Samuel Katz provided an overview of the tremendous impact of vaccines on the infectious disease burden in the United States (Table 1), while Gillian Stoltman drew attention to state-level effects in Michigan (Figure 2 ). The reduced burden of illness represents significant improvements in both mortality rates and the quality of life in each community, as well as cost savings for local and state health agencies, since public hospitals no longer need to care for patients affected by vaccine-preventable disease. Workshop participants noted that achieving high levels of immunization coverage not only offers immediate protection of vaccinated individuals but also conveys long-term benefits by reducing the reservoir of disease and hence the number of future cases in the general population.

The nation is fortunate that the renewed attention to early childhood immunization following the 1989–1991 measles outbreak has helped achieve historically high levels of vaccine-preventable childhood diseases. Despite best efforts, however, the nation as a whole and most individual states did not reach the national health goals of 90 percent coverage rates for recommended childhood vaccines by the year 2000 (Table 2). Workshop participants emphasized, however, that as long as infectious disease reservoirs remain, children who have not been adequately vaccinated are still at risk. They also commented that lack of familiarity with the seriousness of vaccine-preventable diseases and the increasing prominence of concerns about the safety of some vaccines may contribute to delays in vaccination. As reported in Calling the Shots, about 300 children die each

TABLE 1 Comparison of 20th-Century Maximum (Year) and Current Morbidity of Vaccine-Preventable Diseases

Disease

Maximum Cases (Year)

2000 Provisional

% Decrease

Smallpox

48,164 (est.)

0

100.00

Diphtheria

206,939 (1921)

1

100.00

Measles

894,134 (1941)

86

99.98

Mumps

152,209 (1968)

338

99.80

Pertussis

265,269 (1934)

7,867

95.50

Polio (paralytic)

21,269 (1952)

0

100.00

Rubella

57,686 (1969)

176

99.60

Congenital rubella syndrome

20,000 (1964-65)

9

98.90

Tetanus

1,560 (1923)

35

97.30

Haemophilus influenzae

 

Type B and unknown

 

(< 5 years)

20,000 (est.)

167

99.20

SOURCE: CDC (2001a).



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