P0340 INADEQUATE HEPATITIS B VACCINE COVERAGE IN OLDER HOMELESS CHILDREN IN BALTIMORE

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Introduction: Although the American Academy of Pediatrics recommends universal HBV (hepatitis B virus) vaccine for children 0 – 18 years of age and HBV infection in childhood occurs most frequently in the urban poor, little is known about HBV vaccine coverage rates in this population. Methods: The purpose of this study was to investigate HBV vaccine rates in homeless children 2 – 18 years of age living in Baltimore City in order to 1)Determine if the 2001 mandate for HBV vaccine at kindergarten entry in Baltimore affected vaccine coverage in this population 2)Assess the most efficient means of tracking HBV vaccines: BIRP(the Baltimore Immunization Registry Project), school records, shot records, and medical caregivers and 3)Quantify the labor associated with obtaining vaccine records from the various sources. Results: During the 21 month period from 10/11/01–7/2/03, 252 children were enrolled in the study. The percentage of children in the various age groups with 3 or more shots was as follows: 2–3years 87%, 4–5 years 92%, 6–12 year 71%, and 13–18 years 27%, demonstrating a strong inverse correlation between age and completion of the HBV vaccine series (p<0.0001). Among the 63 children 6–9 years of age, only 1 (2%) lacked 3 vaccines whereas among the 57 children 10–12 years of age, 34 (60%) lacked 3 vaccines (p<0.0001). Seventy-nine percent of the children in the 2–5 year age group had at least some of their vaccine history recorded in BIRP; multiple medical caregivers supplied the majority of vaccine history for the older children. The labor to track vaccines was inversely proportional to the number of shots in the record, p<0.0001. Conclusion: In conclusion, 1) The school mandate for HBV vaccine coverage has been highly effective even in the unstable homeless population 2) BIRP is an effective means of tracking HBV vaccine for young homeless children. 3) Tracking of vaccine records in older homeless children is very labor intensive despite institution of mandatory reporting in BIRP. Older homeless children remain at risk for HBV; better public health strategies to both track and deliver HBV vaccine to this vulnerable population are urgently needed.

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