OBJECTIVES: The CDC recommends that patients ≥7 years old with an unknown or incomplete vaccine history (including recently resettled refugees), complete a 3-dose primary catch-up series with tetanus-diphtheria toxoid-containing (Td) vaccines. The primary series should include 1 pertussis-containing (Tdap) dose. This study identifies the proportion of recently resettled refugees with documentation of 1 dose of Tdap, the 3-dose primary catch-up series, and factors associated with completing the catch-up series.

METHODS: We conducted a retrospective analysis using data from the Jefferson Longitudinal Refugee Health Registry, which contains clinical, demographic, and immunization data. Refugees ≥7 years old resettled to the US who received an initial domestic medical examination from a primary care clinic in Philadelphia, Pennsylvania from 2008 to 2016 were included. Descriptive statistics were conducted to describe documentation of 1 dose of Tdap and completion of the catch-up series for those eligible. Multivariable logistic regression was conducted to determine factors associated with documented completion of the catch-up series.

RESULTS: Of 1,405 patients included, mean (SD) age was 35.1 (14.8) years and 55.5% were male. 91.7% received 1 dose of Tdap and 32.7% completed the catch-up series. Patients with increased odds (OR, 95% CI) of documented completion of the catch-up series included those with a history of receiving Td abroad (1.62, 1.15-2.27), an initial screen from 2011-2013 (2.08, 1.49-2.90), from Bhutan/Nepal (1.80, 1.00-3.24), and a diabetes diagnosis (2.02, 1.08-3.76).

CONCLUSIONS: While a high proportion of recently resettled refugees received Tdap, a low proportion had documentation of completing the catch-up series. Resources to support overseas vaccination programs should be continued and expanded because those who started the tetanus-diphtheria series abroad had increased odds of completing the series once resettled in the US. Additionally, medical institutions should enhance follow-up coordination to ensure patients return to clinic to complete the vaccination series.