CDC Focuses on Late-Vaccinated Toddlers
By LAURAN NEERGAARD
.c The Associated Press
WASHINGTON (AP) - Mary-Clayton Enderlein worried when a baby brought to her son's play date had a very distinctive cough - a high-pitched ``whoop'' while gasping for air. It might indeed be whooping cough, the baby's mother agreed, explaining that the family didn't believe in vaccines against that or any other disease.
A week later, a now-coughing Enderlein gave birth to her second son - and the newborn promptly sickened, too. Little Colin spent 10 days in intensive care in a Seattle hospital, turning blue as 50 coughs in a row would wrack his body. It took months for Enderlein, Colin and the playmate who infected them to all recover.
About 75 percent of the nation's toddlers get vaccinated on time, protecting them from getting - and spreading - nine different diseases.
But coverage varies widely among states and major cities, with pockets of the country where far too few youngsters are up-to-date on their shots, federal health officials warned Thursday as they urged communities to eliminate those disparities.
As Enderlein's scare shows, getting shots late or not at all doesn't just endanger the unvaccinated child. He or she in turn can spread disease to people with weakened immune systems like elderly grandparents, friends with cancer, pregnant neighbors or younger children - a reason that so-called community immunity is vital to public health.
Last year, Colorado had the most immunization laggards, with just 62.7 percent of toddlers getting all their shots, the Centers for Disease Control and Prevention said.
Nine other states have fewer than 70 percent on-time toddler vaccinations: Arizona, Idaho, Kansas, Louisiana, Montana, New Mexico, Oklahoma, Texas and Washington.
Massachusetts was doing the best job, immunizing 86 percent of toddlers on time. Also raising the national average were the five other New England states as well as North Carolina, Georgia, Michigan, Wisconsin and South Dakota - states that immunize more than 80 percent of toddlers on time.
There was even more variation when CDC checked records of some large cities. In Newark, N.J., for example, just 57.5 percent of toddlers had up-to-date shots.
The government's goal is that by 2010, 80 percent of all toddlers get on-time vaccinations against diphtheria, whooping cough, tetanus, meningitis-causing Haemophilus influenza or Hib, hepatitis B, polio, measles, mumps and rubella.
Nationally, vaccination rates for those diseases have remained about the same for the last few years, as doctors struggled to keep toddlers up to date amid shortages of some key shots. So far this year, supplies seem adequate.
In addition to the nine most-measured vaccines, toddlers are supposed to get shots against chickenpox and the pneumococcal vaccine that protects against certain types of meningitis and ear infections. Last year, a record 81 percent of toddlers received the chickenpox inoculation, up from 76 percent in 2001, the CDC said. And 41 percent of youngsters received the pneumococcal immunization, the first time the CDC ever counted this vaccine, which hit the market in 2000.
It's not clear why some states have a harder time vaccinating, said CDC immunization chief Dr. Walter Orenstein.
Vaccine-phobic parents like the mother Enderlein encountered are a minority - well over 90 percent of infants get vaccinated. Instead, Orenstein said, simply remembering to keep up with the roughly 20 doses required by age 2 is hard for parents and doctors alike.
States should identify communities where vaccination rates are significantly below the national average and eliminate the disparities. Poorer children are most likely to be missed.
Parents should get their child's immunization records and ask if the child is up to date every time they see the pediatrician.
Doctors should check vaccine records even if the child is just in for, say, an ear exam. Any visit is an opportunity to give a missed vaccine.
States should invest in computerized vaccination registries, which can automatically send parents reminders about overdue shots and help keep physician records up to date.
``If we let down our guard ... vaccine-preventable diseases will return,'' Orenstein warned.
08/01/03 09:12 EDT
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