ANN ARBOR—Community interventions would significantly increase the vaccination rates among hard to reach and at-risk populations such as sex-workers or shut-ins during a flu pandemic or national shortage, new research shows

During such times, immunizing hard-to-reach populations could be challenging but important, said Sandro Galea, a study author and associate professor at the University of Michigan School of Public Health. Unvaccinated populations may serve as undetected reservoirs of infection and spread the disease to other populations.

The paper, “Project VIVA: A multilevel community based intervention to increase influenza vaccination rates among hard to reach populations in New York City,” is highlighted in the July issue of the American Journal of Public Health. It’s one of a series of papers using data from the VIVA (Venue Intensive Vaccines for Adults) project.

“When there is a (vaccination) shortage the people who need the most attention are the ones who will fall through the cracks,” Galea said. Most flu and emergency preparedness plans do not address vaccinating hard to reach populations.

During the 2004-2005 flu vaccine shortage, the vaccination rate for the general population was double the rate for hard to reach populations, at 42 percent and 21 percent respectively. Among the 21 percent, the people most likely to be vaccinated had ties to a primary care doctor, Galea said. Those findings are outlined in a separate paper, though both papers use data collected during Project VIVA. There is no concrete definition of hard-to-reach populations; VIVA researchers looked at substance abusers, sex workers, undocumented immigrants, the homeless, and elderly shut-ins in East Harlem and the Bronx.

Low vaccination rates and barriers to health care place these populations at high risk for the flu. Additionally, the likelihood that the flu could be fatal is higher among those populations.

Researchers surveyed 6,826 participants from February to October 2005, and 37 percent were members of hard-to-reach populations. Researchers intervened on three different levels: by contacting individuals, by working in different neighborhoods, and through community organizations.

Methods of intervention included: Disseminating project information; giving presentations at meetings; offering street-based and door-to-door vaccinations during two flu seasons.

The University of Michigan School of Public Health has been working to promote health and prevent disease since 1941, and is consistently ranked among the top five public health schools in the nation. Faculty and students in the school’s five academic departments and dozens of collaborative centers and initiatives are forging new solutions to the complex health challenges of today, including chronic disease, health care quality and finance, emerging genetic technologies, climate change, socioeconomic inequalities and their impact on health, infectious disease, and the globalization of health.
For more on Galea, visit: http://www.ns.umich.edu/htdocs/public/experts/ExpDisplay.php?ExpID=1033

For more on VIVA: http://www.projectviva.org

The studySandro GaleaVIVA