Study finds needle-free vaccinations can improve immunization rates in low-income families

Efforts to increase immunization rates of vulnerable children—such as those at high risk for vaccine-preventable diseases such as pneumonia—would be aided by lowering the number of parents who delay or refuse vaccines, according to a new study.

The research is the first to use a combination of measures, including needle-free immunization and vaccination boosters, to encourage parents to up their immunization levels, according to a research summary published in JAMA.

Parents delaying or refusing vaccines often do so on religious, philosophical or personal grounds, the authors of the study say. This does not imply that they don’t believe in vaccines, but that they have alternate beliefs or understand that the lack of vaccination is a public health problem.

“Many parents, whether they explicitly or not, lack adequate information about the importance of vaccinations and the overall protective benefits for their children,” said Dr. Anne Schuchat, an assistant surgeon general and acting director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.

The JAMA findings were published this week.

Schuchat said the study provided a useful basis for individual states, health departments, community groups and other groups that support immunization efforts to jointly pursue better outreach strategies.

The number of children not up to date on their vaccines increased from nearly 19 percent in 2016 to 19.9 percent in 2017, according to a recent CDC report.

The study noted that prior studies have suggested that the number of non-vaccinated children is not directly related to the rate of vaccine refusal. But the new study provides evidence that the relationship may exist if boosters are provided before shots are considered “perfectly effective,” said Schuchat.

While the exact mechanism of needle-free immunization is not known, there has been evidence that it contributes to higher immunization rates, the study noted.

Researchers at the Children’s Hospital of Philadelphia tested a combination of home vaccinations via a handheld device that is used in the doctor’s office. These home vaccines are by far the most common form of home vaccination. The device allows trained medical professionals to administer needle-free vaccinations, such as shots, sprays and syringes, in the home.

The researchers say that if the device were rolled out in schools, the rate of children not up to date on vaccines would fall by about 5 percent.

“There is a strong potential to see an increase in vaccination of vulnerable children,” said one of the authors, Dr. Paula Baron, a professor of pediatrics and associate dean for research at the University of Pennsylvania Perelman School of Medicine.

The use of needle-free immunization in a physician’s office comes at no cost to the patient or the health care system, and with fewer complications than in in-office needle-and-glue injections.

The researchers also found that in the beginning, the non-immune parents who received a home immunization largely stayed away from the group receiving a booster vaccination. But afterward, the vaccination-deficient group returned to vaccination.

The authors of the study say the findings suggest that booster vaccinations should also be presented at doctor’s offices as part of an integrated package of home, school and community-based interventions.

They said many other studies have focused solely on the effects of bringing parents back into the vaccination process after a delay.

The new study shows that a healthy vaccination trajectory remains achievable in low-income, high-risk groups, Schuchat said. But she said the challenge is to improve vaccination rates throughout the population to protect all vulnerable children, especially those with suppressed immune systems.

Funding for the study was provided by the Research Initiative for Infectious Diseases and Social Preparedness at National Institutes of Health.

The American Academy of Pediatrics, the leading pediatric health organization in the United States, was not involved in the study.

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