A survey of vaccinations of immigrants and refugees in San Diego County, California.

PURPOSE: This report summarizes a vaccination coverage survey of 65 immigrant and refugee families in San Diego County. It included gathering information from 19 community and government organizations on the immunization system, and on families' barriers impeding immunization. METHODS: The "rapid appraisal" exploratory method flexibly used several research methods, such as informant interviews and door-to-door surveys, changing methods as new questions were uncovered. The researcher went alone, or with organizations' staffs, to interview families, record their vaccination records, and give them forms telling which vaccine doses they lacked. PRINCIPAL FINDINGS: The 4:3:1 (4 DTP, 3 polio, 1 MMR) vaccination series completion rate among children while they were aged 19-35 months old ranged from 33% in those born in 1984-1985, to 60% in those born in 1996-1997. The hepatitis B vaccine completion coverage rate among children in the 1984-1993 birth cohorts was 73%. The hepatitis B vaccine completion coverage rate among Hmong, Vietnamese, and Chinese adolescents ranged from 86%-100%, and among the Kurdish was 85%, Somali 73%, Lao 43% and Cambodian adolescents 35%. CONCLUSIONS: The hepatitis B vaccine completion coverage rate was higher among Hmong, Vietnamese, and Chinese adolescents probably because they lived near clinics and schools providing the vaccine to many, and among the Kurdish and Somali because they received many doses in refugee programs. The families experienced immunization barriers involving transportation, languages, little knowledge of immunizations, and missed opportunities. Two populations have cultural barriers: numerous European-Americans believe in anti-vaccine ideas; and many East Africans have little knowledge of the English language and the American system. RECOMMENDATIONS: Health personnel should continue using current methods to promote immunizations. Community organizations' staffs should consistently check vaccination records, and health officials should do more trainings for those staffs. The National Task Force on Hepatitis B Immunization, Focus on Asians and Pacific Islanders should broaden its work from Asians and Pacific Islanders, to other nationalities with intermediate or high hepatitis B endemicity.