• A Chicago study found coverage rates of 36 percent for African American children in general and 29 percent for African American children in public housing, as compared with the NIS estimate of 59 percent coverage for children countywide (Kenyon et al., 1998).

Although the objective that 60 percent of elderly Americans receive an influenza immunization has been met, problems in adult coverage rates persist, especially for chronically ill working-age adults who are at high risk for complications from influenza and pneumococcal disease. Many have argued that a 60 percent influenza coverage rate is too low, and the national goal has been raised to 90 percent for 2010 (Department of Health and Human Services, 2000). Pneumococcal immunization levels for the elderly are particularly low. Nationally, only 42 percent of noninstitutionalized adults over age 65 had ever received a pneumococcal vaccination by 1997 (National Center for Health Statistics, 1997). Just 17 states had achieved pneumococcal immunization rates of 50 percent or greater among elderly persons by 1997 (information provided by CDC). In addition, noninstitutionalized high-risk adults aged 18 to 64 have extremely low immunization rates. Data from the 1997 National Health Interview Survey show that only 26 percent of this group had received an influenza vaccination, and just 13 percent had received a pneumococcal vaccination (National Center for Health Statistics, 1997). Data on national coverage rates for adult immunizations other than influenza and pneumococcal are severely limited.

While the generally low adult immunization coverage levels are disconcerting, disparities in the immunization rates among ethnic populations represent an even more serious situation. In 1997, 66 percent of white adults aged 65 and over received an influenza vaccination, compared with 45 percent of black and 53 percent of Hispanic adults in the same age group (National Center for Health Statistics, 1997). The trend is similar for pneumococcal immunizations. As of 1997, 46 percent of elderly whites had received a one-time pneumococcal vaccination, but only 22 percent of elderly blacks and 23 percent of elderly Hispanics. These disparities result in communities at heightened risk for outbreaks of influenza and pneumococcal disease, in addition to other VPDs. Among persons aged 65 and over, influenza and pneumococcal disease were the fifth leading cause of death for African Americans and Hispanics as well as non-Hispanic whites. Reductions in these deaths are hindered by rela-