crisis; vaccine coverage; immunization; health equity; vaccine uptake; hidden populations
• ISSN: 1660-4601; 1661-7827; 1660-4601
• DOI: 10.3390/ijerph18041447

In the US, adult immunization coverage remains low, especially among vulnerable populations, as recent hepatitis A outbreaks have demonstrated. We studied the vaccination history variation among the US adults who use drugs by implementing a community-engaged research survey to identify reported immunization coverage, missed opportunities (MO), and places where immunizations might be delivered. Our analysis of a sample of 1127 participants recruited at community syringe exchanges in three cities identified higher overall vaccination receipt in Los Angeles compared to Atlanta or Las Vegas (e.g., HAV receipt 52.2% LA, 42.1% LV, 41.4% Atlanta). Overall, fewer participants reported having received HAV (45.9%), HBV (47.5%), or influenza (47.6%) vaccines than MMR (57.1%) or Td/Tdap (61.1%). Across sites, HAV receipt was higher for participants incarcerated ≥ 5 years (54.2% vs. 43.6% for those incarcerated < 5 years, 49.4% no incarceration history, = 0.02). HBV receipt was higher among participants who were not intravenous drug users (56.1% vs. 46.0%, = 0.03). Additionally, income >$20k predicted higher rates of MMR receipt (67.0% vs. 56.5%, = 0.009), as did stable housing (62.8% vs. 54.3%, = 0.01). To address the need to expand vaccine coverage among vulnerable adults, delivering vaccine at sites where persons who use drugs access services, or in correctional facilities, may be warranted.