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Childhood Immunizations Still at All-Time High

Coverage for chicken pox, pneumococcus rise rapidly in U.S.

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THURSDAY, July 31, 2003 (HealthDayNews) -- Childhood immunization rates have stabilized at all-time high levels while the coverage rates for chicken pox and pneumococcal conjugate vaccines, relatively new additions to the universe of recommended vaccines, have increased considerably.

Still, experts are troubled by the variations that persist between states and some urban areas. While national coverage remains at 75 percent, rates can be as low as 57 percent in certain states and cities.

These are some of the results of the National Immunization Survey, conducted by the U.S. Centers for Disease Control and Prevention (CDC) and presented Thursday at a press conference sponsored by the National Partnership for Immunization. The press conference launched the third annual National Immunization Awareness Month (NIAM) in August.

"Immunization is one of the most effective and cost-effective ways to prevent serious infectious diseases," said Dr. Walter Orenstein, director of the CDC's National Immunization Program, at the press conference. "Each year, immunization prevents about 10.5 million cases and 33,000 deaths. In cost savings terms, we save about $10.5 billion in direct medical care costs and, if you think about societal savings, $42 billion."

Experts now recommend that children be vaccinated against 11 diseases. Since vaccines for these 11 diseases were introduced, the incidence of eight of them have been reduced by at least 94 percent, Orenstein added.

The National Immunization Survey really consists of 78 independent surveys covering all 50 states and 28 major urban areas. The findings cover children 19 to 35 months old (as of 2002).

Almost 41 percent of children received at least three doses of pneumococcal conjugate vaccine, which is being reported for the first time. Also reported for the first time is the immunization series known as 4:3:1:3:3:1, which includes four doses of the diphtheria-tetanus-pertussis (whooping cough) combination , three doses of polio vaccine, one of measles, three of haemophilius influenzae type B (a guard against childhood meningitis), three of hepatitis B, and one dose of varicella (chicken pox) vaccine. Coverage increased from 54.1 percent in 2000 to 61.3 percent in 2001 and 65.5 percent in 2002.

If you take out the one dose of varicella vaccine, the coverage ranged from 86.2 percent in Massachusetts to 62.7 percent in Colorado. New England states historically have had high rates of vaccination.

Santa Clara County, Calif., was the urban area with the highest rate of coverage (79.3 percent) while Newark, N.J., had the lowest rate (57.5 percent). Nationally, chicken pox vaccine coverage increased from 76.3 percent in 2001 to 80.6 percent in 2002. The coverage is steady for all other vaccines.

"Our goal in immunization is to get homogeneity because we don't want to have any area to be at more risk not only for its own protection but also to serve as a reservoir," Orenstein said.

"By the age of 35 months, there are still tens of thousands of children in the U.S. at risk of acquiring potentially life-threatening but preventable diseases," says David Neumann, executive director of the National Partnership for Immunization. "Nearly 4 million babies are born each year in the U.S. If 10 percent were unimmunized, we're adding 400,000 susceptible individuals to our population each year; 25 percent totals 1 million." That doesn't even begin to count people in higher age brackets. In a typical flu season, Neumann points out, 36,000 Americans die, and many of these deaths could have been prevented by more extensive use of the influenza vaccine.

At issue is the concept of "community immunity," or what used to be known as "herd immunity." The idea is to immunize as many people as possible in a community so as to lessen the chance that someone whose immunity has worn off (or in whom the vaccine never worked) will get sick.

"Some of us don't take to a vaccine, or immunity wanes over time," explained Lynn Frank, chief of public health services for the Montgomery County Department of Health and Human Services in Maryland. "If a whole community is protected, then there would be a strong community of immunity that would have protected everyone."

"The choice not to immunize is not just a choice that affects your life, it's a choice that affects the whole community," said Mary-Clayton Enderlein, of PKIDS Parents for Prevention Program. "Your child can get sick, but think about all the other people that can also get the disease -- pregnant women, older people. Pertussis is inconvenient as an adult, but to an infant it can be deadly."

Enderlein had contracted whooping cough from an unimmunized child and passed it on to her newborn son the first time she kissed him. Although Enderlein's son survived, he was ill for the first few months of his life.

When the National Partnership for Immunization conducted a recent survey, it found that 15 percent of adults did not believe that vaccines are necessary to prevent certain diseases. Most of those people were between 25 and 45 years of age, unmarried, less likely to have a college degree, and more likely to have annual household incomes of less than $50,000 than the general population.

Of those respondents who were suspicious of the value of vaccines, 64 percent felt it was difficult to find trustworthy information. Others cited concerns with safety and effectiveness.

More information

Fore more information, try the CDC's National Immunization Program or the National Partnership for Immunization.

SOURCES: News teleconference with David A. Neumann, Ph.D., executive director, National Partnership for Immunization; Walter Orenstein, M.D., director, National Immunization Program, Centers for Disease Control and Prevention; Lynn Frank, chief, Public Health Services, Montgomery County, Md., Department of Health and Human Services; Mary-Clayton Enderlein, PKIDS Parents for Prevention Program
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