need for immunization, and improve measurement of immunization levels. States and some major cities are receiving additional federal funds from the Centers for Disease Control and Prevention (CDC) to support Immunization Action Plans that should improve the systematic delivery of immunization services. Legislation before Congress proposes the development of state-based immunization registries. Among the activities in the private sector, national organizations are promoting community-level efforts to improve immunization services, and vaccine companies have started pilot projects to improve the availability of vaccines to Medicaid-eligible children.

In 1990, the U.S. Public Health Service, in Healthy People 2000, set a national objective for the year 2000 that 90 percent of 2-year-olds complete the basic immunization series against the major preventable childhood illnesses (USDHHS, 1991). Under the President's Childhood Immunization Initiative, a 90-percent immunization target has now been set for 1996 (Table 1-1).1 This target presents a formidable challenge that requires an urgent response. The children who will need to be immunized by 1996 are already being born. The question must not be whether better immunization rates can be attained but how to attain them.

Reaching and sustaining a commitment to universal and systematic delivery of immunization services to preschool children will require addressing many problems: for example, costs of vaccine and of delivery of services, the inaccessibility of services, complexities of the immunization schedule, missed opportunities for immunization at health care visits, incomplete information about children's immunization status, apprehensions about the safety of vaccines, and lack of appreciation for the risks of vaccine-preventable diseases. Families, health care providers, communities, and states also face larger social, economic, and political challenges that affect their ability to respond to the specific problems of immunization.


The immunization schedule recommended by the Advisory Committee on Immunization Practices and the American Academy of Pediatrics calls for children to receive by 2 years of age four doses of diphtheria-tetanus-pertussis (DTP) vaccine, three doses of oral polio vaccine, one dose of measles-mumps-rubella vaccine, three to four doses of Haemophilus influenzae type b vaccine, and three doses of hepatitis B vaccine. For the 1996 immunization target, assessment of DTP coverage will be based on the proportion of 2-year-olds who have received at least three doses of DTP vaccine. Recent CDC reports (e.g., CDC, 1994a) also use this reference point. Coverage rates based on three doses of DTP vaccine will be higher than rates based on four doses.

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