TABLE 1–1 Comparison of 20th-century Baseline and Current Morbidity, Vaccine-Preventable Diseases

Disease

20th Century

1999 Provisional

Percent Decrease

Smallpox

48,164

0

100.0

Diphtheria

175,885

1

100.0

Measles

503,282

86

100.0

Mumps

152,209

352

99.8

Pertussis

147,271

6,031

95.9

Polio (paralytic)

16,316

0

100.0

Rubella

47,745

238

99.5

Congenital Rubella Syndrome

823

8

99.0

Tetanus

1,314

33

97.5

Haemophilus influenzae

Type b and unknown

(<5 years)

20,000

146

99.2

 

SOURCES: CDC, 1999a; Cochi et al., 1985.

integration of immunization services (including vaccine purchase and delivery) within private and public systems of personal health care services; and (3) the development of a public health infrastructure that can monitor disease patterns and improve immunization coverage rates, especially among vulnerable populations. The combination of these three strategies has resulted in unprecedented high levels of vaccination coverage for a growing number of vaccines for both children and adults within the United States (see Table 1–2). The U.S. immunization system has also demonstrated an ability to achieve high immunization coverage levels among all age groups, across economic and social class lines, and spanning all racial and ethnic populations (CDC, 1998a). To sustain this success is difficult, however, requiring constant vigilance to detect signs of erosion and decline in coverage rates among vulnerable populations.

Costs of Achieving Current Levels of Immunization Coverage

Enormous effort is required within the U.S. health care system to maintain high levels of immunization coverage for a growing number of vaccines and among various age groups. The effort is especially challenging since a new birth cohort of 11,000 infants born each day requires attention within the routine immunization schedule. The first 2 years of life is perhaps the most vulnerable period for transmission of infectious diseases; thus it is crucial that this population be brought up to date as quickly as possible with regard to immunization status. Indeed, immuni-



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