Before vaccines became widely available, diseases like measles, polio and whooping cough were common in childhood, and thousands died or were left blind, deaf or brain-damaged by them. Today, vaccines have totally or nearly eradicated several diseases such as smallpox, polio, diphtheria, and Hib infections, according to the national Centers for Disease Control and Prevention.
Yet other diseases persist, mostly in unvaccinated babies and toddlers--the children who are most vulnerable to the effects of disease. An estimated 37 percent to 56 percent of American children are not fully immunized by age 2, according to CDC. In some inner city areas, only 10 percent of children have been properly immunized.
Some people blame the low rates on inconvenience. There are 11 diseases to vaccinate against, with as many as 16 doses in about five visits to the doctor before a child's second birthday.
Others point out that parecnts are required to have children vaccinated only before enrolling them in school or day care. Ninety-six percent of children have their shots before entering school, according to CDC. But babies and toddlers not in licensed day care are most likely to miss their shots.
The cost of vaccines may be another factor in low immunization rates. According to CDC, vaccines for one child in 1993 cost about $89 in the public sector and $213 in the private sector, in addition to administrative fees usually charged. Only half of health insurance plans cover childhood vaccines, though many public health departments offer them free or at a reduced fee based on income. Congress allocated $500 million for fiscal year 1994 to provide free vaccinations to all uninsured children and to educate parents about the need for childhood immunizations.
Education is necessary, physicians say, because many parents do not understand how dangerous childhood illnesses are.
"They're not real in people's minds," says Donald S. Gromisch, a spokesman for the American Academy of Pediatrics and a member of its committee on infectious diseases. "Years before the whooping cough vaccine, many children died of whooping cough. In inner cities a few years ago where vaccination rates are dismal, people continued to die [of whooping cough]."
In fact, diseases that are uncommon in most parts of the United States today are nearly epidemic in American communities where children are not properly vaccinated.
Measles, for instance, had dropped to a record low of fewer than 1,500 cases in 1983, according to CDC. A resurgence of measles between 1989 and 1991, however, resulted in 55,000 cases and 132 deaths, mostly among unvaccinated babies and toddlers. In urban areas, minority children are four to nine times as likely to get measles as white children.
The resurgence of childhood illnesses costs money as well as lives. According to the National Academy of Sciences' Institute of Medicine, every $1 in vaccinations saves $10 in later health-care costs.
Whether a child receives vaccinations at a pediatrician's office or health department, the health-care provider is expected to keep careful records of when each shot was given and what brand it was. Some brands have slightly different schedules than others. Parents should ask for copies of the shot record to keep at home as a reminder for the next round.
Even if a child misses an appointment, it's possible to catch up. Says Gromisch of the AAP, "Usually it's not too late. In general, if you miss a vaccine, you can get it the next time around."
Reprinted with the permission of the U.S. Food and Drug Administration.
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