Texas faces challenges in its efforts to implement evidence-based strategies to improve and sustain immunization rates. For example, problems in staffing and training led the Dallas health department to discontinue its immunization activities through WIC. Also, health departments have limited resources to devote to assessments of immunization coverage in provider practices under the AFIX program. The immunization registries have great potential as a tool for improving immunization coverage rates and reducing the levels of overimmunization, but the usefulness of the Texas registry is reduced by the opt-in provision that results in the omission of children and by restricted access that prevents some immunization providers from checking immunization records or recording the immunizations that they have provided. Dr. Siegel suggested, however, that concerns about bioterrorism might add weight to efforts to modify the registry to improve its usefulness for monitoring immunizations and other health interventions for all children. There may also be a role for registries in addressing emergency preparedness, provided such registries are fully functional, can track mass vaccination campaigns, monitor potential adverse effects, and facilitate the delivery of vaccines that need to be administered under emergency conditions.

POTENTIAL FOR GREATER IMMUNIZATION BENEFITS FOR ADULTS

In discussions of immunization issues, attention often focuses on the youngest children and the delivery of the array of vaccines in the childhood immunization schedule. W. Paul Glezen, of the Baylor College of Medicine in Houston, focused instead on potential gains from improved rates of immunization against influenza, especially in high-risk adult populations. He also commented on the broader public health benefits that would result from a strong infrastructure for immunization programs.

Influenza remains an important source of vaccine-preventable illness and death, especially among elderly individuals (aged 65 and over). However, the disease also poses a risk for younger adults and children. Dr. Glezen noted that rates of hospitalization for influenza for children under age 5 are similar to those for the elderly population. Studies have shown that immunization against influenza not only reduces the incidence and severity of the disease but also saves money by reducing health care costs and lowering the amount of time lost from work (Nichol et al., 1994, 1995, 1999).

Official recommendations call for annual immunizations against influenza for high-risk children and younger adults, such as persons with chronic illnesses or pregnant women, but coverage rates are low. To help



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