PNEUMOCOCCAL VACCINATION IN A REMOTE POPULATION OF HIGH-RISK ALASKA NATIVES

In response to an increasing prevalence of serious pneumococcal diseas e among adult Alaska Natives of northwest Alaska, a 3-year program was begun in 1987 to identify residents of that remote region who were at high risk for developing invasive pneumococcal disease, to determine their pneumococcal vaccination status, and to deliver vaccine to at le ast 80 percent of those at risk. After reviewing public health nursing and Indian Health Service data bases, the authors identified 1,337 pe rsons, 20 percent of the 6,692 residents of the region, at high risk f or invasive pneumococcal infection, defined either by having a specifi c chronic disease or by age criteria. Cardiovascular disease and alcoh olism were the two most common chronic diseases. Only 30 percent of th ose determined to be at high risk had received one or more doses of pn eumococcal vaccine previously. Half of those persons had received thei r most recent vaccination 6 or more years earlier. The program used bo th customary and innovative methods to deliver 23-valent polysaccharid e vaccine to 1,046 of those at high risk (78 percent), including 388 p ersons who were revaccinated. At the completion of the project, 1,123 persons, 84 percent of those at high risk, had received at least 1 dos e. They included 1,088 persons, 81 percent of those at high risk, with vaccination within the previous 5 years as a result of the project, c ompared with a 15-percent rate prior to the vaccination phase of the p roject. The program demonstrated that high levels of vaccination again st pneumococcal disease, exceeding Year 2000 objectives of 60 percent, are attainable in a remote rural Alaskan population.