Pediatric vaccine compliance

For more than two decades, the US Public Health Service has used health-promotion and disease-prevention objectives to improve the health of the US population. In the framework of Healthy People 2000, improving immunization rates makes up 22 of 300 national health objectives.(27) The goal for the year 2000 is to increase the immunization rate of children up to age 2 years to at least 90%. The United States has enjoyed some success in reaching the 90% national coverage level despite substantial variation in vaccination rates at the state and local levels. The measles epidemic in 1989 to 1991 drew national attention to the low immunization rates in urban neighborhoods and pointed out some of the shortcomings in the efforts to improve immunization coverage.(28) Much research has been conducted since then to understand the barriers to timely immunization and to develop strategies to improve immunization coverage. The benefits of vaccination have been self-evident during the twentieth century, with an observed decrease in morbidity and mortality from nine vaccine-preventable diseases and their complications.(11) Efforts to promote vaccine use among all children began in 1955 with the appropriation of federal funds for polio vaccination.(11) Since that time, an ongoing collaborative effort to support these efforts has been made in the public and private health care sectors. The pediatric vaccination schedule is increasingly complex to implement and demands a well-designed infrastructure. Approximately 80% of immunizations recommended for children are scheduled during the first 2 years of life. Each child, by age 18 months, requires 15 to 19 doses of vaccine to be protected against 11 childhood diseases. For adolescents, the routinely recommended vaccines should be given at age 11 or 12 years, and adequate systems for the delivery of vaccines to adolescents have not been well established. Among children aged 15 to 35 months, vaccination rates were reported to have exceeded 90% for a select group of vaccines, including those receiving three or more doses of diphtheria and tetanus toxoids and pertussis vaccine, three or more doses of poliovirus vaccine, three or more doses of Haemophilus influenzae type b vaccine, and one or more doses of measles-containing vaccine.(11) Despite much progress, many challenges remain for the US vaccine-delivery system. Many states, however, have not achieved the 90% coverage level for specific vaccines. Underimmunizations associated with demographic factors including poverty, urban areas, and minority groups have been well described and pose significant challenges in the efforts to implement effective strategies to achieve and sustain high vaccination levels.(34) The magnitude of pockets of high-risk, underimmunized populations is not fully quantified, however, because of the structure of the vaccine surveillance system.(33) The primary source for data is the National Immunization Survey, which provides a national estimate of coverage and comparable, statistically valid estimates for each of the 50 states and 28 of the largest urban areas.(26) Assessment of immunization status at the local level is more difficult to measure because it often relies on cluster surveys and retrospective reviews for data.(26) The pediatric standards call for the development of immunization registry systems with five primary functions: To monitor the immunization status of individuals To monitor the immunization status of defined populations To remind individuals or parents of the need for immunization To recall individuals in need of immunization To remind practitioners to administer needed immunizations when they see patients who are due or overdue for vaccination Although all 50 states are involved in the development of immunization registries, none is yet fully implemented.(26)