Journal of Community Health

, Volume 42, Issue 3, pp 573–582 | Cite as

Factors Related to Pertussis and Tetanus Vaccination Status Among Foreign-Born Adults Living in the United States

  • Liliana Sánchez-González
  • Alfonso Rodriguez-Lainz
  • Alissa O’Halloran
  • Ali Rowhani-Rahbar
  • Jennifer L. Liang
  • Peng-jun Lu
  • Peter M. Houck
  • Stephane Verguet
  • Walter W. Williams
Original Paper


Pertussis is a common vaccine-preventable disease (VPD) worldwide. Its reported incidence has increased steadily in the United States, where it is endemic. Tetanus is a rare but potentially fatal VPD. Foreign-born adults have lower tetanus–diphtheria–pertussis (Tdap) and tetanus–diphtheria (Td) vaccination coverage than do U.S.-born adults. We studied the association of migration-related, socio-demographic, and access-to-care factors with Tdap and Td vaccination among foreign-born adults living in the United States. The 2012 and 2013 National Health Interview Survey data for foreign-born respondents were analyzed. Multivariable logistic regression was conducted to calculate prevalence ratios and 95% confidence intervals, and to identify variables independently associated with Tdap and Td vaccination among foreign-born adults. Tdap and Td vaccination status was available for 9316 and 12,363 individuals, respectively. Overall vaccination coverage was 9.1% for Tdap and 49.8% for Td. Younger age, higher education, having private health insurance (vs. public insurance or uninsured), having visited a doctor in the previous year, and region of residence were independently associated with Tdap and Td vaccination. Among those reporting a doctor visit, two-thirds had not received Tdap. This study provides further evidence of the need to enhance access to health care and immunization services and reduce missed opportunities for Tdap and Td vaccination for foreign-born adults in the United States. These findings apply to all foreign-born, irrespective of their birthplace, citizenship, language and years of residence in the United States. Addressing vaccination disparities among the foreign-born will help achieve national vaccination goals and protect all communities in the United States.


Adult vaccination Foreign-born Pertussis Tetanus Vaccination coverage 


Compliance with Ethical Standards

Conflict of interest

The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.


The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Liliana Sánchez-González
    • 1
  • Alfonso Rodriguez-Lainz
    • 2
  • Alissa O’Halloran
    • 3
  • Ali Rowhani-Rahbar
    • 4
  • Jennifer L. Liang
    • 5
  • Peng-jun Lu
    • 3
  • Peter M. Houck
    • 4
  • Stephane Verguet
    • 6
  • Walter W. Williams
    • 3
  1. 1.Department of Global HealthUniversity of WashingtonSeattleUSA
  2. 2.Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious DiseasesCenters for Disease Control and PreventionAtlantaUSA
  3. 3.Immunization Services Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaUSA
  4. 4.Department of EpidemiologyUniversity of WashingtonSeattleUSA
  5. 5.Division of Bacterial Diseases, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaUSA
  6. 6.Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonUSA

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