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SERIOUS GAPS IN CHILDHOOD IMMUNIZATION.

Two studies in a special issue of JAMA devoted to vaccines report serious gaps between recommended and actual immunization of U.S. infants.

The first study analyzed follow-up data for 7035 infants from the 1988 National Maternal and Infant Health Survey. All infants were at least eight months old and living with their mothers; roughly half were white and half black. Only 46 percent of white infants and 34 percent of blacks had received adequate immunization by eight months of age. Children living in poverty were at high risk for inadequate immunization and an inadequate number of well-baby visits.

The second study interviewed mothers of healthy full-term newborns shortly after the birth and 9 to 12 months later at a large municipal teaching hospital. Most patients (86 percent) were insured by Medicaid. Despite the availability of free vaccine to most patients, only 29 percent of infants had up-to-date vaccinations at 7 months, including just 23 percent of infants from poor families. Poverty, unmarried status, and inadequate prenatal care all independently predicted incomplete immunization. Infants who lived with their grandmothers were almost twice as likely as those who did not to have complete immunizations. Comment: Both studies show that in some socioeconomic groups in the U.S., the majority of infants do not receive adequate vaccination. Because there seem to be barriers other than lack of health insurance, efforts to improve vaccination coverage should seek to remove nonfiscal barriers to care.

— TH Lee

Published in Journal Watch General Medicine October 25, 1994

Citation(s):

Bates AS et al. Risk factors for underimmunization in poor urban infants. JAMA 1994 Oct 12 272 1105-1110.

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Mustin HD et al. infants born in 1988. JAMA 1994 Oct 12 272 1111-1115.

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