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Current Trends Childhood Immunization Initiative, United States -- 5-Year Follow-Up

In 1977, approximately 20 million of the 50 million persons in the United States who were 15 years old were estimated to need at least 1 dose of 1 vaccine in order to be considered fully protected against the 7 diseases for which vaccines are routinely administered in childhood--i.e., diphtheria, measles, mumps, pertussis, poliomyelitis, rubella, and tetanus. To remedy this situation, the Department of Health, Education, and Welfare (now Department of Health and Human Services) announced, on April 6, 1977, a nationwide Childhood Immunization Initiative. The Initiative had 2 stated objectives: 1) To attain immunization levels in the nation's children of at least 90% by October 1979. 2) To establish mechanisms to maintain high immunization levels by ensuring that children received vaccinations at the proper times.

The Initiative mobilized the public as well as the private sectors with extensive involvement by volunteers and voluntary organizations, including a major public information and education campaign. More than 28 million individual immunization records of school children were reviewed to identify children in need of vaccinations and to refer them for these vaccinations. School immunization requirements were enacted and enforced by state and local governments. Government agencies that had not formerly been involved in immunization activities established standards for immunization levels among their constituents. A major increase in federal support for immunization grant programs helped to eliminate the backlog of unimmunized and incompletely immunized children and to create systems to maintain high levels of immunization.

The results of the Childhood Immunization Initiative are reflected in the following: 1) Immunization levels of children entering school for the first time in the fall of 1980 were 96% for measles, rubella, and diphtheria-tetanus-pertussis (DTP); 95% for poliomyelitis; and 92% for mumps. Immunization levels of children entering school for the first time in 1981 are not yet available. 2) Disease incidences are at or near record low levels. In 1981, provisional data indicate that measles, mumps, paralytic poliomyelitis, rubella, and tetanus all reached record low levels, with diphtheria and pertussis being at near record low levels (Table 1). 3) All 50 states now have laws requiring documentation of immunity as a condition of first entry to school. For measles, in 40 states these laws extend from kindergarten through 12th grade. 4) In all 50 states, a standard immunization record has been developed and distributed for use in both the public and private sector to ease problems of documention of immunizations. 5) In 35 states, systems have been instituted in public clinics throughout the state to ensure that children actually receive needed vaccinations. This involves scheduling visits for immunizations and recalling children who fail to come in for these visits. 6) In 15 states, hospital-based maternal education programs have been implemented to provide new mothers in over 90% of targeted hospitals with information about vaccinations before they are discharged with their infants. 7) The initial success in the Childhood Immunization Initiative was so encouraging that a new target was enunciated--i.e., the elimination of indigenous measles from the United States by fall of 1982. As documented in numerous previous articles, this program is proceeding on schedule. 8) Since 1978 approximately 120,000,000 doses of childhood vaccines have been administered by the public sector. Reported by Immunization Div, Center for Prevention Svcs, CDC.

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