LOW IMMUNIZATION RATES AMONG SOME CITY CHILDREN RAISE CONCERN

Despite widespread access to medical care, only about half of
Baltimore's inner-city children are fully vaccinated by the
time they reach age 2, according to a School of Public Health
study published in the July issue of _Pediatrics_.
     The survey of immunization coverage and preventive health
care for inner-city preschool children in Baltimore was begun
in response to an outbreak of measles in Baltimore and other
urban areas in 1989 and 1990. The outbreak was attributed to
low rates of immunization.
     Principal investigator Bernard Guyer, professor and chair
of maternal and child health in the School of Public Health,
said the results of the study indicate the need for a more
responsive primary health care system.
     By age 3 months, almost 80 percent of the children
surveyed had made age-appropriate health visits, and 75 percent
had made similar visits between the ages of 12 and 17 months.
Yet the study found only 53 percent of the children had
received a measles-mumps-rubella vaccination, and 39 percent
had received the third in a series of four
diphtheria-tetanus-polio shots needed for complete
immunological coverage. Overall, the immunization rate for
2-year-olds in Baltimore's inner city was 54 percent.
     The low rates occurred even though the majority of the
children were taken for preventive health care, their treatment
is covered by Medicaid and their providers receive free vaccine
from public agencies. Similar low levels of coverage have been
observed for low-income children in inner-city areas of
Philadelphia and Los Angeles.
     Dr. Guyer called for a cooperative effort -- including
changes in how immunizations are administered -- between city
and state health departments, advocacy groups, providers and
parents to improve the nation's childhood immunization rates.
     Some changes have already been made. Earlier this year,
the Centers for Disease Control and Prevention and the American
Academy of Pediatrics recommended that doctors begin giving
children the measles-mumps-rubella vaccine at 12 months,
instead of 15.
     "This is important because we found that 18 percent of
children made a preventive health visit during this early
period, but did not return in time for their immunization," Dr.
Guyer said.
     Researchers based their findings on a random sample of 557
2-year-old children living in the inner city of Baltimore. Data
were collected from the children's medical records and through
interviews with parents and health care providers.