A report in the May issue of the Archives of Pediatrics & Adolescent Medicine indicates that there is improvement in the timetable of childhood vaccinations in low-income households than in previous years. However, there are still inequalities associated with their economic status.
Background data sustained in the report show that a reappearance of measles from 1989 to 1991 was due to the reason of low vaccination rates among low-income children. Government representatives responded by taking into consideration the disparities in vaccination coverage. The Vaccines for Children Program was set up in October of 1994 in order to eradicate cost restrictions and supply free vaccines for eligible children.
The authors explain: “An important conclusion of Centers for Disease Control and Prevention [CDC] research conducted during the U.S. measles resurgence was that vaccines need to be administered on time because delays indicate inadequate protection against vaccine-preventable diseases.”
In order to review the evolution of the program, Philip J. Smith, Ph.D., and his colleagues at the CDC, in Atlanta, evaluated information from 232,318 children. All children lived in low-income households, where the annual income was of 133 percent or less of the federal poverty level. They were also all involved in the U.S. National Immunization Survey between 1995 and 2007. The participants were considered as having timely vaccination coverage when they had received the recommended doses of vaccinations against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, Haemophilus influenza type b, hepatitis B and varicella by the age of nineteen months. The degree of coverage was assessed in contrast with that of children of high-income households, on which the annual income was 400 percent or more than the federal poverty level. Variations were registered for children born between 1994 and 2004.
The authors indicate: “In our analyses, we found that among low-income children, timely vaccination coverage rates for all vaccines except Hib [Haemophilus influenza type b] have increased significantly between consecutive cohorts born after the measles resurgence.” Timely coverage improved each year for low-income children born between 1994 and 2004, by 5.3 percent for varicella vaccines, 1.2 percent for hepatitis B, 0.6 percent for measles, mumps and rubella (MMR), 0.5 percent for the diphtheria, tetanus and pertussis (DTaP-DTP) vaccine and 0.3 percent for polio.
“Also, significant disparities in timely vaccination coverage were found between low- and high-income children for all childhood vaccines and nearly every birth cohort born between 1994 and 2004,” the authors explain. “However, these disparities have been declining significantly for the MMR [an estimated 0.3 percent decline], hepatitis B [0.3 percent] and varicella [0.5 percent] vaccines.” On the contrary, disparities amplified considerably by 0.4 percent for the DTaP-DTP vaccine but there was not change for polio.
The study shows that there is an improvement, but the authors advise that further efforts are required. “Further progress in timely vaccination may be achieved by improving health care providers’ reminder/recall systems, implementing educational interventions that address barriers to vaccination and increasing parents’ awareness of the Vaccines for Children Program,” they comment in conclusion.
“Progress in Timely Vaccination Coverage Among Children Living in Low-Income Households”
Philip J. Smith; Nidhi Jain; John Stevenson; Nancy Männikkö; Noelle-Angelique Molinari
Arch Pediatr Adolesc Med. 2009; 163[5]:462-468
Written by Stephanie Brunner (B.A.)