By Phyllis Griffin Epps

Houston, home to a concentration of medical knowledge and talent unparalleled in the world, ranks last among the nation’s urban areas in rates of toddler immunizations. A report issued in March 1999 showed that Houston bucks the national trend toward increasing rates of immunization coverage. Only 61% of Houston’s young children are adequately immunized, compared to rates of 92% and 79% in Boston and New York, respectively. Houston’s current rates mark a decline from peak coverage levels of 73% in 1994.

Houston-area practitioners, administrators, and policymakers convened on February 10, 2000, to develop strategies to increase immunization rates. The meeting, "Houston, We Have A Problem: Our Children Are Under-Immunized," was sponsored by the Houston Area Immunizations Coalition, Houston Department of Health and Human Services, Episcopal Health Charities, and Merck Vaccine Division.

Attendees identified numerous factors behind the poor immunization rates, including the following

• Complexity of the vaccination schedule. The American Academy of Pediatrics recommends immunization against 11 diseases at several different intervals over 16 years. Parents have difficulty adhering to the schedule without help from the practitioner or provider.
• Absence of reliable and accessible recordkeeping. Adherence to the recommended vaccination schedule requires documentation or knowledge of the child’s history of vaccination. Correct, timely immunization is thwarted by the rate at which families change residences, jobs, and health care providers. The current system often results in incomplete records, duplication of vaccinations and missed opportunities of receive vaccinations.
• Misinformation regarding vaccine safety. A significant number of parents choose not to immunize their children due to fears about the safety of the vaccination. Adverse side effects do occur, but only rarely. The greater danger lies in failing to control the resurgence of diseases through widespread immunization.

• Statewide immunization registry – An immunization registry is a database intended to centralize recordkeeping and thereby increase vaccination coverage. A child’s history of vaccination and other information are confidential but accessible via the Internet by health care providers for the purpose of determining the proper administration of vaccines. In some states, the registries have facilitated mailings to parents to remind them when the next vaccination is due. ImmTrac http://www.tdh.state.tx.us/immunize/faq2list.htm is the statewide childhood immunization-tracking system developed by the Texas Department of Health and Electronic Data Systems (EDS). The Texas Department of Health has also funded the Dr. Celine Hanson/Texas Children’s Hospital Immunization Project to develop a childhood immunization registry for Houston and Harris County. http://imreg.tch.tmc.edu/about.htm The development of the local registry is the direct result of the state’s determination of a need to address gaps in coverage for reasons unique to the city and county. The local registry, scheduled to begin in May 2000, will be linked to the state registry.
• Partnerships between the public and private sector – The private sector can play an important role in educating the general public about the importance of proper immunization. Large employers must accept a responsibility to emphasize immunization as a priority among employees and to stress the importance of immunization as a factor in negotiating contracts with health care providers. In one city, the local utility company included leaflets intended to educate and remind adults about immunizing the children in their lives. Detroit, ranked lowest in the nation seven years ago but now enjoying a childhood immunization coverage rate of 75%, benefited from coalitions on four levels: (1) senior-level corporate representatives helped gather information about public attitudes and other factors; (2) public and private health systems focused on education initiatives; (3) in the hospital community, research coalitions funded in part by the Centers for Disease Control and Prevention helped track and analyze the success of attempts to improve rates; and (4) vaccine manufactures joined with public health officials and private health care providers to create a "tool kit" for use by clinicians intended to simplify the actual vaccination process.

03/07/00