Closing the gap on childhood immunization
■ In the wake of National Infant Immunization Week, increased emphasis is placed on the need for continued vaccination vigilance.
Posted May 26, 2008.
Measles. Mumps. Chickenpox. Polio. These are a mere sampling from the list of 16 life-threatening diseases against which very young children can be immunized.
Not too long ago, these illnesses had a haunting, everyday presence. Now, for many, these diseases are barely a memory.
This accomplishment is considered one of public health's greatest triumphs.
It's celebrated annually during National Infant Immunization Week. This year, from April 19 to April 26, events were held across the country to highlight successful programs and remind parents and health care professionals of the benefits of vaccination.
It's also a continuing call to action.
According to the Centers for Disease Control and Prevention, more than 4 million children are born each year in the U.S., and each one should receive this array of shots during his or her first two years of life.
The American Medical Association has long-standing policy that supports this goal, endorsing the need for adequate resources and programs to ensure that children are vaccinated on schedule -- with an eye on reaching the Healthy People target of a 90% coverage rate by 2010.
So far, the message has found traction. Infant immunization coverage has topped 80%, based on government estimates.
But this figure has a flip side. About 20% of the nation's 2-year-olds still are not fully protected. A recent study conducted by CDC researchers set that percentage even higher.
They examined compliance with CDC Advisory Committee on Immunization Practices recommendations and time frames -- a different tack than the usual dose-counting method. Their analysis, published April 29 by the American Journal of Preventive Medicine, found that more than one in four children between the ages of 19 months and 35 months were not in compliance. Missed doses accounted for two-thirds of the nonadherence. Mistimed doses also came into play.
Meanwhile, one only needs to read the newspaper to grasp what can go wrong when people become lax or back away from these preventives. This year's U.S. measles' upsurge -- the largest since 2001 -- is a reminder of how quickly the population can become vulnerable.
According to the CDC, from Jan. 1 through April 25, 64 measles cases in nine states were confirmed. No deaths occurred, but 14 hospitalizations were reported. When one considers that approximately 20 million cases occur each year worldwide, this number seems quite small. But health officials view it as a canary in the coal mine.
Among these cases, prior vaccination could be documented in only one. The communities where the illness took hold contained many families who opted not to vaccinate because of philosophical or religious reasons. The AMA traditionally has warned against these exemptions and encourages physicians and state and local medical associations to work to change the state or local regulations that allow them.
Also, transmission of 17 cases occurred in health care settings, including a 12-month-old who ironically was infected during a doctor's office visit for a routine MMR dose. Infected individuals spent time in waiting rooms or emergency departments because physicians and other professionals did not immediately recognize the sickness -- thereby putting other patients at risk.
These circumstances highlight important points. Health care professionals should be aware that, even though ongoing U.S. transmission of measles was declared eliminated in 2000, the disease still can find its way here. It can be acquired through international travel to many countries, including Israel and developed European nations. And physicians need to be prepared to identify it and respond quickly, as well as implement infection-control measures.
The fact that these outbreaks were limited in size is a credit to the nation's high vaccination rates and quick public health response. But diligence still is essential.
These examples demonstrate that coverage and prevention are sometimes taken for granted. But vaccine-preventable illnesses are persistently circulating around the globe, and the United States could see a return if high immunization rates are not maintained.