2013 Vaccination Coverage Survey

The number of homeless families has risen sharply over the past decade in France. Little is known about the sociodemographic and health characteristics of this population. The Samusocial Observatory conducted a survey, one of the objectives of which was to estimate vaccination coverage (VC) among homeless children. A cross-sectional survey was conducted in the Île-de-France region on a sample of 801 families residing in social housing, emergency shelters, social reintegration centers, or centers for asylum seekers. Children under the age of 13 were selected through a three-stage random sampling process. Vaccination data were collected by a nurse from health records during face-to-face interviews. VC was defined as the ratio of the number of children vaccinated with a given vaccine to the number of children included in the analysis. The association between vaccination and sociodemographic variables was analyzed using Poisson regression. Among homeless children born in France, vaccination coverage rates were generally high (>90% at 24 months of age for most vaccinations) and similar to those in the general population, whereas those for homeless children born outside France were significantly lower (all <50% at the same age). At 24 months of age, the probability of being vaccinated for a homeless child born in France was generally 2 to 14 times higher (depending on the vaccine) than that of a child born outside France (p < 0.001). In the latter group, vaccination coverage improved beyond 24 months, but catch-up vaccination remained insufficient. Although it is possible that part of this gap is due to a failure to record vaccinations administered before arrival in France, these data suggest that homeless children in the Île-de-France region born abroad are less well vaccinated, at the same age, than other children. Particular attention should be paid to this specific population.

  • Guthmann JP, Mansor-Lefebvre S, Lévy-Bruhl D, Caum C, Arnaud A, Jangal C, Vandentorren S, Le Strat Y. Vaccination coverage among homeless children in the Île-de-France region: results of the Enfams survey, 2013.

Socioeconomic determinants of BCG and pneumococcal vaccinations among children in the Paris region

While vaccination coverage among young children in France is now generally well documented, there is very little data on the socioeconomic determinants of vaccination. We conducted a survey to investigate the association between certain socioeconomic factors and two childhood vaccinations: BCG and the heptavalent pneumococcal conjugate vaccine (PCV7). This cross-sectional survey included 710 children aged 0 to 5 years residing in Paris and the inner suburbs (departments 92, 93, 94). Selection was based on a two-stage stratified random sampling, and data were collected via a face-to-face, named questionnaire. Poisson regressions were used to analyze the association between explanatory variables and reported vaccination coverage, as well as coverage confirmed by the health record. For the BCG vaccine, vaccination coverage was high and close to 100% among children from the lowest-income families, whereas in higher-income families, it was higher among children from families originating from a country with high tuberculosis endemicity (98.2%) compared to other children (76.2%). Regarding PCV7 vaccination, the survey showed that in lower-income families, vaccination coverage was lower compared to that of higher-income families (83.2% and 97.3%, respectively, for one dose among children aged at least 6 months). PCV7 coverage was not linked to the existence of supplemental health insurance. This survey is important because it provides new data on the determinants of vaccination coverage in France. Children in the Île-de-France region from disadvantaged socioeconomic backgrounds and those of immigrant origin (regardless of socioeconomic background) are clearly identified as being at high risk for tuberculosis and are properly vaccinated with BCG. The association between insufficient PCV7 vaccination coverage and low income—without any association with the type of health insurance—suggests the existence of barriers to this vaccination that are of a nature other than purely financial.