Immune system

A community vaccination program gives kids their best shot.

By Brooke E. O’Neill, AM’04
Photography by Dan Dry

Bundled in a black ski jacket and plaid wool cap, Patricia Donald, a 50-something African American woman, clutches a clipboard to her chest and treks up the icy steps of a brick two-story on South Justine Street. Following close behind is Brittney Moore, her younger coworker. Plows have yet to clear the remains of last night’s snowstorm from this South Side neighborhood, and a handful of homes display boarded windows. “Pediatric Immunization Program,” Donald says, breaking the midmorning silence with a sharp knock. A young woman with her hair tied in a blue-and-white bandana opens the door. Perched on her left hip is her daughter Malaysia, soon to turn 1.

Outreach worker Patricia Donald tracks toddler Malaysia’s immunization record.

Entering the family’s living room, Donald reviews a checklist of seven vaccinations Malaysia should receive at her 12-month doctor’s visit. They include the measles, mumps, and rubella vaccination and the final shot to prevent hepatitis B. Donald and Moore, both outreach specialists with the University’s Lisa Verber Pediatric Immunization Program (PIP)—named for a former outreach worker who died of breast cancer two years ago—work to protect the inner city’s youngest residents against a host of deadly yet preventable diseases. They’ll meet mother and child again at the clinic on appointment day. For now Donald gives the woman and her baby a quick hug and heads back into the cold.

The exchange takes only a few minutes, but it goes a long way toward making sure kids like Malaysia get the care they need. “It’s reminder recall on foot,” says PIP director Robert Daum, a U of C pediatrician who helped launch the program in the early 1990s after a measles outbreak in Chicago. At the time, only 23 percent of public-housing children age 19–35 months were up to date on the American Academy of Pediatrics’s (AAP) recommended vaccinations. Of the rest, 11 percent had never received a single immunization. “We can’t have this,” thought Daum.

Today all children who have completed the PIP program receive their recommended immunizations by age three. Leading the on-the-ground efforts are Donald, Moore, Tynisha Dozier, Sandra Potts, and Felicia Fredricks, a group of South Side residents affectionately known as “the ladies.” Schooled by each other and the program staff on the early-childhood vaccine schedule—the group recommends immunizations for 14 diseases based on AAP and the Advisory Committee on Immunization Practices guidelines—they make phone calls, home visits, and doctor’s-appointment drop-ins.

Potts, a 12-year veteran, joined when PIP operated mainly in the Robert Taylor Homes, once the country’s largest public-housing facility. In the high-rise complex notorious for gang violence, she and a handful of other trained residents went door-to-door, canvassing buildings for unimmunized kids and directing mothers to nearby medical clinics. From October 1993 through April 1996, the workers enrolled roughly 1,075 children age six and under. Soon 40 percent of 15-month-olds in PIP had received their first MMR vaccination, a significant jump from the expected rate of 22 percent for kids their age in the homes. Vaccination rates continued to rise, but the door-to-door approach was time-consuming, and gang activity made it dangerous.

Now outreach begins in the University of Chicago Medical Center nursery, where PIP workers teach new mothers about the importance of on-time immunization. Since 2004 the team has signed up four groups of 200 babies each. When enrolled, babies receive their first dose of the hepatitis B vaccine, a three-shot immunization and the only one safe for newborns. As Daum and his colleagues discovered from the Robert Taylor interventions, children who get the hep B shot at birth are more likely to complete the series and get all other vaccinations.

Two months after a baby is born, mothers receive their first PIP reminder call. Outreach workers check that the mom has scheduled a well-child appointment, and they meet her at the doctor’s office to collect immunization records. If the mother misses the appointment, the workers pay her a home visit. “We get in their face when we have to,” says Dozier, a seven-year PIP veteran. A mother herself, she finds most women grateful for the guidance, particularly because it comes from within the community. She suspects most might not be so receptive if Daum, a middle-aged white man, showed up at their door.

“It’s all about trust down here,” says Dozier, who grew up in the Robert Taylor Homes. “They know us, and we get to know them,” agrees Moore. To develop that trust, the women brave bad weather, broken elevators, unruly dogs, and suspicious looks. “You’ll get guys out here watching you because you’re on their territory,” Moore notes as she and Donald make a stop in Parkway Gardens, an apartment complex off South Calumet Avenue. “We aren’t allowed to travel alone.”

When they’re not on the road, the workers do plenty of detective work to track down missing enrollees. By the time immunization milestones roll around, many families have moved. Cell phones become disconnected, emergency contacts nonexistent, and addresses deserted. On a given day, a pair of workers might visit eight houses but make contact with only two moms on their list. The success rate improves in the summer, when neighbors outside can help point them in the right direction.

Despite the challenges, Daum and the ladies remain undeterred. Since enrolling the first group of babies, PIP has expanded the geographic region workers travel to follow U of C–born babies from a single ZIP code (60637) to the entire city. “We follow them anywhere in Chicago that they move,” says Daum. Eventually the team anticipates enrolling as many as 40,000 city kids.

This year the program also will expand beyond the University Medical Center to three South Side community hospitals: Roseland, Mercy, and St. Bernard. Workers now also track newborns using the State of Illinois’s I-CARE immunization registry, an electronic database that helps with long-term follow-up. Ideally, says Daum, a registered child could walk into any Illinois pediatrician’s office, and the doctor could see his or her immunization records. Ultimately, he hopes to “PIP” every kid in the country, making on-time inoculations a reality for children everywhere.

“We’re a long way from that,” Daum admits, but thanks to his team of outreach workers, the health of South Side children continues to improve, one shot at a time.

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