EMERGENCY DEPARTMENT VACCINATION OF PRESCHOOL-AGE CHILDREN DURING A MEASLES OUTBREAK

Study objective: To determine the effectiveness of an emergency department vaccination program for preschool-age children during a measles outbreak. Design: Cross-section study. Setting: Urban pediatric ED with an annual census of 24,000. Participants: Children, 12 to 59 months old, who presented to our ED between April 1 and April 30, 1994. Intervention: Staff trained in rationale for and protocol of ED vaccination offered measles-mumps-rubella (MNIR) vaccine, free of charge, to all eligible children. Results: Of the 541 children seen, 7% lacked measles vaccination; MMR vaccination status could not be determined in 10%. From history it was determined that all the others had been vaccinated. Of the vaccination-eligible children, 25% were vaccinated in the ED. Of the eligible children who were not vaccinated, parents declined in half of the cases and physicians did not offer vaccination in the other half. Eligible children with physical injury were more likely to be vaccinated, and those with upper respiratory tract infections were less likely to be vaccinated than were eligible children with other diagnoses (P<.05). Conclusion: During a measles outbreak, few children receiving care at a busy pediatric ED were definitively identified as vaccination eligible. Only a few children identified as eligible for vaccination were vaccinated. Significant logistic barriers to effective ED vaccination exist.