Childhood Vaccination Rates High, but Measles Re-emerging

Donya Currie

Nations Health. 2008;38(9) 

Although vaccination rates for children are at an all-time high in the United States, measles cases are at the highest level in more than a decade, with nearly half of U.S. measles cases among children whose parents rejected vaccination.

Childhood immunization rates remain at or near record levels, according to the Centers for Disease Control and Prevention, with at least 90 percent coverage for all but one of the individual vaccines in the recommended series for young children. More than 77 percent of children were fully vaccinated in 2007. There were no differences in coverage among any racial or ethnic group for the recommended series of vaccines, and fewer than 1 percent of U.S. children had received no vaccine by age 19 months to 35 months in 2007, according to the Sept. 5 issue of Morbidity and Mortality Weekly Report.

"The ongoing success of our nation's immunization program is largely dependent on the trust that parents put in the safety of vaccines and in those caregivers who administer them," said CDC Director Julie Gerberding, MD, MPH. "I want to encourage parents to continue to be informed and to ask their pediatricians about the safety of vaccines or any other concerns they may have about their child's health."

Distrust of the safety of vaccines has led some parents to choose to skip some or all childhood immunizations, and federal health officials said those decisions have led to a spike in U.S. measles cases. Sporadic importations of measles into the country have been reported since the disease was declared eliminated from the United States in 2000, according to a study in the Aug. 22 MMWR. From Jan. 1–July 31, 2008, 131 measles cases were reported to CDC from 15 states and the District of Columbia — the highest number of cases since 1996. Among those 131 cases, just 17 were imported, which is the lowest percentage of imported measles cases since 1996, according to the study.

The majority of the 131 measles patients were younger than 20, and 112 were unvaccinated or had an unknown vaccination status. Of those 112 patients, 95 were eligible for vaccination, and 66 percent of those were unvaccinated because of parents' philosophical or religious beliefs.

The study's authors said the increase in unvaccinated children who develop measles "is a concern and might herald a larger increase in measles morbidity, especially in communities with many unvaccinated residents."

"Measles can be a severe, life-threatening illness," said Anne Schuchat, MD, director of the National Center for Immunization and Respiratory Diseases. "These cases and outbreaks serve as a reminder that measles can and still does occur in the United States."

Nationally, the recommended vaccine series consists of four doses of the diphtheria, tetanus and pertussis vaccine, three doses of polio vaccine, one or more doses of measles, mumps and rubella vaccine, three doses of Haemophilus influenza type B vaccine, three doses of hepatitis B vaccine and one or more doses of varicella, or chickenpox, vaccine. The series typically begins shortly after birth and continues through age 2.

The only vaccine in the recommended series that has not reached 90 percent coverage, according to the recent National Immunization Survey, was the vaccine for diphtheria, tetanus and pertussis, which reached 84.5 percent in 2007. That marked the first year there was 90 percent coverage for varicella vaccine and for the third dose of polio vaccine.

Varicella and pneumococcal conjugate vaccine coverage among American Indian and Alaska Native children increased from 85.4 percent in 2006 to 94.9 percent in 2007, and coverage with the fourth dose of pneumococcal conjugate vaccine increased from 62.7 percent to 80.4 percent.

"Because our nation has been so successful in reducing and eliminating vaccine preventable diseases, it is easy to take the benefits of immunizations for granted," Schuchat said. "However, recent cases and outbreaks of measles in our country have been a sobering reminder that we must not let our guard down."

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