Keep childhood immunization rates high

Promote registries, address barriers for best results

The immunization coverage for young children in the United States has never been higher. In fact, coverage is greater than 90% for every recommended vaccine, says Lance Rodewald, MD, director of the Immunization Services division of the Centers for Disease Control and Prevention (CDC) National Immunization Program (NIP) in Atlanta. But vigilance is still required, Rodewald says, because a 1,000 babies are born every day, and each will need a series of vaccines by age 2.

While the word has gotten out about the need for vaccines, there are still many deterrents, warns Amy Pisani, MS, executive director of Every Child by Two in Washington, DC.

A shortage of some vaccines, such as the pneumococcal conjugate, could cause parents to lose confidence in the vaccine program, Pisani says. When there is a shortage and private health care providers are unable to get vaccines, they often send their patients to the public health department. This extra trip could be a deterrent for some.

"One of the reasons the rates have been so high is that children are getting all their care in one place now. Parents don’t have to take their children to the doctor’s office for the [well-baby] visit, and the public health department for immunizations," says Pisani. Ten years ago 70% of vaccines were given at the public health department and now 70% are given in private practice, she says.

In addition, obtaining vaccines at different sites makes tracking more difficult. About 21% of children 19 to 35 months old receive one extra dose of vaccine because tracking is so poor, says Pisani. This costs the American public $15 million per year. But computerized immunization registries make tracking much easier and far more efficient. They can help a provider assess which immunizations a child needs and automatically generate reminder cards when vaccines are due.

Participation in registries has a dramatic impact on coverage rates, says Rodewald. Yet it is estimated that only about 20% of providers use these registries.

To boost providers’ participation in registries, the Everybody Counts Immunization Coalition in Savannah, GA, provides an incentive. Each year it holds a birthday party with games and door prizes for 2-year-olds who are fully immunized. The invitation list is compiled from the All Kids Count immunization registry, says Marianne Pappas, coalition coordinator. Parents are told that, if they didn’t get an invitation, their children are either not up to date or their physician is not in the registry, in which case, they should contact the physician’s office and ask him or her to join.

Another hindrance to keeping immunization rates high among children is the cost of vaccines. "It costs about $500 to fully vaccinate a child through school entry and, when parents are faced with having to pay for the cost, their child’s immunization coverage is lower," says Rodewald.

The Vaccines for Children government program helps by providing vaccines free of charge to children who are eligible for Medicaid, are uninsured or underinsured, and are of American Indian or Alaska native descent.

The Shots for Tots program which was initiated by the Douglas County Immunization Coalition in Oregon removed the cost barrier by partnering with the local Rotary club, the state health department, and several charities to provide the vaccines for free, says Lynne Weaver, immunization outreach coordinator for Douglas County. "We wanted people to be able to walk through the door no matter what their income level was, no matter what their situation was, and be able to get their kids [immunized]," says Weaver.


For more information about how to keep child immunization rates up, contact:

  • Marianne Pappas, Coordinator, Everybody Counts Immunization Coalition, Chatham County Health Department, 2011 Eisenhower Road, Savannah, GA 31406. Telephone: (912) 356-2679. E-mail:
  • Amy Pisani, MS, Executive Director, Every Child By Two, 666 11th St. N.W., Suite 202, Washington DC 2001. Telephone: (202) 783-7034. Web site:
  • Lance Rodewald, MD, Director of Immunization Services, National Immunization Program, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333. Telephone: (404) 639-3311. Web site:
  • Lynne Weaver, Immunization Outreach Coordinator, Douglas County, OR. Telephone: (541) 672-6631.