Resurgence of Preventable Diseases Spurring New Push for Immunizations
In response to an unprecedented resurgence of vaccine-preventable diseases in preschool-age children, the federal government and others have begun new efforts to ensure that all young children receive needed immunizations.
Over the past two years, health officials have recorded numerous outbreaks of measles, rubella, and whooping cough, especially among very young inner-city children. Although immunizations can prevent all of these diseases, most of the infants and toddlers who contracted these illnesses had not been vaccinated, health officials have found.
They note that while virtually all children meet states' requirements to be vaccinated against measles and other childhood diseases by the time they enter school, there is no such universal requirement for preschool-age children.
As a result, the experts say, a significant number of poor children are failing to receive a full series of vaccines while they are infants and toddlers, as is recommended by the U.S. Centers for Disease Control.
The current measles epidemic is indicative of the general health-care crisis that is affecting poor children, many health experts say.
"What we have seen is a failure of the preventative mechanism," said Dr. Walter Orenstein, head of the immunization division at the CDC ''We believe that it is a harbinger, potentially, of other epidemics."
"If we can't do this well, then what can we do?" he asked.
According to the CDC, more than 26,500 cases of measles were reported nationwide last year, up from the 18,193 confirmed cases in 1989. More than half of the cases that developed from outbreaks occurred among unvaccinated preschool-age children, the CDC has found.
In contrast, an average of 3,100 cases of measles were reported each year between 1981 and 1988.
Other diseases that were also once nearly eliminated in the United States are making an unwelcome comeback.
Last year, for example, nearly 1,100 cases of rubella, also known as German measles, were reported by the CDC That was up from the 396 cases in 1989, and well above the 225 cases in 1988, the lowest yearly total ever reported. The biggest increases in both 1989 and 1990 occurred among young people and children, most of whom had not been vaccinated against the disease.
In response, a federal advisory panel earlier this year recommended that the government spend up to $50 million more each year to prevent future measles epidemics.
The report, released by the National Vaccine Advisory Committee, took the medical community to task for failing to provide immunizations to inner-city infants and toddlers.
Unless the medical system removes the barriers that inhibit parents from having their children immunized--such as requiring appointments for immunizations and failing to provide sufficient staff or clinic hours--there will be more measles outbreaks in the future, the panel concluded.
To implement these recommendations, the Bush Administration has proposed boosting federal funding for immunization efforts by $40 million, to $258 million.
"I think the measles epidemic is a national embarrassment," said Kay Johnson, a senior health-policy adviser at the March of Dimes. "In response to a crisis and a lot of publicity, it's not so surprising that [the Administration] should pursue this this year."
Although child-health advocates welcome the proposed increase, they note that federal spending has not kept pace with the rising costs of vaccines. According to the American Academy of Pediatrics, it cost $6.69 in 1982 to fully immunize a child in a public-health clinic. By 1990, manufacturers' concerns over product liability had pushed the price of the same vaccine series to $91.20.
At the same time, more families that cannot afford to receive childhood immunizations from private physicians are going to public-health clinics for free immunizations. As a result, public clinicians say, more of their money has been spent on purchasing vaccines than on expanding staff or increasing clinic hours. The CDC estimates that as many as 50 percent of all children get their vaccines from the public sector.
Probably the most controversial part of the Bush Administration's initiative is a proposal to link immunization efforts with federal assistance programs. Officials insist, however, that no family will be denied federal benefits if their child remains unimmunized. (See Education Week, March 20, 1991.)
James Mize, the chief of program development and coordination activity for the program-services branch within the CDC's immunization division, said federal health officials began exploring ways to link immunization efforts to social-service programs after several studies showed that a large percentage of unimmunized children under the age of 2 come from families enrolled in public-assistance programs.
Several cities are already setting up pilot projects, Mr. Mize said. Starting this month, vaccines are available in several welfare offices in Jersey City, N.J., the site of several measles outbreaks.
In New York City, in contrast, mothers whose children are not fully immunized will receive nutritional vouchers good for just one month, instead of the normal three months, at six centers for the Special Supplemental Food Program for Women, Infants, and Children program. These families will be escorted or referred to vaccination centers, Mr. Mize said.
As long as the children are not fully immunized, the families will continue to receive one-month vouchers, Mr. Mize said. "It's a positive incentive," he said.
In Chicago, where a similar program is being set up at several WIC sites, public-health officials said they hope to reach children who are not enrolled in licensed day-care centers, which require immunizations for entry.
"A lot of people forget that measles is a problem," said Edward Mihalek, the director of immunization programs for the city's health department. "It's sort of out of sight, out of mind."
Without such novel efforts, Mr. Mize said, it is unlikely that the government will achieve its goal for 2000 of having 90 percent of children fully vaccinated by the age of 2.
He estimated that between 50 percent and 60 percent of children currently meet this standard in some inner cities, but, because the federal government stopped collecting such data in 1985, no firm figures are available. The government will begin to collect such information again later this year or next year, he said.
As part of its initiative, the government will also conduct studies of parents to determine why some fail to get their children immunized according to the recommended schedule.
Answers to such questions would be particularly welcomed at the local level, where public clinics in some cities have been unable to reach many unvaccinated children.
During one such vaccination drive in Camden County, N.J.,health officials widely publicized that they would be offering free vaccines on two successive Sundays at four locations, in addition to those given during their normal weekday clinic hours. Dr. Jung H. Cho, the county's health officer, said he estimates that approximately 5,600 children in the county between the ages of 1 and 5 have not been vaccinated. Yet, only 60 of these children were vaccinated during the Sunday sessions.
"I know they are there," Dr. Cho said of the unvaccinated children. "I don't know how to reach them. If I can immunize 600 children before the end of June, I will be very happy."
Outside of the government, several groups have also mounted efforts to improve immunization rates. This week, for example, the Association of Junior Leagues is running a public-awareness campaign telling parents "Don't wait to vaccinate" in dozens of cities across the country.
Likewise, the Children's Action Network, a Los Angeles-based group that is heavily supported by the entertainment industry, will be conducting a similar effort next fall.
Some have also begun to look at the role day-care centers might play in transmitting such diseases. Although most states require children to be immunized before they can attend licensed day-care centers, child-care experts acknowledge that it is sometimes difficult for centers to ensure that infants and toddlers stay up to date on their immunizations.
"We are trained in child development, not immunization schedules," said Peggy Pizzo, director of the Better Care for the Babies project at the National Center for Clinical Infant Programs.
To address some of these concerns, model child-care standards that will be released this summer by the aap and the American Public Health Association will discuss immunizations, said Debra Hawks Peabody, the project's director.
Linda Lovett, the executive director of Lovett's Children, a child-care facility in Riverside, Calif., said her center has routinely sent home notices to parents about the presence of diseases in the center for three years. She noted that a greater emphasis in recent years has been placed on training child-care workers in preventing the transmission of diseases.
"As providers, we have become much more aware about the prevention and spread of diseases," Ms. Lovett said. "We've been known to stop everything and call the parents of infants when we know a disease is spreading."
Vol. 10, Issue 31, Page 10