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Vaccine Effort to Target Adolescents, Older Minorities

Officials call teens the 'orphans' of immunization program

WEDNESDAY, July 31, 2002 (HealthDayNews) -- American adolescents continue to be the "orphans" of the country's immunization infrastructure, having coverage rates for many shots well below what health officials would like.

Dr. Bonnie Word of the National Medical Association said 35 million adolescents aren't fully immunized, putting them at risk of potentially serious infection.

"The primary focus is always directed at young children," said Word, who lamented the lack of good data for vaccine coverage of older children at a Washington, D.C., press conference today to launch National Immunization Awareness Month.

Of particular worry, Word added, were boosters for tetanus and diphtheria, as well as final doses against hepatitis B and the triple inoculation against measles, mumps and rubella. Rates for these vaccinations among children between the ages of 11 and 13 remain far below even 2000 goals.

Because coverage today for young children is at an all-time high, officials said some of these gaps should close as the current generation of toddlers grows up. However, adherence to tetanus and diphtheria booster recommendations isn't a generational issue and demands vigilance.

Word said state school systems need uniform requirements for inoculations of young teens. And she called on doctors to be more aggressive about checking the immunization status of these children at sick-patient and sports-physical visits -- and then topping them off if needed.

Also today, the government announced an initiative to boost flu and pneumonia vaccine rates among older minorities, especially blacks and Hispanics, who frequently lag far behind their whites peers. Each year, flu claims 18,000 lives among the elderly, and pneumonia kills another 12,000.

"We are not doing as well as we should be doing" at preventing these deaths, particularly among racial minorities, said Claude Allen, deputy secretary of health and human services, in announcing the program.

While two-thirds of whites age 65 and up said in 2000 that they got the flu vaccine, only 48 percent of blacks and 56 percent of Hispanics reported doing so. For the pneumococcal vaccine, which prevents pneumonia, 57 percent of elderly whites reported getting the shot that year, compared with about 30 percent for the two minority groups.

To shrink these differences, Allen's agency is funding two-year demonstration projects in five areas -- Milwaukee, San Antonio, Chicago, Rochester, N.Y., and Mississippi -- targeting older minorities. If the pilot programs succeed, Allen said, the government will try to expand them nationwide.

Officials were more optimistic about childhood vaccine coverage, which for nearly all early inoculations is at or above 90 percent. Preliminary numbers for 2001 show no gains in these rates except for the chicken pox, or varicella, vaccine, which is now at 76 percent. That's triple the 1997 figure.

Racial disparities in immunization rates continue to exist among young children, officials said, but they're much smaller than those for older adults. For measles, mumps, and rubella, whites and blacks are only 3 percentage points apart. And for other shots, the gap is even slimmer.

Still, Dr. Walter Orenstein, assistant Surgeon General and director of the Centers for Disease Control and Prevention's National Immunization Program, said pockets of unevenness persist, especially in states in the West and Midwest. These areas tend to have lower coverage for children than the east and southeast.

By the time their immunization schedule is complete, children receive 16 to 20 shots to prevent 11 diseases by age 2, plus another four during their teens. Parents "don't understand how much it takes" to meet that standard, which may help explain why full coverage isn't even more common, he said.

Orenstein said the government and doctors need to do more to ratchet up vaccination rates.

On a reassuring note, Orenstein said shortages that bedeviled five vaccines covering eight infections are now effectively over.

The only shot still in low supply is pneumococcal conjugate, which guards against meningitis, pneumonia, ear infections and sinusitis. Orenstein said supplies will probably remain low through the end of the year.

What To Do

For more on vaccinations, try the National Immunization Program or the National Coalition for Adult Immunization.

SOURCES: July 31, 2002, National Partnership for Immunization teleconference with Bonnie Word, M.D., National Medical Association; Walter Orenstein, M.D., Assistant Surgeon General, and director, National Immunization Program, Centers for Disease Control and Prevention; Claude Allen, deputy secretary, U.S. Department of Health and Human Services
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