Implementation of the Immunization Policy (S94-26)

Prevention of disease through immunization always has been a priority for pediatricians and a major goal of comprehensive pediatric health care. Before 1994, the recommendation of the American Academy of Pediatrics (AAP) was that children should be completely immunized against diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b disease, measles, mumps, and rubella. Universal hepatitis B immunization of all infants and adolescents was recommended in the 1994 Red Book,1 adding a ninth disease to the previous list. Only those children with specific contraindications to one or more of the immunizations should be excluded. Childhood immunizations, per the AAP recommended schedule, must continue to be an essential component of continuous, comprehensive child health care. Furthermore, a child's immunization status warrants evaluation at every health care visit. In recent years, inadequate immunization rates attributed to multiple causes have indicated that the Academy's original immunization policy (1977) calling for universal immunization of all children has not been fulfilled. From data collected in the National Health Interview Survey in 1993 and 1994, the Centers for Disease Control and Prevention (CDC)2 currently estimates that only about two thirds of 2-year-old children in the United States have received all appropriate immunizations. Vaccine coverage levels include the following ranges: 67% coverage for four doses of diphtheria, tetanus, and pertussis (DPT) vaccine; 76% for three doses of oral polio vaccine (OPV); 90% for one dose of measles, mumps, and rubella vaccine (MMR), and 71% for age-appropriate doses of H influenzae type b vaccine. Recent outbreaks of measles, particularly in preschool children but also in adolescents and young adults, attest to inadequate protection and demonstrate a continuing need for surveillance and modification of current immunization recommendations.