gies to improve immunization coverage. A follow-up survey, planned for 2002, will assess the effectiveness of these interventions.

Adult Immunization

In contrast to the multiple programs designed to improve pediatric immunization rates, relatively few systematic efforts exist to address low adult immunization levels. In addition to the limited use of Section 317 funds to purchase vaccine for adults and the limited insurance coverage for adult immunization (noted above), the workshop discussions pointed to other factors that contribute to undesirably low rates of adult immunization. For example, adults often receive care from a variety of specialists (e.g., cardiologists, obstetricians-gynecologists) who may not attend to primary care concerns and who are generally less familiar with immunization issues and vaccine recommendations than are pediatricians and others who care for children. Some providers may lack adequate information about the seriousness of vaccine-preventable diseases in adults and the efficacy of the vaccines. The education of physicians and others who care for adults about the value of immunization is important because appropriate advice from health care providers improves immunization rates. Also highlighted was the growing contribution to adult immunization of services offered at nontraditional sites, such as pharmacies, super-markets, and workplaces.

CONDUCTING SURVEILLANCE OF IMMUNIZATION COVERAGE AND VACCINE SAFETY

Many of the workshop presentations emphasized the importance of surveillance programs as an important part of efforts to improve immunization rates, but such programs require adequate resources for imple-mentation and ongoing support. The Englewood study in Chicago, for example, demonstrated the value of having highly specific local data to identify problems and to stimulate a response. The city now needs ways to identify other neighborhoods with low immunization rates. The CDC survey conducted in the Englewood District is too expensive and labor intensive for routine use, so clinic assessments or reviews of immunization histories in school records or selected private practices may be more practical approaches unless training local interviewers can be demonstrated as a feasible alternative.

Immunization registries have the potential to provide local data without requiring special surveys, but they require extensive collaboration between public and private health care sectors to implement and sustain the exchange of immunization data within a designated community. If



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