Universally Recommended Vaccinations: Vaccination Programs in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Settings

Vaccination interventions in WIC settings involve activities to assess the immunization status of infants and children participating in the program, and to promote and assist efforts to obtain recommended vaccinations. At a minimum, WIC vaccination interventions involve the periodic assessment of each client’s immunization status and referral of underimmunized infants and children to a vaccination provider.

Additional WIC interventions include client reminder and recall systems or tracking and outreach efforts, and incentives to obtain recommended vaccinations (e.g., monthly voucher pickup, which requires more frequent WIC visits when clients are not up-to-date). Access can be enhanced through the provision of vaccinations in WIC settings, or through collocation and coordination of WIC programs with available healthcare services.

Summary of Task Force Recommendations & Findings

The Community Preventive Services Task Force recommends coordinated vaccination interventions in WIC settings based on strong evidence of effectiveness in increasing vaccination coverage in children. Evidence on effectiveness was considered strong based on studies in which assessment of client immunization status and referral to a vaccination provider was combined with additional interventions or with the provision of vaccinations on-site or in a collocated healthcare service. Studies included in this review combined assessment and referral with monthly voucher pickup requirements, tracking and outreach, client reminder and recall systems, or enhanced access to vaccination services.

The Task Force finds insufficient evidence to determine the effectiveness of assessment and referral in WIC settings when implemented alone.

Task Force Finding & Rationale Statement

 

Results from the Systematic Reviews

The Task Force finding is based on evidence from a Community Guide systematic review published in 2000 (search period 1980-1997) combined with more recent evidence (search period 1997-2009). The Task Force now recommends this intervention based on strong evidence of effectiveness; they previously recommended this intervention based on sufficient evidence of effectiveness.

Sixteen studies qualified for the review (four from the previous review and twelve from the more recent search).

• Vaccination rates: median increase of 10.5 percentage points (Interquartile Interval [IQI]: 4 to 19 percentage points; 8 studies, 10 study arms)
• Improvements in vaccination rates were reported in studies with monthly voucher pickup requirements (5 studies).
• Improvements in vaccination rates were reported in studies that coordinated activities between collocated WIC and health care services, or provided vaccination services on-site (4 studies).
• One study evaluated the use of assessment and referral alone and observed no effect on vaccination rates (1 study).

Economic Review

Four studies qualified for the economic review; two from the previous review and two from the updated review.

• The cost per additional fully immunized child ranged from $44 (2009 dollars) for vaccinations provided off-site via referral, to $142 (2009 dollars) for vaccinations provided by an on-site WIC nurse (3 studies). The fourth study reported only the cost of assessing the vaccination status of each child.

The effectiveness and economic review findings are based on systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to vaccinations to prevent diseases.

Publications

The findings and results of this systematic review have not been published. Read other Community Guide publications about Vaccinations to Prevent Diseases in our library, including articles about the previous review. You may also subscribe to be notified as new materials on this topic become available.

 

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Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Universally recommended vaccinations: vaccination programs in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) settings. http://www.thecommunityguide.org/vaccines/universally/WICsettings.html. Last updated: MM/DD/YYYY. YYYY.

Review completed: March 2009