N.a., not available.

NOTE: Beginning in 1976 the category "don't know" was added to response categories. Prior to 1976 the lack of this option resulted in some forced positive answers, particularly for vaccinations requiring multiple-dose schedules, that is, polio and DPT.

a Diphtheria-pertussis-tetanus.

b Three doses or more.

c The data in this panel are based only on 35 percent of white respondents and 19 percent of all other respondents who consulted records for some or all vaccination questions. One month prior to the interview, all sampled households were asked to check vaccination records, such as those from a private physician, health department, or military.

SOURCE: Unpublished data from the U.S. Immunization Survey, conducted by the Centers for Disease Control, Center for Prevention Services, Division of Immunization.

3 years old or younger exceeded 95 percent. The same success rate was achieved by France, West Germany, and the Netherlands with the DPT vaccine (Williams, 1990). The DHHS in its Health Objectives for the Year 2000 (U.S. Public Health Service, 1991) adopted a goal of immunization for 90 percent of U.S. preschoolers.

Immunization levels for children between the ages of 5 and 6 are significantly higher than those for preschoolers. The reason is that laws in every state require up-to-date vaccinations as a prerequisite to school entry. Provisional data for the 1989–1990 school year indicate that at least 97 percent of students in kindergarten through first grade had received a full course of DPT, polio, and measles-mumps-rubella vaccines (Hinman, 1991). The rates for younger children enrolled in day care centers (95 percent for all vaccines) and Head Start programs (between 94 and 97 percent for all vaccines) were slightly lower. For school-age children and children in day care who must meet the vaccination requirements, the DHHS's Year 2000 Health Objective of at least 95 percent coverage for the basic immunization series has been achieved.

A major barrier to vaccination is financial in that private-sector administration of vaccines currently costs about $300 ($200 for vaccines and $100 for physician visits) before children can enter school. Public-sector prices for the vaccines are approximately $90 (Hinman, 1991). Because parents generally are not charged the full cost of the vaccines, federal support and state willingness to appropriate funds for vaccination have been the deciding factors in whether health departments and nonprofit agencies can vaccinate all those needing the service.

A 1986 survey of health care accessibility found that children of the poor and the near poor were 50 percent more likely than those of higher-income groups not to have up-to-date immunizations. The survey found



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