摘要：Objectives. The Whiteriver Service Unit (WRSU) used proven effective methods to conduct an influenza vaccination campaign during the 2002–2003 influenza season to bridge the vaccination gap between American Indians and Alaska Natives and the US population as a whole. Methods. In our vaccination program, we used a multidisciplinary approach that included staff and community education, standing orders, vaccination of hospitalized patients, and employee, outpatient, community, and home vaccinations without financial barriers. Results. WRSU influenza vaccination coverage rates among persons aged 65 years and older, those aged 50 to 64 years, and those with diabetes were 71.8%, 49.6%, and 70.2%, respectively, during the 2002–2003 influenza season. We administered most vaccinations to persons aged 65 years and older through the outpatient clinics (63.6%) and public health nurses (30.0%). The WRSU employee influenza vaccination rate was 72.8%. Conclusions. We achieved influenza vaccination rates in targeted groups of an American Indian population that are comparable to or higher than rates in other US populations. Our system may be a useful model for other facilities attempting to bridge disparity for influenza vaccination. Influenza accounted for approximately 36 000 deaths annually in the United States during 1990–1999. 1 Only Streptococcus pneumoniae resulted in more vaccine-preventable deaths. 2 Death rates for pneumonia and influenza in American Indians/Alaskan Natives of all ages were 70% greater than the overall US rate of 12.9 per 100 000 population during 1997, 3 and American Indians/Alaskan Natives aged 65 years and older were 20% more likely to die of pneumonia and influenza than the US population as a whole during 1992–1994. 4 Diabetes has a substantial impact on deaths associated with pneumonia and influenza, 5 and American Indian/Alaskan Native (AIAN) adults have an age-specific prevalence of diabetes 2 to 3 times higher than that for US adults as a whole. 6 American Indians/Alaskan Natives have lower education and income levels than the US population as a whole, 7 characteristics associated with lower rates of influenza vaccination. 8 , 9 Other disparities of health indicators between American Indians/Alaskan Natives and other racial/ethnic groups have been documented in recent years. 7 , 10 The Healthy People 2000 goal for influenza vaccination coverage among noninstitutionalized persons aged 65 years and older was 60%, 11 (p287) and the goal was increased to 90% in Healthy People 2010. 12 Influenza vaccination coverage among American Indians/Alaskan Natives aged 65 years and older was 51.2% during the 2002–2003 influenza season according to a nationwide Indian Health Service (IHS) performance evaluation assessment. 13 In comparison, the median percentage of adults reporting receipt of influenza vaccine in 2002 was 68.4% (range 32.2% to 76.6%) among persons aged 65 years and older in 50 states, the District of Columbia, and 3 US territories 14 determined through Behavioral Risk Factor Surveillance System analysis. Other target groups of persons who are at increased risk for complications from influenza have been identified, 15 (pp7–8) but vaccination rates among American Indians/Alaskan Natives in most target groups have not been well established. Behavioral Risk Factor Surveillance System analyses indicate a median influenza vaccination rate among persons aged 50 to 64 years in US states/areas of 38.4% (range 15.9% to 49.0%). Vaccination rates among persons with diabetes were reported at 51.5% and 72.6% in persons aged 50 to 64 years and aged 65 years and older, respectively. 14 Eliminating racial and ethnic health disparities, including disparities in vaccination coverage, is an overarching goal of Healthy People 2010. 12 The Whiteriver Service Unit (WRSU) has met this goal for influenza vaccination coverage for adults older than 50 years and in persons with diabetes. We describe the influenza vaccination program used to eliminate this disparity in this American Indian community.
