City of Houston - Health Dept.

Houston and the National Immunization Survey

There has been considerable concern recently regarding low immunization rates for Houston children. Infant immunizations is a complex issue of delivery, timing, documentation and assessment. About 60 percent of Houston children receive their immunizations from private physicians. The other 40 percent rely on one or more of several publicly supported services including the Houston Department of Health and Human Services.

The 1998 National Immunization Survey (NIS) results were released locally March 31, 1999. The NIS is an immunization survey conducted by the Centers for Disease Control and Prevention (CDC) annually in 50 states and 27 large urban areas. The NIS has been conducted since 1994 utilizing telephone interviews. Each survey attempts to poll the immunization status of 400 children selected from random digit dialing. Houston has typically had a survey response rate of less than 50 percent.

Former First Lady, Rosalyn Carter and Betty Bumpers of the Kids Count Foundation visit La Nueva Casa de Amigos Health Center to promote infant immunizations in Houston

Nationally and in Houston, 99 percent of children are fully immunized when they enter school. Ideally, though, every child should receive 16 of the 19 recommended immunizations before the age of two. The NIS indicates the percentage of children between 19 and 35 months of age who have received eight key immunizations (four diphtheria, tetanus and pertussis [DTaP]; three polio and one measles containing vaccine, aka 4:3:1) following the schedule approved by the American Academy of Pediatrics, the American Academy of Family Practitioners and the Advisory Committee on Immunization Practices. The national goal of 90 percent of two year olds fully immunized by the year 2000 was established by President Clinton in 1993.

Houston has historically struggled to properly immunize infants and toddlers on time. The immunization rate in 1991 was estimated by CDC to be 11 percent. By 1995, Houston had achieved a 74 percent immunization rate according to the NIS. (This followed a Houston measles epidemic in 1989- 1991, as well as epidemics throughout the country. An infusion of federal dollars in 1993, along with unprecedented public and private partnerships increased coverage levels dramatically throughout the country. There have been no subsequent epidemics in Houston and external funding and partnerships have decreased.) Houston's rate last year, 1997, was 64 percent. The most recent survey, 1998, indicated a 4:3:1 immunization rate for 19 to 35 month old children at 66 percent, a two percent improvement over 1997

HDHHS immunization administrators are working with local partners to quantify the exact reasons for Houston's low immunization rate compared to the 76 other NIS surveys. They believe some of the reasons include:

Poor public and provider appreciation for the dangers of vaccine preventable disease.

Practitioners and parents fail to recognize the urgency of timely immunization due to lack of familiarity with vaccine preventable diseases. In the absence of an outbreak or legal requirement (school entry or Texas Assistance to Needy Families), there is little motivation for non-compliant parents to aggressively seek to inflict the physical discomfort of shots on their child.