Child Vaccinations Hit New High; Pockets of Low Rates Remain

A record high number of toddlers in the US received their early childhood vaccinations on time in 2003, gaining protection from a wide variety of diseases, but pockets of very low immunization rates remain in central urban communities and low-population rural areas.

Just over 79% of young children received their full set of inoculations last year, the Centers for Disease Control and Prevention (CDC) reported. The series of vaccines fights nine diseases: measles, mumps, polio, diphtheria, tetanus, pertussis, meningitis-causing Haemophilus influenza, rubella and hepatitis B. Rates were also improved for vaccination against chickenpox, meningitis and ear infections.

"The good news is that overall the numbers are definitely going up and this is very promising" said Svapna Sabnis, MD, Medical College of Wisconsin Assistant Professor of Pediatrics, who practices at the Downtown Health Center in Milwaukee. "But this looks at the big picture and does not look at the 'sub-picture,' where in our concern we're looking at inner city rates, and those remain low.

"I've been meeting with the chair of the Wisconsin Committee on Immunization Practices (WCIP), looking at the inner city Milwaukee immunization rate, and they believe it to be about 50%. This is still unpublished data, but we do know it's significantly lower."

While the national goal of on-time vaccinations for 80% of children by 2010 has almost been met, thanks to a major effort led by the federal government and administered by state agencies and health care providers, experts cautioned that there is much work to be done to raise immunization rates for millions of toddlers.

Access a Big Issue
Wisconsin's 2003 statewide rate for child immunizations was 81.2% and the rate in Milwaukee County was 78.9%. The difference between the overall county rate and the rough estimate of 50% in the inner city points out a huge disparity in access to preventive health care in general.

"There are pockets of under-immunization and they tend to be in 'inner urban' areas and also some distant rural areas," said Dr. Sabnis. "So we still need to focus on those areas, recognizing that overall the rates are better."

Inner city parents face unique problems in getting their children immunized, Dr. Sabnis noted. "I think it's due to limited access to health care in general and infrequent visits to doctors," she said. "When they come in they come in for sick visits, not necessarily for well-child care, which is when most doctors typically will immunize children. So if they only come in for a cold or when they're sick they are not going to get their immunizations.

"Vaccines are available. Many of us use the national Vaccines for Children program administered by the WCIP through the Milwaukee Health Department, so money should not be an issue. If you're uninsured or underinsured you should be able to get vaccines for free. So again it's not a money issue; it's an access issue as to when they actually come in contact with the medical system. We might not be able to immunize them, so it's about missed opportunities for immunizations."

Shortages, Local Efforts
Even though vaccines can be obtained at little or no cost, shortages of specific vaccines continue to have an impact on childhood vaccination rates. "Shortages have been an issue," said Dr. Sabnis. "We're trying to catch up our kids on their Prevnar immunizations (for meningitis and ear infections).

"Prevnar was gone for a while, and we were debating whether to actually send out letters, but the practicality of trying to catch those families (whose children did not receive the vaccine) and track them down is limited. Right now, as they come in we identify those families and we catch them up. There have been shortages of other vaccines in various areas of the country, and of course right now the flu vaccine shortage keeps hitting the headlines, so this tends to be a recurring problem."

Efforts to improve inner city and rural childhood vaccination rates in Wisconsin are continuing. WCIP is developing an online database that will enable health care providers and parents to check on which vaccinations children have received and when they receive them.

The Medical College is also directly involved in the work to get more children inoculated in Milwaukee. "We're working with Earnestine Willis" (MD, MPH, Medical College Associate Professor of Community Pediatrics and Director, Center for the Advancement of Urban Children), said Dr. Sabnis. "In October we attended a meeting with inner city leaders and we're going to be looking at ways to improve inner city immunization rates. It's on the agenda for the next couple of years, looking at local efforts we can use in the city to improve rates."

Dan Ullrich
HealthLink Contributing Writer

For more information on this topic, see the HealthLink articleThe Facts about Vaccines for Children/Recommended 2004 Childhood and Adolescent Immunization Schedule.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.