better information about their actual performance and tools that can help them monitor their immunization practices.

Providers will benefit from more information about new vaccines and changes in the immunization schedule. Academic health centers and other sources of professional training can ensure that the content of their curricula is consistent with current guidelines. CDC and professional organizations can develop materials that help providers learn about and implement practices consistent with the Standards for Pediatric Immunization Practices (CDC, 1993b).

Informing Families and the Community

More and better efforts should be made to inform families and communities about the importance of immunization and to encourage them to have children immunized appropriately—by 2 years of age rather than when they start school. Individual providers, office and clinic staff, community groups, and public health officials should be able to deliver accurate and effective messages. To have a long-term impact, public information programs must be sustainable and sustained. Strong community support and culturally appropriate messages and materials are essential for both education and outreach efforts.

Families' fears and the small but real risks of adverse reactions to vaccines must be acknowledged, but more can be done to communicate the benefits of immunization, particularly in CDC's Vaccine Information Pamphlets. Providers and health educators also may benefit from better risk communication skills and resources. Immunization successes, such as the recent dramatic reduction in meningitis after the introduction of Haemophilus influenzae type b (Hib) vaccines, should be publicized more extensively.

Information Resources

Information is fundamental to all of the immunization issues discussed in this report, and, in general, better information and better information systems are needed. Activities on two fronts will help. New CDC-sponsored telephone surveys will begin producing data on immunization levels for states and major urban areas by the end of 1994. Immunization registries and tracking systems under development in states and communities across the country also will become important information resources. Health maintenance organizations and individual practices are implementing tracking systems as well. Tracking systems allow children and their families to benefit from individualized outreach and follow-up. They help providers more easily identify children who are due for immunizations and assess their own compliance with immunization



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