example, data collected in fall 2000 on 5-year-old kindergarten entrants reflect coverage 3 years ago, when these children were age 2 (information provided by CDC).

Such conditions include the following: the records were transferred to another provider; the chart indicates that the child has moved or gone elsewhere; a mailed reminder card was returned without another local forwarding address; and the chart indicates that the parent says the child is seeing another provider, or that a home or telephone visit revealed the child was seeing another provider.

Examples cited are based on personal communication with providers in the New York inner-city area.

The New York City Department of Health provides such separate reports.

What constitutes a “fully functional registry” has been discussed and debated. Both NVAC and Wood et al. (1999:232) define a fully functional registry as one that tracks more than 95 percent of children under age 2 in the specified catchment area and provides an electronic immunization record that is accessible to providers. The Robert Wood Johnson Foundation (RWJF) considers a fully functional registry as one that includes all children in a given catchment area, with information about all doses of all vaccines delivered by all providers (NVAC, 1999b:16).

The items were derived from a conceptual definition prepared by the Cecil G.Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, which served as the national evaluation office for the All Kids Count initiative. RWJF also established a national program office for the initiative at the Task Force for Child Survival at the Carter Center in Atlanta, Georgia.

Duplicate records are included in these statistics, causing some states to show more than 100 percent of their children enrolled in the state registry.

The CDC survey defined public providers as “facilities operated partially or wholly with public funds (e.g., county public health clinics, community/migrant health centers, Indian Health Services, etc.) and/or the individual practitioners providing immunizations in such facilities.” Private providers are defined as “health care facilities or practices operated solely with private funds and/or the individual practitioners providing immunizations in such facilities.”

For the purposes of the CDC survey, enrollment was defined as “providers who have authorized access to the registry (e.g., written agreement, passwords, rights and responsibilities defined)” (information provided by CDC). Participation entails actually having submitted data to a registry in the last 6 months.

The percentage breakdown of vaccines claimed to cause adverse events is as follows:

The TFCPS report includes only three strategies (increasing community demand for vaccination, enhancing access to vaccination services, and implementing provider-based interventions). Reducing out-of-pocket costs is described in the report as one of six interventions under the strategy of enhancing access to vaccination services. Given the importance of finance approaches in the present study, out-of-pocket cost intervention is categorized as a fourth strategy in this discussion.

It is possible that immunization records for these children were not available, contributing to a lower reporting rate than actually was the case.