Delivering Pneumococcal Vaccine to a High Risk Population: The Navajo Experience

High rates of preventable diseases such as pneumococcal disease occur among the Navajodespite their universal health insurance through the Indian Health Service. The objective of thisstudy was to determine the proportion of Navajo adults vaccinated with pneumococcalpolysaccharide vaccine and to examine key features of vaccination programs of the NavajoIndian Health Service. For this cross-sectional study, medical charts of Navajo patients withvaccine indications were randomly selected and reviewed to determine who had been vaccinatedas of January 1, 1999. Among 480 Navajo > 65 years old, 73% were vaccinated (95%confidence interval [CI]: 69%-77%). Among 111 Navajo 18-64 years old with vaccineindications, 54% were vaccinated (95%CI: 45%-63%). Vaccination programs utilized extensivepublic health nursing, home visits, standing orders, and “express lane” clinics. In spite ofexcellent delivery systems and universal healthcare, the proportion of Navajo persons vaccinatedwas still below the goals for Healthy People 2010 of having 90% of persons >65 years oldvaccinated and 60% of high-risk persons 18-64 years old vaccinated.