. "Challenges Facing the Immunization System." Setting the Course: A Strategic Vision for Immunization Finance -- Part 1: Summary of the Chicago Workshop. Washington, DC: The National Academies Press, 2002.
year from these potentially preventable diseases or their complications. And the burden of mortality and morbidity in the adult population is significantly greater, as will be discussed later.
Participants indicated that immunization coverage rates for children in urban areas such as Chicago and Detroit tend to be lower than state averages—and lower still in some disadvantaged neighborhoods in those cities. A disturbing decline in immunization rates is evident in both Chicago and Detroit (see Table 3). In Chicago, coverage was at 74 percent in 1996 but dropped to 59 percent in 2000. In Detroit, reported coverage levels peaked at 70 percent in 1998 but dropped to 59 percent in 1999 before increasing to 62 percent in 2000. More extensive international travel was cited as posing known risks of importing disease that can spread among unprotected children in such communities. Children in families of undocumented immigrants may be at special risk and pose an added risk to the community if they are underimmunized and their families are apprehensive about using health care services.
William Schaffner from Vanderbilt University contrasted the relative success in preventing disease in children with adults’ continued high rates of illness and death related to vaccine-preventable diseases, including influenza, pneumococcal disease, and hepatitis B. He estimated that